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Evidence That Cyproterone Acetate Improves Psychological Symptoms and Enhances the Activity of the Dopaminergic System in Postmenopause

Clinica Ginecologica Ostetrica e di Fisiopatologia della Riproduzione Umana del Dipartimento Chirurgico Materno-Infantile e di Scienze delle Immagini, Dipartimento di Neuroscienze, Università degli Studi di Cagliari (M.D.Z.), 09124 Cagliari, Italy; and Direzione Scientifica Schering AG Italia (D.C., R.O.), 20090 Milan, Italy

Address all correspondence and requests for reprints to: Prof. Gian Benedetto Melis, M.D., Clinica Ginecologica Ostetrica e di Fisiopatologia della Riproduzione Umana del Dipartimento Chirurgico Materno-Infantile e di Scienze delle Immagini, Università degli Studi di Cagliari, Via Ospedale 46, 09124 Cagliari, Italy. E-mail: paoletti{at}freemail.it

The psychological symptoms assessed with a validated psychometric scale, SCL-90, were significantly higher in postmenopausal women (PMW; 60 subjects) than in premenopausal women (20 subjects). In the same PMW, the activity of the dopaminergic system, assessed with the PRL response to the dopamine-blocking agent sulpiride, was significantly lower than that in premenopausal women. During a period of 12 weeks the 60 PMW were randomly divided into 3 groups: no treatment (group A; n = 20), treatment with estradiol (E₂) alone (patches with a E₂ release of 50 µg/24 h; group B; n = 20), and treatment with hormonal replacement therapy [estradiol valerate (EV) at a daily dose of 2 mg for 11 days and EV at the same daily doses plus cyproterone acetate (CPA) at a daily dose of 1 mg/day for 10 days; group C; n = 20). At the 12th week of the observation, only in group C women were the psychological symptoms significantly decreased, and the indirect evaluation of the dopaminergic system activity through PRL response to sulpiride showed a significant increase. During the same period, no changes in testosterone levels were observed in any group of PMW, whereas a significant increase in E₂ levels was found in both groups B and C. Although it is likely that the improvement in psychological symptoms with EV and CPA was due to progestin, we cannot rule out the possibility that greater estrogen exposure may have played a role.

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