Women’s Health: Hormones, Emotions, and Behavior

This book is part of the Psychiatry and Medicine series, intended for clinicians and trainees in psychiatry, internal medicine, and primary care. Each volume in the series reviews areas in medicine in which psychological factors and psychiatric morbidity are especially important. Each volume is coordinated by an experienced clinician and combines clinical insights with relevant, up-to-date research findings. In this case, the editor, Regina Casper, is Director of the Women’s Wellness Clinic at Stanford University School of Medicine, and most of the chapters, although not all, are written by Stanford University staff and academics.

Although the physiology and psychology of women and men are almost identical, the small differences, attributable mainly to sex hormones, influence mood and behavior and lead to differential responses on the part of others. Most cultures, throughout history, have institutionalized these differences and encouraged the evolution of two separately elaborated social roles, one for women and one for men. This has resulted in many inequities, notably unequal opportunities in the workplace, which have had further effects on the consequences of sex on the individual. At this stage of cultural evolution, it is almost impossible to disentangle the role of hormonal difference from the many layers of social attributions that have magnified and complicated this difference. From a health viewpoint, however, it is important, when it comes to sex, to try to sweep away the elaborate and enticing cobwebs of role expectations and biased perceptions and carefully to examine what makes men and women hormonally different and how this difference influences emotion, behavior, prevention of illness, psychiatric morbidity, optimal treatment strategies, and, ultimately, outcome of illness. It is also tempting to think that, by comparing men and women who become depressed, who develop schizophrenia, or who become demented, we will be able to probe deeper into the etiologies of these, as of now, mysterious disorders.

This book does not attempt to do it all but to concentrate on those illnesses which, perhaps more than others, require both medical and psychological intervention: depression, sexual dysfunction, problems of pregnancy and menopause, eating disorders, coronary artery disease, and breast cancer. Chapter 1 describes female development as a backdrop to the material in the chapters that follow. It relies on experimental evidence from other species, on longitudinal studies in humans, and on work in anthropology to discuss brain differentiation, identity formation, puberty and adolescence, hormonal and psychological maturation, body image and self-image, and self-concept and self-esteem. Chapter 2 covers a wide territory: some historical material; current evidence for neurotropic effects of gonadal hormones; premenstrual dysphoric disorder; anxiety, depression and psychosis during pregnancy; postpartum psychiatric problems; and menopause, hormone replacement, and mood. The authors concentrate on the effects of hormones in the brain but recognize the interplay between the neurotropic effects of hormones and the psychological meaning of events as they inevitably occur over the life cycle.

The next chapter is on women’s sexual function. Then comes a chapter on brain differences between the sexes and the epidemiology of psychiatric disorders. Chapter 5 is on thyroid hormones and their effects in mood disorders. Chapter 6 is on the hypothalamic-pituitary-adrenocortical system and its involvement in depression. Chapter 7 is devoted to eating disorders, and chapter 8 is on coronary artery disease and women. Chapter 9 is on the psychophysiology of breast cancer. Chapter 10 is on psychopharmacology and women. The last chapter is on intervention trials for disease prevention.

This book is full of important information that is pertinent to women’s health, medical and psychiatric. One difficulty for the reader is that the progression of chapters is not clear. I find myself longing for the old days when we learned anatomy, then physiology, then pathology. These were building blocks that led on to clinical manifestations, epidemiology, prevention, and treatment. For me, the book would have been easier to read if the logical progression of chapters were more evident, but books on women’s health have always been difficult to organize, especially if one wishes, as Dr. Casper does to her great credit, to integrate biology with social role.