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Background Estrogen has been considered as a potential antidepressant in postmenopausal women. Our goal was to study whether estrogen therapy is effective in treating depressive disorders in older postmenopausal women and to determine whether progestins are associated with a deterioration of mood. Methods After 2 weeks of single-blind placebo treatment in 87 patients, 57 were randomly assigned to receive 8 weeks of treatment with estradiol (.1 mg/day; n = 31) or placebo ( n = 26). All patients were then treated with medroxyprogesterone 10 mg/day for 2 weeks combined with the study patch. Depressive symptoms were rated with the 21-item Hamilton Depression and Center for Epidemiologic Studies Depression scales. Results A clinically significant antidepressant effect of estradiol was excluded after 8 weeks of estradiol treatment. The estradiol group and placebo group improved in depressive symptoms at a similar rate based on the Hamilton Depression Scale (40% decreases in depression for estradiol vs. 44% for placebo). No significant increase in depressive symptoms was demonstrated with the use of progestins; however, positive affect decreased slightly with the use of combined estradiol-medroxyprogesterone compared with medroxyprogesterone alone (5.8%, p = .027). Conclusions Estradiol cannot be considered as an effective treatment in postmenopausal women with mild to moderate depression.

Background New strategies are needed for preventing HIV infection in women. One potential approach is female-initiated use of an effective topical microbicidal gel in combination with a cervical barrier such as the diaphragm. Study design Randomized, placebo-controlled safety and feasibility trial of diaphragm with vaginal gel during 6 months of use among 120 HIV-negative sexually active women in Johannesburg, South Africa. Results Pelvic event rates were 338.3 and 247.1 per 100 women-years in the ACIDFORM gel (plus diaphragm) and K-Y® Jelly (plus diaphragm) groups, respectively, with a rate ratio of 1.37 (95% CI: 0.89–2.11). Most women found diaphragm with gel use acceptable. Conclusion There was a trend towards more safety events in the ACIDFORM plus diaphragm group, although no primary comparisons achieved statistical significance. Adding an effective microbicidal gel to a mechanical barrier may still prove to be an important and acceptable combination method to help prevent pregnancy and HIV/sexually transmitted infection transmission.

The complex nature of sleep among perimenopausal women warrants a biopsychosocial conceptualization; however, research on the psychological factors that contribute to the increased prevalence of poor sleep quality during this time is limited. We conducted a survey study of perimenopausal women (N = 168) to investigate the relations among nocturnal hot flashes, mood, dysfunctional beliefs and attitudes about sleep (DBAS), and subjective sleep quality. Self-report ratings of depressive symptoms, trait anxiety, hot flashes, and DBAS significantly correlated with poor sleep quality. Ratings on the DBAS Scale-Short Form mediated the relations both between nocturnal hot flashes and sleep quality and between mood and sleep quality. The interplay between physiological and psychological mechanisms among perimenopausal women is highlighted.