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Ask the Mental Health Expert Archives 2001-2004

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Late-Onset Schizophrenia

Q. Have any studies been done on women who have late-onset schizophrenia after a hysterectomy without hormone replacement therapy? I know three women that have had a hysterectomy and absolutely no signs of schizophrenia until after the hysterectomy. Does this relate to the role of sex hormones in triggering schizophrenia?

A. I am not aware of any studies linking hysterectomy with late-onset schizophrenia. However, the symbolic meaning of losing the uterus--in effect, losing one's youth or procreative power--could possibly trigger a psychotic depressive episode in some vulnerable women, which might easily be mis-diagnosed as schizophrenia.

Keep in mind that removal of the uterus per se (i.e., hysterectomy) does not directly affect the so-called female hormones, estrogen and progesterone. Those would be reduced only if the patient had also undergone an ovariectomy--removal of the ovaries--which is not necessarily the case when the uterus is removed for medical reasons.

That said, there is a hypothesis linking some forms of late-onset schizophrenia with diminishing estrogen levels. For example, the loss of the protective effects of estrogen may be related to the slight increase in the incidence of schizophrenia in women at menopause (for a review of this, see GE Robinson, CNS Drugs 2001;15(3):175-84).

Also, some evidence suggests that higher estrogen levels in female patients with schizophrenia are associated with better cognitive ability (Hoff et al, Am J Psychiatry 2001 Jul;158(7):1134-9).

August 2002

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