Skip to main content
NASPAG ACRM 2024 Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME Credit
CME Credit
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
International Speakers
International Speakers
On Demand
On Demand
Back

Endocrinology

Session: Poster Session I

(3) 17-Year-Old with Primary Ovarian Insufficiency and Menstrual Psychosis

Thursday, April 4, 2024
3:10 PM – 4:25 PM ET
Location: Peninsula Foyer

    Presenting Author(s)

  • Mariana Moncada-Madrazo, MD, MEd

    Resident Physician
    Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA, USA
    FALLS CHURCH, Virginia, United States

    • Senior Author(s)

  • RC

    Rachel K. Casey, MD

    Inova Children's Pediatric and Adolescent Gynecology, Fairfax, VA, USA
    Fairfax, Virginia, United States

    • Primary Author(s)

  • Mariana Moncada-Madrazo, MD, MEd

    Resident Physician
    Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA, USA
    FALLS CHURCH, Virginia, United States

Background: Menstrual psychosis is a rare disorder characterized by acute onset of psychotic symptoms of brief duration associated with the hormonal fluctuations of the menstrual cycle. The onset of menstrual psychosis has been described at various stages of the reproductive life. To our knowledge, no cases of primary ovarian insufficiency (POI) on hormone replacement therapy (HRT) and menstrual psychosis have been described.

Case: 17-year-old patient with a past medical history significant for POI and premenstrual dysphoric disorder (PMDD) followed by Pediatric Gynecology. The patient was initially started on transdermal estrogen for POI with a good response, and subsequently, cyclic progesterone was added to provoke endometrial shedding. After initiating progesterone therapy, she experienced unexplained psychosis (disorganized, illogical thoughts, anxiety, insomnia, irritability, and auditory hallucinations). She was evaluated in the ED and as an outpatient by pediatric psychiatry. After evaluation due to the intermittent nature of the psychosis and its relation to the start of progesterone, Pediatric Psychiatry established menstrual psychosis as the likely diagnosis. Toxicology was also consulted and progesterone toxicity was ruled out. Genetic testing for progesterone metabolism was performed, but the results of her tests were inconclusive. EEG was normal. Pediatric Psychiatry started the patient on olanzapine 5 mg nightly. HRT was briefly stopped but the patient experienced hot flashes and difficulty sleeping. Due to the symptoms experienced and benefits of HRT, after shared decision-making, both parents and the patient agreed on starting continuous HRT with transdermal estrogen and oral daily progesterone. The patient is doing well and has not had repeat episodes of psychosis or mood symptoms on the current regimen.

Comments: Limited literature exists regarding menstrual psychosis. Menstrual psychosis and PMDD have been associated with hormonal fluctuations. Continuous HRT might be a treatment option for POI patients who present with menstrual psychosis or PMDD that allows the continuation of hormonal support throughout life. A multidisciplinary approach might prove beneficial for these cases.