Anxiety in Natural and Surgical Menopause — Physiologic and Therapeutic Bases

Abstract

Generalized anxiety disorder is one of the most common psychiatric disorders, affecting a high percentage of human beings around the world. This emotional disorder possesses marked gender differences and occurs more often in women than in men, in a proportion of . Accompanying the reproductive cycle of women are significant fluctuations in plasma and brain steroid hormone concentrations, including oestradiol, progesterone, and allopregnanolone, among others. These hormonal changes are related to some illnesses and with the development of anxiety and mood swings occurring in the premenstrual and postpartum period, and particularly during the menopause. Menopause is a clinical term used to indicate the cessation of the woman's reproductive ability that occurs naturally, but also may be surgically induced by bilateral oophorectomy, with or without the removal of the Fallopian tubes and uterus. Natural menopause includes specific periods related to the physiological and hormonal changes produced by ovarian failure, it is usually a natural stage that occurs to women in midlife, during their late s or early s, indicating the end of the reproductive period in the woman. During the menopause transition years, women experience changes in the production of ovarian hormones, which are associated with significant changes in the physiological, emotional, and affective processes. Unfortunately, surgical menopause occurs at an early age, and produces similar physiological and psychiatric disorders, but they are more severe in this instance. In both cases, typical symptoms associated with menopause critically deteriorate the mental health of the women. In this way, the therapeutic management of clinical symptoms of menopause include replacement hormone therapy, the use of anxiolytic and antidepressant drugs, and other natural alternatives based on the use of chemical compounds obtained from plants such as soya. However, a general effective treatment for menopause symptoms does not yet exist. For this reason, experimental studies have proposed ovariectomy in rats as a potential tool to study the effects of a long-term absence of ovarian hormones associated with surgical menopause, which also allowed the study of substances with potential therapeutic application to ameliorate typical symptoms associated with surgical menopause. The aim of this chapter is to review the participation of ovarian hormones in the regulation of emotional and affective disorders in women with natural or surgical menopause particularly their anatomical pathways, neurotransmission systems, and the resulting behavioural patterns. Finally, preclinical and clinical research suggested that longterm absence of ovarian hormones associated with natural or surgical menopause is the principal cause of physiological and psychiatric disorder in the women therefore, oestrogenic compounds seem to play an important role in the maintenance of the brain structures that regulate anxiety, mood, memory, and cognitive functions in menopausal women.

Ovarian Sex Hormones Modulate Compulsive, Affective and Cognitive Functions in A Non-Induced Mouse Model of Obsessive-Compulsive Disorder

“…Such dysfunction in mood and cognitive functions has also been reported in women with surgical menopause (Chen et al, 2013; Faubion et al, 2015). Physiological challenges during surgical menopause are much more drastic due to a sudden depletion of ovarian sex steroids as compared to progressive menopause which follows fluctuating patterns of steroid levels (Bachmann, 2001; Rodriguez and Shoupe, 2015; Rodríguez-Landa et al, 2015). This results in greater predisposition to mood and anxiety disorders when compared to natural menopause (Rodríguez-Landa et al, 2015).…”

Menopause in Nonhuman Primates: A Comparative Study with Humans

“…The decrease in ovarian hormones during natural and surgical menopause is associated with a higher incidence of psychiatric disorders, such as anxiety and depression in vulnerable women, where the decrease of hormones-principally E 2 and P 4 -can induce neural changes that exert affects on both the emotional and affective levels [100]. In this regard, ovariectomies…”

Association of 5-HT1A Receptors with Affective Disorders

“…It is well known that in this biological phase, women are more susceptible and vulnerable to socioenvironmental factors that predispose them to develop emotional and affective disorders [94].…”