Sex therapy in psychiatric treatment has a new partner: reproductive hormones.

he remarkable benefits of estrogen replacement therapy in preventing cardiovascular illness and osteoporosis in postmenopausal women are well known. However, hormone replacement therapy is not just for the women’s health physician to prescribe. Recent advances in neurobiology have demonstrated that estrogen exerts dramatic effects on the central nervous system (CNS). Psychiatrists are beginning to exploit this fact to benefit women with psychiatric disorders, especially depression. By targeting key receptors in the CNS, reproductive hormones modulate diverse behaviors such as mood, cognition, and libido. Thus, sex hormones are neuromodulators. It is not surprising, therefore, that these behaviors can change as reproductive hormones change across the normal life cycle. Premenstrual irritability, postpartum “blues,” and perimenopausal mood swings may all represent behavioral fluctuations linked to shifts in reproductive hormone levels. Additionally, shifts in reproductive hormones can herald the onset of psychiatric disorders. This shift is exemplified by the impressive link between episodes of affective disorder and the normal female life cycle. Women have about the same rate of new onset of major depressive disorder as men both before puberty and after menopause. The rate skyrockets, however, for women of childbearing potential, with slight decreases during pregnancy and peak increases postpartum and in the 5to 7-year perimenopausal period prior to the complete cessation of menses.