Feature Article

Biological aspects of treating women with severe mental illness

Jayashri Kulkarni, Emmy Gavrilidis, Roisin Worsley



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.

Key Points

  • 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.