Consider the endocrine system when dealing with mental health


Hormonal changes are among a variety of issues that can affect women’s psychiatry and medical condition, and awareness of the bigger picture can profoundly impact the management of these patients, C. Neill Epperson, MD, told attendees at the 2022 Psychiatric TimesTM World CME Conference taking place this week in San Diego.1

Epperson, professor and chair of the Department of Psychiatry at the University of Colorado in Aurora, Colorado, discussed the interaction between the endocrine system, early childhood influences, the brain and the nervous system at the meeting.

Epperson noted that it is important for psychiatrists to consider the endocrine system when treating patients, particularly in relation to women, as there are marked gender differences in how hormones affect their mental health. Differences in the impact of hormone treatments on women begin during puberty, she said, with young girls being prescribed a steroid twice as often as male counterparts, often related to the treatment of unprotected intercourse at the sexual debut.

“Always think about what type of steroid/contraceptive you are taking as they can profoundly affect the endocrine system,” Epperson explained. This is also true for menopausal women, as hormones have been shown to affect executive function, sexuality, cardiovascular disease, and mental health issues, including major depressive disorder, in women in transition. Postpartum oxytocin has been shown to play a key role in milk production and uterine contraction, and to have a profound impact on maternal nutrition.

“I’m not saying it’s all about the hormones, but I’m saying if you don’t think about it, you’re missing a big piece of the puzzle,” Epperson said.

Moving on to another “piece of the puzzle,” Epperson addressed how early life experiences can affect hormones, which in turn can have an impact on a patient’s mental health. She discussed the work of Ida Haahr-Pedersen, PhD, of the Trinity Center for Global Health in Dublin, Ireland, and colleagues in a study that took 1,839 participants in a US household survey and assessed self-reported rates of adverse childhood experiences (ACE). The researchers found that women were twice as likely as their male counterparts to report ACE and childhood social and emotional difficulties. 2

In perimenopausal women, Epperson said the most common ACEs associated with status 4+ for women were emotional abuse, domestic violence, emotional neglect and physical neglect, and 15% of women in this age group belong to the ACE group 4+ There’s also a lot of variability in the effects of ACE on women based on where they live, so it’s also important to consider that when considering how to interact with patients, and female patients in particular, she said.

Looking at the full picture of the patient, including any medications they may be taking, as well as conducting a thorough initial assessment that assesses past trauma is key to resolving potential mental health issues, Epperson concluded.


1. Epperson N. Practical Psychoneuroendocrinology: How the Brain, Nervous System, and Endocrine Systems Interact. Presented at: 2022 Annual Psychiatric TimesTM World CME Conference. 11-13 August 2022. San Diego.

2. Haahr-Pedersen I, Perera C, Hyland P, et al. Women have more complex patterns of childhood adversity: implications for mental, social, and emotional outcomes in childhood. EurJ psycho traumatol. 2020; 11(1):1708618.

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