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Estrogen, menstrual cycle phases, and psychopathology in women suffering from schizophrenia

  • DOI:
  • Published online: 01 April 2007

Estrogen has been hypothesized to have a protective and antipsychotic-like effect in women at risk for schizophrenia. The aim of the present study was to evaluate the association between menstrual cycle and/or estrogen levels and psychotic symptoms in a sample of women with schizophrenia.


One hundred and twenty-five premenopausal women with schizophrenia and regular menses were examined. The levels of 17β-estradiol and other hormones of the gonadal axis were assessed in the follicular, peri-ovulatory, and luteal phases of the menstrual cycle. The effects of the menstrual cycle phase and/or the estradiol level on the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) scores were calculated by means of regression analyses.


Significant improvement in psychotic, but not depressive, symptoms was observed during the luteal phase, compared with other days of the menstrual cycle.


The present findings indicate that estradiol may have specific antipsychotic-like effects on the symptoms of schizophrenia. Thus further investigation into the therapeutic effect of estrogen may be worthwhile.

Corresponding author
*Address for correspondence: Niels Bergemann, M.D., M.Sc., Ph.D., Department of General Psychiatry, University of Heidelberg, Voss-Str. 4, D-69115 Heidelberg, Germany. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

K. Abe & M. Ohta (1998). Recurrent brief episodes with psychotic features in adolescence: periodic psychosis of puberty revisited. Psychiatry and Clinical Neurosciences 52, 313316.

S. Akhondzadeh , A. A. Nejatisafa , H. Amini , M. R. Mohammadi , B. Larijani & L. Kashani (2003). Adjunctive estrogen treatment in women with chronic schizophrenia: a double-blind, randomized, and placebo-controlled trial. Progress in Neuropsychopharmacology and Biological Psychiatry 27, 10071012.

N. Bergemann & A. Riecher-Rössler (eds) (2005). Estrogen Effects in Psychiatric Disorders. Springer: New York.

N. Bergemann , C. Mundt , P. Parzer , I. Nagl , U. Eckstein-Mannsperger , S. Haisch , B. Salbach , B. Runnebaum & F. Resch (2005 a). Plasma concentration of estradiol in women suffering from schizophrenia treated with conventional and atypical antipsychotics. Schizophrenia Research 73, 357366.

N. Bergemann , C. Mundt , P. Parzer , M. Pakrasi , U. Eckstein-Mannsperger , S. Haisch , B. Salbach , K. Klinga , B. Runnebaum & F. Resch (2005 b). Estrogen as an adjuvant therapy to antipsychotics does not prevent relapse in women suffering from schizophrenia: results of a placebo-controlled double blind study. Schizophrenia Research 74, 125134.

N. Bergemann , P. Parzer , I. Nagl , B. Salbach , B. Runnebaum , C. Mundt & F. Resch (2002). Acute psychiatric admission and menstrual cycle phase in women with schizophrenia. Archives of Women's Mental Health 5, 119126.

I. F. Brockington , A. Kelly & P. Hall (1988). Premenstrual relapse of puerperal psychosis. Journal of Affective Disorder 14, 287292.

W. L. Chua , A. Izquierdo de Santiago , J. Kulkarni & A. Mortimer (2005). Estrogens for schizophrenia. The Cochrane Database of Systematic Reviews 19(4), CD004719.

G. Fink , B. E. H. Sumner , J. K. McQueen , H. Wilson & R. Rosie (1998). Sex steroid control of mood, mental state and memory. Clinical and Experimental Pharmacology and Physiology 25, 764775.

G. Fink , B. E. H. Sumner , R. Rosie , O. Grace & J. P. Quinn (1996). Estrogen control of central neurotransmission: effect on mood, mental state, and memory. Cellular and Molecular Neurobiology 16, 325344.

L. M. Garcia-Segura , I. Azcoitia & L. L. DonCarlos (2001). Neuroprotection by estradiol. Progress in Neurobiology 63, 2960.

W. F. Gattaz , P. Vogel , A. Riecher-Rössler & G. Soddu (1994). Influence of the menstrual cycle phase on the therapeutic response in schizophrenia. Biological Psychiatry 36, 137139.

C. Gerada & A. Reveley (1988). Schizophreniform psychosis associated with menstrual cycle. British Journal of Psychiatry 152, 700712.

I. D. Glick & D. Stewart (1980). A new drug treatment for premenstrual exacerbation of schizophrenia. Comprehensive Psychiatry 21, 281287.

U. Halbreich , N. Rojansky , S. Palter , H. Tworek , P. Hissin & K. Wang (1995). Estrogen augments serotonergic activity in postmenopausal women. Biological Psychiatry 37, 434441.

J. D. Hallonquist , M. V. Seeman , M. Lang & N. A. Rector (1993). Variation in symptom severity over the menstrual cycle of schizophrenics. Biological Psychiatry 33, 207209.

S. Hammarback , T. Backstrom , J. Holst , B. von Schoultz & S. Lyrenas (1985). Cyclical mood changes as in the premenstrual tension syndrome during sequential estrogen-progestagen postmenopausal replacement therapy. Acta Obstetricia et Gynecologica Scandinavica 64, 393397.

A. H. Harris (1997). Menstrually related symptom changes in women with schizophrenia. Schizophrenia Research 27, 9399.

V. Hendrick , L. L. Altshuler & V. K. Burt (1996). Course of psychiatric disorders across the menstrual cycle. Harvard Review of Psychiatry 4, 200207.

S. W. Hopker & I. F. Brockington (1991). Psychosis following hydatidiform mole in patient with recurrent puerperal psychosis. British Journal of Psychiatry 158, 122123.

Ph. Jolly (1915). Menstruation und Psychose. Archiv für Psychiatrie und Nervenkrankheiten 55, 637686.

S. R. Kay , A. Fiszbein & L. A. Opler (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.

K. Klinga (1997). Determination of hormones and hormone receptors. In Gynecological Endocrinology and Reproductive Medicine, Vol. 1 (ed. B. Runnebaum and T. Rabe ), pp. 4554. Springer: Heidelberg, Berlin, New York.

R. E. Kendell , J. C. Chalmers & C. Platz (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry 150, 662673.

R. v. Krafft-Ebing (1878). Untersuchungen über das Irresein zur Zeit der Menstruation. Archiv für Psychiatrie und Nervenkrankheiten 8, 65107.

J. Kulkarni (2005). Clinical estrogen trials in patients with schizophrenia. In Estrogen Effects in Psychiatric Disorders (ed. N. Bergemann and A. Riecher-Rössler ), pp. 107122. Springer: New York.

J. Kulkarni , A. deCastella , A. Riedel , J. Taffe , P. Fitzgerald & H. Burger (2001). Estrogen – a potential new treatment in schizophrenia. Schizophrenia Research 48, 137144.

J. Kulkarni , A. deCastella , D. Smith , J. Taffe , N. Keks & D. Copolov (1996). A clinical trial of the effects of estrogen in acutely psychotic women. Schizophrenia Research 20, 247252.

S. J. Lee & B. S. McEwen (2001). Neurotrophic and neuroprotective actions of estrogens and their therapeutic implications. Annual Review of Pharmacology and Toxicology 41, 569591.

F. A. Leidenberger (1992). Klinische Endokrinologie für Frauenärzte. Springer, Berlin.

L. A. Lindamer , D. C. Buse , J. B. Lohr & D. V. Jeste (2001). Hormone replacement therapy in postmenopausal women with schizophrenia: positive effect on negative symptoms? Biological Psychiatry 49, 4751.

M. R. Louzã , A. P. Marques , H. Elkis , D. Bassitt , M. Diegoli & W. F. Gattaz (2004). Conjugated estrogens as adjuvant therapy in the treatment of acute schizophrenia: a double-blind study. Schizophrenia Research 66, 97100.

S. Lovestone (1993). Periodic psychosis associated with the menstrual cycle and childbirth. British Journal of Psychiatry 162, 424425.

W. Magharious , D. C. Goff & E. Amico (1998). Relationship of gender and menstrual status to symptoms and medication side effects in patients with schizophrenia. Psychiatry Research 77, 159166.

V. Mahé & A. Dumaine (2001). Oestrogen withdrawal associated psychoses. Acta Psychiatrica Scandinavica 104, 323331.

M. D. Majewska (1992). Neurosteroids: endogenous bimodal modulators of the GABA-A receptor. Mechanism of action and physiological significance. Progress in Neurobiology 38, 379395.

B. S. McEwen & S. E. Alvers (1999). Estrogen actions in the central nervous system. Endocrine Reviews 20, 279307.

M. Morissette & T. DiPaolo (1993). Sex and estrous cycle variations of rat striatal dopamine uptake sites. Neuroendocrinology 58, 1622.

North American Menopause Society (2003). Estrogen and progestogen use in peri- and postmenopausal women: September 2003 position statement of The North American Menopause Society. Menopause 10, 497506.

M. T. Notman & C. C. Nadelson (2002). The hormone replacement therapy controversy. Archives of Women's Mental Health 5, 3335.

J. E. Overall & D. R. Gorham (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 799812.

T. Rabe & B. Runnebaum (1997). Hormones. In Gynecological Endocrinology and Reproductive Medicine, Vol. 1 (ed. B. Runnebaum and T. Rabe ), pp. 143. Springer: Heidelberg, Berlin, New York.

M. J Rey , P. Schulz , C. Costa , P. Dick & R. Tissot (1989). Guidelines for the dosage of neuroleptics 1: chlorpromazine equivalents of orally administered neuroleptics. International Clinical Psychopharmacology 4, 95104.

A. Riecher-Rössler (2005). Estrogens effects in schizophrenia – update and potential therapeutic implications. In Estrogen Effects in Psychiatric Disorders (ed. N. Bergemann and A. Riecher-Rössler ), pp. 3152. Springer: New York.

A. Riecher-Rössler , H. Häfner , A. Dütsch-Strobel & M. Stumbaum (1998). Gonadal function and its influence on psychopathology – a comparison of schizophrenic and non-schizophrenic female inpatients. Archives of Women's Mental Health 1, 1526.

A. Riecher-Rössler , H. Häfner , M. Stumbaum , K. Maurer & R. Schmidt (1994). Can estradiol modulate schizophrenic symptomatology? Schizophrenia Bulletin 20, 203214.

M. V. Seeman (1983). Interaction of sex, age, and neuroleptic dose. Comprehensive Psychiatry 24, 125128.

M. V. Seeman (1997). Psychopathology in women and men: focus on female hormones. American Journal of Psychiatry 154, 16411647.

S. K. Severino & K. A. Yonkers (1993). A literature review of psychotic symptoms associated with the premenstruum. Psychosomatics 34, 299306.

D. Stein , A. Hanukoglu , S. Blank & A. Elizur (1993). Cyclic psychosis associated with the menstrual cycle. British Journal of Psychiatry 163, 824828.

D. W. Swanson , A. Barron , A. Floren & J. A. Smith (1964). The use of norethynodrel in psychotic females. American Journal of Psychiatry 120, 11011103.

J. S. Teja (1976). Periodic psychosis of puberty. A longitudinal case study. Journal of Nervous and Mental Disease 162, 5257.

S. W. Woods (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. Journal of Clinical Psychiatry 64, 663667.

Writing Group for the Women's Health Initiative Investigators (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association 288, 321333.

Writing Group of the International Menopause Society Executive Committee (2004). Guidelines for the hormone treatment of women in the menopause transition and beyond. Position Statement by the Executive Committee of the International Menopause Society. Climacteric 7, 811.

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Psychological Medicine
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