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The total number of reported drugs in Table 2 exceeds the total number of pregnancies because some participants were prescribed more than one medication and for some participants there were changes to prescribed medication during follow-up. The original title, abstract, Table 2, Table 3, and results section of this article state that 147 pregnancies had been followed through to completion during this study. Reference 1 Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W, et al. (2014) A Prospective Cohort Study of Antipsychotic Medications in Pregnancy: The First 147 Pregnancies and 100 One Year Old Babies. [Extracted from the article]

Rationale: Hyperprolactinemia is a highly prevalent adverse effect of many antipsychotic agents, with potentially serious health consequences. Several guidelines have been developed for the management of this condition; yet, their concordance has not been evaluated. Objectives: The objectives of this paper were (1) to review current clinical guidelines; (2) to review key systematic evidence for management; and (3) based on our findings, to develop an integrated management recommendation specific to male and female patients who are otherwise clinically stabilised on antipsychotics. Methods: We performed searches of Medline and EMBASE, supplemented with guideline-specific database and general web searches, to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia, produced/updated 01/01/2010-15/09/2016. A separate systematic search was performed to identify emerging management approaches described in reviews and meta-analyses published ≥ 2010. Results: There is some consensus among guidelines relating to baseline PRL screening (8/12 guidelines), screening for differential diagnosis (7/12) and discontinuing/switching PRL-raising agent (7/12). Guidelines otherwise diverge substantially regarding most aspects of screening, monitoring and management (e.g. treatment with dopamine agonists). There is an omission of clear sex-specific recommendations. Systematic literature on management approaches is promising; more research is needed. An integrated management recommendation is presented to guide sex-specific clinical response to antipsychotic-induced hyperprolactinemia. Key aspects include asymptomatic hyperprolactinemia monitoring and fertility considerations with PRL normalisation. Conclusion: Further empirical work is key to shaping robust guidelines for antipsychotic-induced hyperprolactinemia. The integrated management recommendation can assist clinician and patient decision-making, with the goal of balancing effective psychiatric treatment while minimising PRL-related adverse health effects in male and female patients. [ABSTRACT FROM AUTHOR]

Background: The association between menopausal vasomotor symptoms (VMS) and depressive symptoms remains controversial. We aimed to examine the associations between moderate-severe VMS and moderate-severe depressive symptoms. Methods: Nationally representative cross-sectional survey of 2,020 noninstitutionalized Australian women aged 40-65 randomly recruited between October 2013 and March 2014. Symptoms were assessed by the Menopause-Specific Quality of Life Questionnaire, the Beck Depression Inventory-II, with score ≥20 defined as moderate-severe depressive symptoms. Cigarette, alcohol, and psychotropic medication use was also assessed. Binge drinking was defined as four standard drinks on one occasion. Results: VMS were classified as moderate-severe for 267 of the 2,020 women (13.3%). After adjusting for multiple factors, including age, partnership status, paid employment, housing insecurity, and body mass index, when compared to women with no or mild VMS, women with moderate-severe VMS were more likely to have moderate-severe depressive symptoms (odds ratio [OR] 2.80, confidence interval [95% CI], 2.01-3.88, p < 0.001). Having moderate-severe depressive symptoms was associated with a greater likelihood of use of psychotropic medications (48.9%, 95% CI, 43.1-54.8 vs. 20.1%, 95% CI, 18.2-22.1, p < 0.001), smoking (25.9%, 95% CI, 20.8-30.9 vs. 12.2%, 95% CI, 10.6-13.7, p < 0.001), and binge drinking at least weekly (15.1%, 95% CI, 11.0-19.2 vs. 10.3% 95% CI, 8.8-11.7, p = 0.015). Conclusion: Moderate-severe VMS are independently and significantly associated with moderate-severe depressive symptoms. [ABSTRACT FROM AUTHOR]

Background Low desire is the most common sexual problem in women at midlife. Prevalence data are limited by lack of validated instruments or exclusion of un-partnered or sexually inactive women. Aim To document the prevalence of and factors associated with low desire, sexually related personal distress, and hypoactive sexual desire dysfunction (HSDD) using validated instruments. Methods Cross-sectional, nationally representative, community-based sample of 2,020 Australian women 40 to 65 years old. Outcomes Low desire was defined as a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI); sexually related personal distress was defined as a score of at least 11.0 on the Female Sexual Distress Scale–Revised; and HSDD was defined as a combination of these scores. The Menopause Specific Quality of Life Questionnaire was used to document menopausal vasomotor symptoms. The Beck Depression Inventory–II was used to identify moderate to severe depressive symptoms (score ≥ 20). Results The prevalence of low desire was 69.3% (95% CI = 67.3–71.3), that of sexually related personal distress was 40.5% (95% CI = 38.4–42.6), and that of HSDD was 32.2% (95% CI = 30.1–34.2). Of women who were not partnered or sexually active, 32.4% (95% CI = 24.4–40.2) reported sexually related personal distress. Factors associated with HSDD in an adjusted logistic regression model included being partnered (odds ratio [OR] = 3.30, 95% CI = 2.46–4.41), consuming alcohol (OR = 1.48, 95% CI = 1.16–1.89), vaginal dryness (OR = 2.08, 95% CI = 1.66–2.61), pain during or after intercourse (OR = 1.63, 95% CI = 1.27–2.09), moderate to severe depressive symptoms (OR = 2.69, 95% CI 1.99–3.64), and use of psychotropic medication (OR = 1.42, 95% CI = 1.10–1.83). Vasomotor symptoms were not associated with low desire, sexually related personal distress, or HSDD. Clinical Implications Given the high prevalence, clinicians should screen midlife women for HSDD. Strengths and Limitations Strengths include the large size and representative nature of the sample and the use of validated tools. Limitations include the requirement to complete a written questionnaire in English. Questions within the FSFI limit the applicability of FSFI total scores, but not desire domain scores, in recently sexually inactive women, women without a partner, and women who do not engage in penetrative intercourse. Conclusions Low desire, sexually related personal distress, and HSDD are common in women at midlife, including women who are un-partnered or sexually inactive. Some factors associated with HSDD, such as psychotropic medication use and vaginal dryness, are modifiable or can be treated with safe and effective therapies. Worsley R, Bell RJ, Gartoulla P, Davis SR. Prevalence and Predictors of Low Sexual Desire, Sexually Related Personal Distress, and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women. J Sex Med 2017;14:675–686. [ABSTRACT FROM AUTHOR]

Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. Method: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery–Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. Results: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery–Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). Conclusion: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia. [ABSTRACT FROM AUTHOR]

Introduction: Sex steroids are important in female sexual function and dysfunction. Aim: To review the role of estrogens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of estrogen therapy for female sexual dysfunction to update the previously published International Society of Sexual Medicine Consensus on this topic. Methods: Panel members reviewed the published literature using online databases for studies pertaining to estrogen in female sexual function and dysfunction. Attention was specifically given to clinical trials that had reported on sexual function outcomes in women treated with estrogen. Main Outcome Measures: Quality of data published in the literature and recommendations were based on the GRADES system. Results: Observational studies that have considered relationship factors and physical or mental health have reported that these factors contribute more to sexual functioning than menopausal status or estrogen levels. Few clinical trials have investigated estrogen therapy with sexual function as a primary outcome. The available data do not support systemic estrogen therapy for the treatment of female sexual dysfunction. Topical vaginal estrogen therapy improves sexual function in postmenopausal women with vulvovaginal atrophy (VVA) and is considered first-line treatment of VVA. Oral ospemifene, a selective estrogen receptor modulator, is effective for the treatment of VVA and might have independent systemic effects on female sexual function. Conclusion: For sexual problems, the treatment of VVA remains the most pertinent indication for estrogen therapy. When systemic symptoms are absent, estrogen therapy ideally can be administered by a vaginal preparation alone. Systemic estrogen therapy with combined estrogen and progestin in non-hysterectomized women is indicated for women who require treatment for vasomotor and/or other systemic estrogen deficiency symptoms. The improvement in well-being achieved by relief of vasomotor and other symptoms might improve libido in some women and abrogate further intervention. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, multiple hormones have been investigated in relation to female sexual function. Because consumers can easily purchase products claiming to contain these hormones, a clear statement regarding the current state of knowledge is required. Aim: To review the contribution of hormones, other than estrogens and androgens, to female sexual functioning and the evidence that specific endocrinopathies in women are associated with female sexual dysfunction (FSD) and to update the previously published International Society of Sexual Medicine Consensus on this topic. Methods: The literature was searched using several online databases with an emphasis on studies examining the physiologic role of oxytocin, prolactin, and progesterone in female sexual function and any potential therapeutic effect of these hormones. The association between common endocrine disorders, such as polycystic ovary syndrome, pituitary disorders, and obesity, and FSD also was examined. Main Outcome Measures: Quality of data published in the literature and recommendations were based on the Grading of Recommendations Assessment, Development and Education system. Results: There is no evidence to support the use of oxytocin or progesterone for FSD. Treating hyper-prolactinemia might lessen FSD. Polycystic ovary syndrome, obesity, and metabolic syndrome could be associated with FSD, but data are limited. There is a strong association between diabetes mellitus and FSD. Conclusion: Further research is required; in particular, high-quality, large-scale studies of women with common endocrinopathies are needed to determine the impact of these prevalent disorders on female sexual function. [ABSTRACT FROM AUTHOR]

Introduction: Androgens have been implicated as important for female sexual function and dysfunction. Aim: To review the role of androgens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of androgen therapy for female sexual dysfunction (FSD). Methods: We searched the literature using online databases for studies pertaining to androgens and female sexual function. Major reviews were included and their findings were summarized to avoid replicating their content. Main Outcome Measures: Quality of data published in the literature and recommendations were based on the GRADES system. Results: The literature supports an important role for androgens in female sexual function. There is no blood androgen level below which women can be classified as having androgen deficiency. Clinical trials have consistently demonstrated that transdermal testosterone (T) therapy improves sexual function and sexual satisfaction in women who have been assessed as having hypoactive sexual desire disorder. The use of T therapy is limited by the lack of approved formulations for women and long-term safety data. Most studies do not support the use of systemic dehydroepiandrosterone therapy for the treatment of FSD in women with normally functioning adrenals or adrenal insufficiency. Studies evaluating the efficacy and safety of vaginal testosterone and dehydroepiandrosterone for the treatment of vulvovaginal atrophy are ongoing. Conclusion: Available data support an important role of androgens in female sexual function and dysfunction and efficacy of transdermal T therapy for the treatment of some women with FSD. Approved T formulations for women are generally unavailable. In consequence, the prescribing of T mostly involves off-label use of T products formulated for men and individually compounded T formulations. Long-term studies to determine the safety of T therapy for women and possible benefits beyond that of sexual function are greatly needed. [ABSTRACT FROM AUTHOR]

Highlights: [•] Brief review of normal androgen physiology in women. [•] Causes of low androgen levels in women. [•] Relationship between androgens and sexual function in women. [•] Current evidence for the use of testosterone therapy in women with sexual dysfunction. [•] Other effects of testosterone therapy. [•] Safety concerns. [•] Appropriate candidates for treatment. [ABSTRACT FROM AUTHOR]

Background: Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown. Methods: We established the National Register of Antipsychotic Medications in Pregnancy in 2005. Women who are pregnant and taking an antipsychotic medication are interviewed every 6 weeks during pregnancy and then followed until their babies are one year old. The baby's progress is closely followed for the first year of life. Findings: As of April 18 2012, 147 pregnancies had been followed through to completion. There were 142 live births and data is available for 100 one year old babies. 18% of babies were born preterm, with a higher dose of antipsychotic medication correlating to an increased likelihood of premature delivery; 43% of babies required special care nursery or intensive care after birth; 37% had any degree of respiratory distress and 15% of babies developed withdrawal symptoms. Congenital anomalies were seen in eight babies. Most pregnancies resulted in the birth of live, healthy babies. The use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the likelihood of babies experiencing respiratory distress or admission to Special Care Nursery or Neonatal Intensive Care Units. Conclusion: There is a great need for safety and efficacy information about the use of antipsychotic medications in pregnancy. Live, healthy babies are the most common outcome following the use of antipsychotic medication in pregnancy, but clinicians should be particularly mindful of neonatal problems such as respiratory distress. [ABSTRACT FROM AUTHOR]

Abstract: There is a high incidence of depression in women presenting to menopause clinics. The aim of this review was to determine if there is an association between depressive symptoms or major depressive disorder (MDD) and vasomotor symptoms (VMS). A systematic review of the literature was conducted according to PRISMA guidelines. 33 relevant publications were found, 12 from three large studies. Overall, we found that there is a bidirectional association between VMS and depressive symptoms. This has been established in well-conducted, large observational studies. There does not appear to be a relationship between VMS and MDD. However, studies examining VMS and MDD were prone to bias making it difficult to draw any conclusions. [Copyright &y& Elsevier]

Abstract: In recent years the perimenopause has become recognised as a ‘window of vulnerability’ for women''s mood. The risk of depression during perimenopause is high and treatment failure is common. Perimenopausal depression encompasses both new onset (first episode) depression occurring during perimenopause as well as a relapse during perimenopause in women with a history of depression. Perimenopausal depression is increasingly recognised as a new subtype of depression with specific clinical characteristics. Current treatments for perimenopausal depression have high failure rates, multiple adverse effects and potentially damaging long term consequences. This review examines both new onset and relapsed depression during perimenopause, biological mechanisms of perimenopausal depression, and the role of hormonal therapies. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Raloxifene for schizophrenia and symptoms of hyperprolactinaemia?" published in previous issue of the journal.

The authors’ comment on an article by Bou Khalil who discussed the potential protective role of orgasm in promoting a positive mood in women suffering from depression. They state that through his approach, Khalil explores the potential biological pathways between orgasm and positive mood. The authors’ opine that women with Female sexual dysfunction (FSD) symptoms may improve over time, but sensitive discussion and understanding of her concerns must be part of the psychiatrist’s role.

The article presents a case study of a 22-year-old woman with suffering with borderline personality disorder and polycystic ovary syndrome (PCOS). The case mentions that the woman has a history of sexual abuse by her stepfather and had multiple psychiatric hospitalizations for suicide attempts, ongoing self-harm and rapid mood swings. It also mentions that the patient received PCOS treatment of metformin, transdermal oestradiol and cyclical progesterone.

There is limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM) in women with mental illness. Studies have demonstrated an association between antipsychotic medications and metabolic problems such as weight gain and diabetes mellitus in non-pregnant patients with psychiatric disorders. GDM increases the risk of adverse maternal outcomes, including pregnancy-induced hypertension, antepartum and postpartum haemorrhage, and caesarean delivery. The National Register of Antipsychotic Medication in Pregnancy (NRAMP) is a prospective Australian cohort study that observed women who took antipsychotics during pregnancy. Data from 205 women were extracted for the final analysis and included women who took first or second-generation antipsychotics (FGA,SGA) during the first trimester of pregnancy (at minimum) and had a diagnosis of a psychotic disorder (n = 180). The comparison (non-exposed) group (n = 25) were women with psychosis who chose not to take any antipsychotic during the first trimester (at minimum). The comparison groups were not matched, although groups were homogenous in terms of sex, age range, diagnosis and perinatal status. The results of logistic regression analysis revealed that women who were exposed to FGAs, SGAs were seven and five times, respectively, more likely to develop GDM compared to non-exposed groups. When adjusted for confounding variables such as BMI and family history of diabetes, the potential of developing GDM decreased for women taking SGAs. In conclusion, the risk of developing GDM is lower in women taking SGAs compared with women taking FDAs. In addition, family history of diabetes and BMI adds to the risk. [ABSTRACT FROM AUTHOR]

The article describes the case of a 29-year-old National Register of Antipsychotic Medication in Pregnancy participant who was diagnosed with schizophrenia and obesity that led her into taking medications such as risperidone and quetiapine during pregnancy. Topics discussed include the introduction of food management, her son's diagnosis with neonatal abstinence syndrome and neonatal hypoglycaemia, and the link between gestational diabetes mellitus (GDM) and obesity.

A letter to the editor is presented in response to the article "Bringing Postnatal Depression Out of the Shadows" in the November 10, 2012 issue.

Objectives: It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect women's workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI).Results: Of 2020 women who comprised the study sample, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age.Conclusions: Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife. [ABSTRACT FROM AUTHOR]

Objectives The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40–65 years, taking into account socio-demographic and lifestyle factors. Study design/Main outcome measures This was a cross-sectional survey of 2020 Australian women, aged 40–65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Results Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient ( β ) = −8.17, 95% confidence interval (CI) −10.90 to −5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered ( β = −2.80, 95% CI −4.74 to −0.86), obese ( β = −5.46, 95% CI −7.24 to −3.68) and a smoker ( β = −3.47, 95% CI −6.10 to −0.84). Older age ( β = 0.29, 95% CI 0.06–0.42) and participation in paid and/or volunteer work ( β = 2.72, 95% CI 0.61–4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Conclusions Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. [ABSTRACT FROM AUTHOR]

Combined oral contraceptives (OCs) are the most commonly prescribed medication in women of reproductive age, but despite widespread use, their effect on cognitive performance remains controversial. Given strong evidence for the neurological impact of reproductive hormones, a clear rationale for investigation exists. This systematic review sought to identify, collate and critically appraise studies assessing the impact of OCs on cognition in healthy premenopausal women. Ovid MEDLINE, PsychINFO and EMBASE were comprehensively searched using relevant keywords for original peer-reviewed observational studies or randomised trials published after 1960. Of 1289 references screened, 22 studies were eligible for inclusion. Assembled evidence supports a cognitive impact of OCs restricted to specific domains; however, the quality of evidence is poor. The most consistent finding is improved verbal memory with OC use. Evidence is also emerging that differing progestin androgenicity may lead diverse OC formulations to differentially impact certain cognitive domains, such as visuospatial ability. At present, evidence is inconclusive, contradictory and limited by methodological inconsistencies. There is scope for further research in this area to definitively determine the cognitive impact of OCs. [ABSTRACT FROM AUTHOR]

Increasing evidence from epidemiological, preclinical and clinical studies suggests that estrogens may exert psychoprotective effects in schizophrenia. Observations of gender differences in the onset and course of schizophrenia have prompted exploration of the effects of estrogen on the CNS. The aim of this paper is to provide an overview of different applications of adjunctive estrogen as a possible treatment for symptoms of schizophrenia in both men and women. Recent trials have suggested that estrogen augmentation therapy may be able to enhance the management of schizophrenia; however, the clinical application of estrogen as a treatment has been limited by potential side effects, the most worrying being breast and uterine cancer in women, and feminization in men. Selective estrogen receptor modulators (SERMs), however, may offer therapeutic benefits for both men and women with schizophrenia without posing threat to breast and uterine tissue and without feminizing effects. The use of estrogen opens up new possibilities for both men and women in the treatment of severe mental illnesses such as schizophrenia. With further preclinical and clinical research, it is hoped that this promising field of hormone modulation can continue to evolve and eventually be translated into real therapeutic potential. [ABSTRACT FROM AUTHOR]

Oral contraceptives (OCs) containing estrogen and progesterone analogues are widely used amongst reproductive-aged women, but their neurocognitive impact is poorly understood. Preliminary studies suggest that OCs improve verbal memory and that OCs with greater androgenic activity may improve visuospatial ability. We sought to explore the cognitive impact of OCs by assessing performance of OC users at different stages of the OC cycle, and comparing this performance between users of different OC formulations according to known androgenic activity. We conducted a prospective, observational trial of OC users, evaluating cognitive performance with CogState software on two occasions: days 7–10 of active hormonal pill phase, and days 3–5 of the inactive pill phase (coinciding with the withdrawal bleed resembling menstruation). Thirty-five OC users (18 taking androgenic formulations, 17 taking anti-androgenic) were assessed. Analysis by androgenic activity showed superior performance by users of androgenic OCs, as compared to anti-androgenic OCs, in visuospatial ability and facial affect discrimination tasks. A growing understanding of cognitive effects of OC progestin androgenicity may have implications in choice of OC formulation for individuals and in future OC development. [ABSTRACT FROM AUTHOR]

Abstract: Transcranial direct current stimulation (tDCS) is a non‐invasive neuromodulatory technique. Responses to tDCS differ substantially between individuals. Sex hormones that modulate cortical excitability, such as estrogen, may contribute to this inter‐individual variability. The influence of estrogen on tDCS after‐effects has not yet been researched. This study aimed to investigate whether endogenous estrogen levels influence cortical response to tDCS. Data from 15 male and 14 female healthy adults were analyzed. Males completed one experimental session. Females completed two, one during the early follicular phase of the menstrual cycle when estrogen was low, one during the mid‐luteal phase when estrogen was high. Each session comprised 15‐min of anodal tDCS delivered to the left dorsolateral prefrontal cortex (DLPFC). Response to stimulation was assessed using electroencephalography with DLPFC transcranial magnetic stimulation (TMS) administered before, immediately after, and 20‐min after tDCS. Changes in amplitudes of N120 and P200 components of TMS‐evoked potentials over time were compared between males, women with low estrogen and women with high estrogen. Blood assays verified estrogen levels. Women with high estrogen demonstrated a significant increase in P200 amplitude at both time points and change over time was greater for the high estrogen group compared with males. No significant differences were observed between males and women with low estrogen, or between women with low and high estrogen. These preliminary results indicate that greater neuroplastic response to DLPFC tDCS is seen in highest compared with lowest estrogen states, suggesting that endogenous estrogen levels contribute to inter‐individual variability of tDCS outcomes. [ABSTRACT FROM AUTHOR]

Background: Many women with no past psychiatric history experience severe mood symptoms for the first time in their life during the menopausal transition, with debilitating long-term consequences. Women with a history of depression can experience a relapse or worsening of symptoms during the menopause transition. Traditional antidepressants, SSRIs or SNRIs, are commonly prescribed as the first line response. However, such treatment has shown only small improvements with side effects. Hormone therapies directly targeting the perimenopausal fluctuations in reproductive hormonal systems such as tibolone, have significant potential to treat perimenopausal depression. Our study investigated the use of adjunctive tibolone, selective tissue estrogenic activity regulator, to treat de-novo or relapsing depression occurring during the menopause transition period.Methods: Women who were going through the menopause transition with depressive symptoms were invited to participate in a double-blind, 12 week randomized control trial with two arms: tibolone (2.5 mg oral/day) or oral placebo (NCT01470092). Forty-four women met inclusion/exclusion criteria; 22 were randomized to tibolone and 22 were randomized to oral placebo. Symptoms were measured with the 'Montgomery- Asberg depression rating scale' (MADRS) as the primary outcome measure. Latent growth curve analysis was used to assess the MADRS scores change over time.Results: Participants in the tibolone group demonstrated a significant improvement in depression scores, as compared to the placebo group, without any significant side effects.Limitations: This trial only monitored tibolone's effects over 12 weeks. Future research should be conducted over an extended timeframe and explore whether the benefits of tibolone extend to other symptoms of perimenopausal depression.Conclusions: The use of hormone therapies such as tibolone provide exciting innovations for the treatment of depression during the menopause transition. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women. Design Randomized, placebo-controlled trial in which participants were randomized (1:1) to transdermal testosterone gel 300 mcg/day, or identical placebo, for 26 weeks. Patients Ninety-two postmenopausal women aged 55-65 years, on no systemic sex hormone therapy. Measurements The primary outcome was the score for the International Shopping List Task ( ISLT) of CogState. Secondary outcomes included other CogState domains, the Psychological General Well-Being Index ( PGWB) and safety variables. Results Eighty-nine women, median age 60 years, were included in the primary analysis. Testosterone treatment resulted in statistically significantly better performance for the ISLT (improved verbal learning and memory) compared with placebo, adjusted for age and baseline score (mean difference 1·57; 95% CI 0·13, 3·01) P = 0·03). There were no significant differences for other CogState domains or the PGWB scores. At 26 weeks, the median total testosterone was 1·7 n m (interquartile range ( IQR) 1·1, 2·4) in the testosterone group and 0·4 n m ( IQR 0·3, 0·5) in the placebo group. Conclusions The small but statistically significant effect of testosterone treatment on verbal learning and memory in postmenopausal women provides the basis for further clinical trials. [ABSTRACT FROM AUTHOR]

Summary: Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone. [ABSTRACT FROM AUTHOR]