The problem of medicating women like the men: conceptual discussion of menstrual cycle-dependent psychopharmacology

While hormonal changes during the ovulatory cycles affect multiple body systems, medical management, including medication dosing remains largely uniform between the sexes. Little is known about sex-specific pharmacology in women. Although hormonal fluctuations of the normal menstruating process alters women's physiology and brain biochemistry, medication dosing does not consider such cyclical changes. Using schizophrenia as an example, this paper illustrates how a woman's clinical symptoms can change throughout the ovulatory cycle, leading to fluctuations in medication responses. Effects of sex steroids on the brain, clinical pharmacology are discussed. Effective medication dose may be different at different phases of the menstrual cycle. Further research is needed to better understand optimal treatment strategies in reproductive women; we present a potential clinical trial design for examining optimal medication dosing strategies for conditions that have menstruation related clinical fluctuations.

Gaps in Menopause Knowledge

The average middle aged woman goes through a volatile period of endocrine fluctuations as she passes through menopause and the stages that precede and follow it. Ovarian hormones are steroid hormones. They readily cross the cell and nuclear membranes and influence transcription of numerous genes. Such influences are tissue specific and state specific. In short, changes in ovarian hormones mean that a women will experience changes in her entire body systems. When an individual woman's constitutional factors, pathologic states, medications, environmental exposures are taken into consideration, the integrated changes become too complex to predict. Inter-study sampling differences with the complexities in the backdrop may have led to conflicting conclusions in menopause research. This paper reviews some of the controversies in the care of menopausal women.

Epidemiologic Survey of Menopausal and Vasomotor Symptoms in Korean Women / 대한폐경학회지

OBJECTIVES: Vasomotor symptoms (VMS) are one of the most annoying symptoms experienced by postmenopausal women. Generally, 75% of women over 50 years of age experience VMS. This study is an epidemiologic survey of menopausal symptoms and VMS in Korean menopausal women. METHODS: Survey participants were recruited from Korean provinces based on the Korean population study conducted in 2010 and using multi-level stratification by age and geographic location, and random sampling. Healthy perimenopausal and menopausal Korean women aged between 40 to 60 years and who participated in the interview survey were included in the study. The Korean version of the Menopause Rating Scale (MRS) and the Korean version of Women's Health Questionnaire (WHQ) was used to investigate the prevalence of menopausal related symptoms and to assess quality of life. RESULTS: Among the 1,500 women, 66% were classified as perimenopause, 28% as menopause, and 7% had undergone hysterectomy. Typically, 41.6% of women in perimenopause reported having experienced VMS in recent six months. About 53.1% of women in early menopause and 36.5% of women in late menopause had experienced VMS in the past six months. Whereas, 30.6% of women with hot flashes, and 27.9% of women with sweating stated that these symptoms were not related to menopause. CONCLUSION: The prevalence of VMS in Korean women seems to be less than women of Western countries. Overall subjective experience of menopause was perceived as increasingly positive with age. Awareness of menopausal symptoms appeared lower than expected. Perimenopausal and menopausal women in Korea rarely sought medical care.