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Exogenous oestrogens, progesterone and progestogens are prescribed for a variety of conditions in spite of lack of proof of efficacy. Supraphysiological levels of oestrogen and progesterone have occurred in some individuals due to demands for increased doses. Brain function, amine metabolism and nutritional status can be altered by exposure to exogenous hormones. Direct and indirect mechanisms of psychoactivity may induce dependency. A doctor's severe `menopausal type' withdrawal symptoms after exposure to oral conjugated oestrogens (Premarin 625 lg/day) are reported.
Keywords: addiction, exogenous steroid hormones, oral contraceptives, psychoactive, lack of efficacy, increasing doses, withdrawal symptoms, menopause, post-menopausal hormone replacement therapy.
INTRODUCTION
Over the last decade it has been suggested that several naturally occurring steroid hormones may be addictive when taken or applied exogenously. These include androgen anabolics in 1989 [1] and 1990 [2], oestrogens in 1994 [3, 4] and progesterone in 1996 [5]. Sex hormones are psychoactive. Oestrogen reduces the activity of monoamime oxidase (MAO) enzymes. Higher amine levels may induce feelings of well-being or even euphoria. Excessively high levels or over-response can result in feelings of irritability, anxiety or insomnia. Progesterone has the opposite effect. Increasing MAO activity and consequent lower amine levels can induce sedation or depression [6, 7].
OESTROGEN DEPENDENCY
Here is the personal experience of Dr Margaret White.
I practised medicine for over 40 years and in the early days I believed all I was taught. About half way through my career I realised that my profession was by no means infallible. At one time Drinamyl was recommended as a first-line treatment for depression but "Purple hearts", the popular name for Drinamyl, soon became notorious as a common drug of addiction among the young. Such experiences were often repeated as I have seen many changes in prescribing fashions. When early oral contraceptive trials began to report sudden deaths in young women due to thrombosis and heart attacks I was interested, and rather surprised, to learn that these steroid hormones were immunosuppressive. More recently I discovered to my cost that in some cases they can be dependencyinducing.
My personal story is interesting because I had a normal asymptomatic menopause when I was 50 with no hot flushes, giddy bouts or flooding. As a general practitioner, I was visited by a young,...