PsychEducation.org (home) Hormones and Mood
(This page was written in 2002 and has not been updated since)
Reference: Dr. Marjorie L. Shuer
Assistant Clinical Professor, Department of Psychiatry, UCSD
Mood and Menopause Clinic, San Diego (www.moodmenopause.com)
Dr. Shuer presented her extensive experience treating women in the perimenopause during a conference in Oct 2002 in Las Vegas, as well as previously at American Psychiatric Association meetings. In the recent conference (15th Annual Psychiatric Congress), she gave 3 separate presentations:
While trying to improve my knowledge base in this area over several years, I've yet to find anyone who knows as much as Dr. Shuer, based on direct experience treating patients. The other source to turn to would be direct research, and there, we find almost nothing to go on. Research in this area is still focusing on safety (e.g. the WHI, below), not who will respond to what treatment for what symptoms. There, we have to rely on experience, and Dr. Shuer appears to be one of the few experts in this area.
Her views are very strong. She feels that menopause represents a "hormone deficiency state" (in her words, an "endocrinopathy", i.e. an abnormal state). She believes that women with mental health symptoms such as depression, fatigue, confusion, and a decline in intellectual abilities should consider hormone replacement to address those symptoms.
Dr. Shuer also gave her views on the Women's Health Initiative (WHI) studyWHI, which recently was halted early because it appeared to show that women taking Premarin had an apparent increase in cardiac and breast cancer risk. She points out (quoting Dr. Joel Hargrove, and OB-Gyn with whom she studied) that this study, the largest of it's kind, could be regarded as a "toxicity study on horse estrogen" and should not be interpreted as showing that estradiol, the most common of the human ovarian estrogens, carries similar risk. Instead, she emphasizes that we still don't know about risk when it comes to estradiol itself.
Rather, she emphasizes that there are very clear health benefits, occurring at very high rates, for women taking estradiol during and after perimenopause. These high rates of benefit should be compared with the very low rates of risk that have generally been shown in the many trials of hormone replacement even prior to the WHI. She showed 12 studies conducted prior to the WHI which showed decreased cardiovascular risk or no clear benefit, versus one study showing increased risk (Table 6, session 432).
This whole issue of risk and hormone replacement is extremely complicated. Here is my attempt to summarize the issue of hormone replacement risk versus benefits.
In the meantime, suffice to say that Dr. Shuer represents on of our best sources of information. Unfortunately, she is preparing to move her practice. Her website, for now, is www.moodmenopause.com .