Colleen Hall

Hormonal changes are among a host of issues that can influence psychiatry and medical conditions in women, and being aware of the total picture can deeply impact these patient’s treatment, C. Neill Epperson, MD told attendees at the 2022 

TM World CME Conference being held in San Diego this week.1

Epperson, who is a 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 

 when treating patients, particularly as it relates to women, since there are pronounced differences between genders in how hormones impact their mental health. The differences in how hormone treatments affect women begin in adolescence she said, with young girls twice as likely than male counterparts to be prescribed a steroid, often related to addressing unprotected sexual intercourse at sexual debut.

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

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

Shifting gears to another “piece of the puzzle,” Epperson addressed how early life experience can impact hormones, which in turn can have an influence on a patient’s mental health. She discussed the work ofIda Haahr-Pedersen, PhD, from Trinity Center for Global Health in Dublin, Ireland, and colleagues in a study that looked at 1839 US household survey participants and assessed self-reported rates of 

 The investigators found that women were twice as likely as their male counterparts to report ACE as well as social and emotional difficulties in childhood. 2

In perimenopausal women, Epperson said, the most common ACEs associated with 4+ status for women included emotional abuse, domestic violence, emotional neglect, and physical neglect, and 15% of women in this age range are in the 4+ ACE group. There is also wide variability of ACE impact on women depending upon where they live, so taking that into account when considering how to interact with patients, and female patients in particular, is important as well, she said.

Looking at the total picture of the patient, including medication they may be taking, in addition to performing a thorough initial assessment that assesses past trauma, is key to helping address any mental health issues that may present, Epperson concluded.

This article originally appeared on Psychiatric Times®. 

1. Epperson N. Practical psychoneuroendocrinology: how the brain, nervous system, and endocrine system interact. Presented at: 

2022 Annual Psychiatric TimesTM World CME Conference

2. Haahr-Pedersen I, Perera C, Hyland P, et al. 

Females have more complex patterns of childhood adversity: Implications for mental, social, and emotional outcomes in childhood

Articles

The endocrine system is an important puzzle piece when addressing psychiatric disorders.

Consider the endocrine system when addressing mental health

About a third of 1,500 women surveyed from Alberta, Canada, reported using cannabis to alleviate some of the commonly-reported symptoms associated with menopause, according to a study presented in a poster at the annual meeting of the North American Menopause Society, being held this week in Washington, D.C.

Katherine Babyn, a master of science student from the University of Alberta, and colleagues conducted a quantitative phase 1 and qualitative phase 2 study, which included one-on-one interviews of 1,500 women between October and December of 2020, recruiting women aged 35 and over from popular social media platforms. Eighteen percent of the women were in premenopause, 33% reported they were in perimenopause, and about 35% were in postmenopause. One-third reported using cannabis within the last month, and slightly more than half of the women, about 52%, reported having used cannabis for more than 3 years.Many of the women reported getting information about cannabis use through Internet searches (about 46%), but said their most desired information about this use comes from their physician, with about half noting it as their preferred method to obtain health information.

Of 499 women who reported using cannabis, three-quarters noted it was for medical use, citing sleep issues, anxiety, muscle aches, irritability, and depression as some of the symptoms that were alleviated due to its use.

The researchers reported that edibles and oils were the most commonly used types of cannabis, at 52% and 47% respectively. Forty-one percent of the women reported smoking cannabis, 25% reported vaping, and 16% reported using capsules.

Researchers noted that the women who reported using cannabis were less likely to report problems sleeping, mood issues, achiness, or painful intercourse, all commonly associated with menopausal transition.

“Our study confirmed that a large percentage of midlife women are using cannabis for symptoms that overlap with menopause, especially those women who reported more symptoms,” Babyn said in a press release about the study.

Researchers said that more study is needed in this area, noting that the study sampling was limited by social media, and that the results do not assess cannabis efficacy for these symptoms.

The study was funded by a grant from the Canadian Institutes of Health Research.

Babyn K, Ross S, Yuksei N. Cannabis use in menopause: capturing the experiences and perspectives of women. Poster presented at: North American Menopause (NAMS) Annual Meeting. Washington, DC. Sept. 22-25, 2021.

One in three women in an Alberta, Canada, survey reported using cannabis to alleviate their symptoms associated with menopause.

Common problems associated with menopause alleviated with cannabis use, patients report

“There’s going to be human gene editing therapies, discovery of new drugs, and new drug targets, CRISPR systems are being used in diagnostics including for SARS-COV-2, vector control, increased crop and food output,” said Neville Sanjana, a New York University professor who spoke virtually at the meeting on his team’s research.

Sanjana cited recently-published research relating to CRISPR with SARS-COV2, as an example of the promise that this technology holds. While the research into vaccines for COVID-19, has provided “great cause for optimism” in drastically reducing the impact that this pandemic has had on the population, vaccines do have their limitations, including not being broadly available across the world and the potential introduction of new viral variants. Using gene-editing technology, researchers may be able hone in on new therapeutic targets if they are needed, he said.

As an example, Sanjana said that his lab at the New York Genome Center and NYU in collaboration with Ben tenOever, PhD,  at Mt. Sinai's School of Medicine used “top-ranked hits from the genome-scale CRISPR screen,” to identify key human genes requires for viral infection.1 Using human lung cells expressing the ACE2 receptor, they found that many of these genes were involved in the endosomal entry pathway, such as RAB7A. More importantly, inhibition of several top-ranked genes from the CRISPR screen led to a robust reduction (>100-fold) in SARS-CoV-2 infection of those human lung cells, demonstrating how CRISPR-identified genes can be used to discover new therapeutics.

Research like this is key to honing in on how the virus functions, and potential therapeutic targets, he noted.

Sanjana was part of the NYU and New York Genome Center research team that also recently developed chemically modified guide RNAs for a CRISPR system that targets RNA, intead of DNA, enhancing their ability to target, trace, edit, and or “knockdown,” RNA in human cells.

Questioned by an audience member on the cost involved in this type of research, Sanjana discussed NPR’s series on Victoria Gray, a woman who became the first patient in the United States to have her sickle cell disease treated using CRISPR technology. The series noted that the treatment was close to a million dollars. While he acknowledged the field is still very much in its infancy, and much more needs to be done to address the costs involved in manufacturing these types of health care answers, he feels as the technology continues to evolve, more research will enable more streamlined, and cost-effective ways to deliver these solutions.

“There is so much potential for this technology to help the world and we have to stay focused on that,” Sanjana said.

1. Daniloski Z, Jordan JK, Wessels HH, et al. Identification of required host factors for SARS-COV-2 infection in human cells. Cell.2021; 184: 92-105.

2. Sanjana N. Promises and challenges of gene editing in the age of CRISPR. Presented at The North American Menopause Society Annual Meeting. September 24, 2021.

CRISPR gene-editing technology holds the potential to usher in a new age in medicine, according to a featured speaker at the North American Menopause Society Annual Meeting, being held this week in Washington, D.C.

Gene-editing technology: potential to usher in a new age in medicine

The recently-released and long-awaited guidelines on screening for sexually transmitted infections (STIs) from the Centers for Disease Control and Prevention (CDC) introduce some new ways of approaching some common questions you’re probably used to asking your patients.

Michael S. Policar, MD, MPH, who is professor emeritus, obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, School of Medicine, addressed attendees of the North American Menopause Society (NAMS) meeting being held this week in Washington, DC, and said that some of the old questions about sexual partners, such as, “do you have sex with men, women or both,” have now been replaced with “are you currently have sex of any kind, oral, vaginal, or anal, with anyone?”

 Also, asking patients if they are having sex with another person, and if so, what kinds of sexual contact do they have, and how they met their partners are important questions to discuss.

Policar also addressed the importance of discussing the “5 P’s of sexual history,” including partners, protection, past history of STIs, and intention to become pregnant, but he added what he called a 6th P – “pleasure, you want to ask, are you satisfied with your sexual relationship with your partner.” This is a particularly important question for patients at midlife, as studies have shown up to 43% of women report sexual problems during this period of their lives.

Discussing sexual history is key during an examination, Policar said, especially as CDC data have shown continual spikes in STIs year after year up until 2020, when rates went down, he said but that was likely due to less people being screened during the pandemic and less access to testing for those infections.

Prior to 2020, however, CDC data showed a nearly 30% increase in chlamydia, gonorrhea, and syphilis between 2015 and 2019. In the most recent CDC update, health officials prioritized prevention and control, noting the importance of risk assessment and education; pre-exposure vaccination for vaccine-preventable STIs, like human papillomavirus; screening for people with an STI; and effective diagnosis and treatment.

Policar said that when screening patients for gonorrhea and chlamydia focus on those patients with a previous or concurrent STI; patients with new or multiple sex partners, a sex partner with an STI; patients who demonstrate inconsistent condom use; people who are not in monogamous relationships; and those patients who report exchanging sex for money, housing or other needs.

He noted that treatment recommendations were updated in the new guidelines as well, with treatment shifting for chlamydia from a single dose of doxycycline to 100 mg orally twice daily for 7 days.

A new alternative gonorrhea treatment of cefixime 800 mg Po x 1 was also offered in the guidelines for people with uncomplicated infections of the cervix, or rectum, if ceftriaxone is not available.

Policar completed his discussion by reviewing the “checklist” of chlamydia and gonorrhea management, including, ensuring timely and appropriate treatment within 14 days of specimen collection, testing for other STIs, patient education and counseling, reporting of the case to the local health department, scheduling a follow up test in 3 months, and finally, ensuring that all sex partners are treated.

1. Policar MS. Sexually transmitted infections in midlife women: what clinicains need to know. Presented at The North American Menopause Society Annual Meeting. September 24, 2021.

New guidelines from the Centers for Disease Control and Prevention (CDC) for the screening of sexually transmitted infections (STIs) offer new ways to ask common questions.

Colleen Hall

Articles

Consider the endocrine system when addressing mental health

Common problems associated with menopause alleviated with cannabis use, patients report

Gene-editing technology: potential to usher in a new age in medicine

CDC guidelines on STIs update some 'old questions'