74. MENOPAUSE IN THE PSYCHIATRIC CLINIC: EXPLORING PATIENT’S PROFILE

Introduction

Introduction: Depressive illnesses result in substantial morbidity and mortality throughout the world, with women exhibiting more depressive diseases than men 1,2. There is strong evidence that reproductive transition phases in women, and menopause in particular, are associated with increased susceptibility to mental illness3,4. Studies also suggest that postmenopausal women with depression are at elevated risk for mild cognitive impairment and dementia 5. This may suggest that depression during or after menopause may represent a unique risk factor for subsequent cognitive decline and dementia in women. Despite this, there is no clear guidance on screening or treating menopausal patients in psychiatry. Evidence supports the preferential use of specific SSRI/SNRI, and certain drugs have received FDA approval for symptomatic menopause 6,7,8. Other studies suggest that Menopausal Hormone Therapy (MHT) may be beneficial for post-menopausal psychiatric symptoms in women, but findings are inconsistent8. No specific guidelines exist for the specific treatment of depression in post-menopausal women.

Objective

To understand the current practices in a tertiary care psychiatric clinic regarding patients who may have menopause-related psychiatric disorders. We hypothesize that psychiatric providers may not readily identify the impact of menopause on psychiatric conditions and may not identify menopausal women as a subpopulation with specific needs.

Methods

In this retrospective chart review study, we obtained data from the Electronic Medical Record (EMR) at The Mount Sinai Behavioral Health Center in New York City outpatient department from 7/1/2023 to 6/27/2024 of female patients, ages 45 to 60 years. We identified patients with a comorbid diagnosis of symptomatic menopause and determined screening status by looking at keywords descriptive of menopause in the psychiatric note: “vasomotor”, “hot flashes”, “menopause", "flushing”, “vertigo", "dizziness”, “sweating”, “vagina” and “menstruation”. Variables such as race, ethnicity, psychiatric diagnosis, presence of MHT prescription, and psychiatric treatment currently used were also obtained for secondary analysis.

Results

Preliminary results: A total sample of 120 patients receiving outpatient psychiatric services with a co morbid menopause diagnosis were identified. Only eight patients (6.66%) had clear evidence of menopause discussion during their psychiatric encounter. Twenty-seven patients (22.5%) were on MHT, of which only 11.6% were a systemic formulation (oral/patch). The majority of identified patients were diagnosed with depressive disorders, followed by anxiety disorder as the most frequent psychiatric diagnosis. The antidepressants most prescribed were escitalopram and fluoxetine.

Conclusions

Conclusion: All individuals with female reproductive organs over the age of 40 will experience menopause. There is substantial evidence suggesting that menopause increases susceptibility to psychiatric decompensation, particularly in the form of depressive and anxiety disorders. However, this critical factor is often overlooked in psychiatric evaluations. As a result, psychiatric patients may be less likely to advocate for themselves and may not receive appropriate treatment for menopause-related symptoms.