Do FSH/LH ratio and gonadal hormone levels predict clinical improvement in postmenopausal schizophrenia women?

Abstract

Menopause is a process characterized by a decline in estrogen levels and is therefore a period of biological vulnerability for psychotic relapse in women with schizophrenia. Our goal was to correlate not only gonadal hormone levels but also follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels with improvement in specific clinical symptoms. Thirty-seven acutely ill postmenopausal schizophrenia women with a newly initiated, clinically determined change in antipsychotic medication participated in a 12-week prospective observational outcome study. Scales used were the PANSS scale for psychotic symptoms, the PSP for functioning, and CGI for global clinical impression. Circulating FSH, LH, estradiol, progesterone, and testosterone serum levels were determined by chemiluminescent immunoassay. Partial correlational analyses were performed along with a Bonferroni significance correction (p < 0.0007). After adjustment for confounding factors, the FSH/LH ratio correlated positively with mean changes in PANSS positive scores, and there was a correlation with worsening of CGI total and cognitive scores. Testosterone was also positively associated with improvement in PANSS positive scores. However, after correction for multiple testing, the initial correlations were no longer statistically significant. In summary, while the hormone assays we did in this small sample did not prove to be significantly linked to clinical improvement in any of the schizophrenia symptom domains, we recommend further investigation of pituitary, adrenal, and gonadal hormone ratios as potential markers of clinical improvement in this population.

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

“…In other words, time since menopause was found to be negatively associated with good response to antipsychotic medications. The same group investigated the role played in this association by the follicle stimulating hormone/luteinizing hormone (FSH/LH) ratio, but the results were inconclusive [73]. A recent study supports the identification of hormonal phenotypes among women with schizophrenia, suggesting that it may help to improve existing treatments and implement personalized-medicine strategies that address the heterogeneity seen in schizophrenia [10].…”

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

“…Misiak and coworkers 135 have postulated a role for androgens in psychosis. Luteinizing hormone 136 alone, or in relation to FSH, 137 has also come under scrutiny, especially in regard to the cognitive symptoms of menopause. Also, the high prolactin levels induced by antipsychotics have been suspected of further impairing cognition at the time of menopause, 138 perhaps especially so when the antipsychotic used, risperidone for instance, is metabolized by the CYP2D6 enzyme.…”

“…Although the evidence for the treatment potential of hormones added to antipsychotics at postpartum or at menopause is only beginning to accumulate, it is worthwhile keeping such options in mind and also appreciating that what may be significant in achieving good response are not levels of individual hormones but the balance of levels of several different hormones. 137…”

Peri- and Post-Menopausal Women with Schizophrenia and Related Disorders Are a Population with Specific Needs: A Narrative Review of Current Theories

“…A potential explanation was that oestrogens exert a neuroprotective effect during reproductive years that lasts for a certain time after menopause and then disappears. The same research team then tried to determine whether gonadal hormone levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH) levels, and FSH/LH ratio correlated with clinical improvement in specific clinical symptoms [ 20 ]. They recruited 37 postmenopausal women with schizophrenia in a 12-week prospective observational outcome study, and were included if they met criteria according to the DSM-IV-TR.…”

“…In our review, we found that the vast majority of studies included mixed samples formed by patients with schizophrenia and schizoaffective disorders [ 19 , 20 , 21 , 29 , 35 , 49 ], very few studies are restricted to patients with schizophrenia [ 15 , 16 , 17 , 25 , 30 , 31 , 33 , 36 , 37 , 44 ], some others include a wide range of psychotic disorders [ 18 , 28 , 32 , 47 ], and other studies include patients with severe mental illness without specific details of the diagnosis of schizophrenia related disorder. Prevalence of each category of diagnosis is difficult to calculate, as several studies grouped patients of different diagnosis.…”