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Age, Estrogens, and the psyche.

At the time of menopause, some women present with a clinical picture that has not only the specificity of estrogen deficiency, such as hot flushes, but also a nonspecific psychologic syndrome characterized largely by anxiety and depression. Both the physiology of aging and environmental stress factors unique to this age contribute to psychologic changes. Estrogen deficiency can further aggravate these psychologic changes. This effect of estrogen lack is mediated or modulated by catecholamines and prostaglandins at the level of the central nervous system. The conceptualization of the magnitude of contributions to psychologic changes occurring at menopause is shown in Figure 2. The therapeutic principle that emerges from this review is that the psychologic aspects of the menopausal syndrome should be treated as any other anxiety or depressive reaction and that only when the relief is persistently incomplete, showing unequivocally the predominance of estrogen deficiency, should replacement hormone therapy be considered.