Peer Reviewed
Feature Article Psychology and mental health
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Biological aspects of treating women with severe mental illness

Jayashri Kulkarni, Emmy Gavrilidis, Roisin Worsley
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Abstract
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.
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