Oestrogen
| OUR RATING | |
| Women - if other treatments don't work |  |
What is it?
Oestrogen (also called 'estrogen') is a hormone that occurs naturally in a woman's body. When used as a treatment, it is usually supplied in tablet form. It is also available in a skin patch, as a cream or gel, injected or implanted just under the skin, and as a suppository. It is usually given with progestin or progesterone to reduce the risk of cancer.
How does it work?
The amount of oestrogen in a woman's body varies. It drops after childbirth, and around and after menopause. It also changes during a woman's menstrual cycle. It is thought that oestrogen may help depression at these times by increasing the amount of the chemical messenger serotonin in the brain. Some people think that oestrogens act as an antidepressant whether or not there are low levels of oestrogen in the body.
Is it effective?
It has been suggested that oestrogen may be an effective treatment for depression in women, particularly where the depression occurs before a period, after childbirth or around or after menopause. Here is what the evidence shows:
- Nobody has looked at the effect of oestrogen on women who become depressed before their period. However, two well-designed studies have shown that oestrogen patches improve mood in women with premenstrual syndrome (PMS).
- There is only one study of the effectiveness of oestrogen in depression following childbirth. In this study, high-dose oestrogen was more effective than placebos (dummy pills) in women with post-natal depression. Although the study was well designed, there were some weaknesses that might have affected the results of the study.
- The results of studies on oestrogen treatment for depressed women around or after menopause have not been consistent. However, the best designed study showed that oestrogen was better than placebos.
- No study has looked at the effect of oestrogen just in young women who are depressed and not menopausal. However, one study included depressed women who were mostly young and pre-menopausal. Some of these women were given very high dose oestrogen for 3 months and the others were given placebos. Only the oestrogen group improved.
Are there any disadvantages?
Oestrogen treatment increases the risk of cancer of the uterus and may increase the risk of breast cancer and blood clots in the veins. It can also cause a number of other problems such as tender breasts and breakthrough bleeding. It is not known if oestrogen is safe in breast feeding.
Where do you get it?
Oestrogen is prescribed by a doctor.
Recommendation
We don't recommend using oestrogen as the first choice for treating depression until more research is carried out. Oestrogen may be worth considering if the depression is severe and other medical and psychological treatments don't work.
Key references
Klaiber EL, Broverman DM, Vogel W, Kobayashi Y. Estrogen therapy for severe persistent depressions in women. Archives of General Psychiatry 1979; 36: 550-554.
Gregoire AJP, Kumar R, Everitt B, Henderson AF, Studd JWW. Transdermal oestrogen for treatment of severe postnatal depression. Lancet 1996; 347: 930-933.
Schmidt PJ, Nieman L, Danaceau MA, et al. Estrogen replacement in perimenopause-related depression: a preliminary report. American Journal of Obsetrics and Gynecology, 2000: 183: 414-420.
Lawrie TA, Herxheimer A, Dalton K. Oestrogens and progestogens for preventing and treating postnatal depression.(Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.
Altshuler LL, Hendrick V, Parry B. Pharmacological management of premenstrual disorder. Harvard Review of Psychiatry 2000; 2: 233-245.