Management of women with severe mental illness needs to take into account the influence of oestrogen and progesterone fluctuations on the illness, as well as sex-specific issues such as contraception, fertility, pregnancy and breastfeeding.
- Fluctuations in oestrogen and progesterone can influence the onset and relapse of mental illnesses in some women.
- For women with premenstrual symptom exacerbations, our clinical practice is to trial the oral contraceptive pill with continuous hormone delivery.
- Contraception, sexual health and pregnancy planning are often overlooked in settings that focus on mental health care.
- Lifestyle advice plus metformin can help weight loss in women with antipsychotic-induced weight gain.
- Oestrogen augmentation and selective oestrogen receptor modulators (SERMS) such as raloxifene are being trialled as adjuncts to antipsychotic medication in women with severe mental illness.
- Choice of antipsychotic medication in pregnancy is not clear; the National Register of Antipsychotic Medication in Pregnancy study may help resolve this question.