May is Mental Health Awareness Month, so let’s take a look at a little known, and little-understood, brain disorder: schizophrenia... especially with regard to what often happens to women with this condition during midlife, including potential improved effectiveness in treatment.

Details about schizophrenia

Though treatable, schizophrenia is not curable. When active, symptoms can include some combination of delusions, hallucinations, exaggerated or distorted perceptions, beliefs, and behaviors, challenges in thinking and concentration, and lack of motivation. When this disorder is active, people with schizophrenia are often unable to distinguish between real and unreal experiences. There are several additional symptoms that can occur, and as with any illness, the severity, intensity, and frequency of symptoms can vary. Also, while people with this illness can lead rewarding lives with the help of treatment, some cases of schizophrenia can be disabling.

It’s important to note that suicidal thoughts and behaviors are common among those with this illness, as are high rates of co-occuring medical conditions such as heart disease and diabetes.

It’s a complex condition, for sure. Affecting less than 1% of the U.S. population, misconceptions about this disorder include the ideas that people with schizophrenia:

  • Have split personality or multiple-personalities, not true according to the American Psychiatric Association
  • Are violent (most are not)
  • Are homeless or live in hospitals (many live with family, in group homes, or on their own)


Causes and symptoms of schizophrenia

Per the Mayo Clinic, precise causes for schizophrenia are unknown. Researchers believe that a combination of genetics, brain chemistry, and environment contributes to this disorder. Continued neuroimaging studies show differences in the brain structure and central nervous system of people with this condition, but researchers are not sure about what the significance is of these differences at the time of publishing this post. 

Also, per the Mayo Clinic,  there are risk factors that are thought to increase the risk of developing or triggering schizophrenia.

These include: 

  • Having schizophrenia in the family history
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
  • Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood


Middle-age onset schizophrenia: MAOS

This paper from 2009 is particularly interesting as it shares details about middle-age-onset schizophrenia. It gathered and reviewed several studies targeting early-onset and middle-age onset of this illness. Findings share that there is a higher proportion of women among MAOS patients and that there is a tendency for MAOS patients to have “...less severe negative symptoms and better neuropsychologic performance (particularly in learning and abstraction/cognitive flexibility)...” This isn't to say that what's called "positive psychotic symptoms" are not present, only that the symptoms categorized as "negative" are less severe.

It’s thought that while middle-age-onset schizophrenia is predominantly neurodevelopmental, it is also a distinct neurobiological subtype of schizophrenia. It seems that more research and shared findings are called for on this front.


Connect with medical support while at home with our online clinic. Learn more about having a better menopause.


Women with schizophrenia entering menopause

There is a hypothesis that endogenous (growing or originating from within an organism) estrogen may have a protective effect against schizophrenia. This has to do with the difference in when men and women experience peak onset. In men, the age of schizophrenia onset peaks between ages 15-25 years. 

In women, peak onset is between 20-35 years, with an additional smaller peak around the time of menopause. We already know (and continue to discover) fluctuating and decreasing levels of estrogen, that mighty hormone, affects the skin, vasomotor function (hello hot flashes and night sweats), sleep, and mood. It seems this could be more intelligence about how estrogen works throughout the entire body, and most definitely affects the brain.


Preexisting schizophrenia? 

This is critically important for health and wellbeing: 

“Women with preexisting schizophrenia frequently experience a postmenopausal exacerbation of psychotic symptoms and a resultant need for an increase in antipsychotic medication.” 

Consider proactively checking in with your doctor as you’re approaching perimenopause or menopause, and absolutely call into the office for a video call or appointment if your symptoms are increasing and/or worsening. Ask about potential needs for a change in your medication, including potential mode of your medication delivery.

In an interview with Amnon Brzezinski, MD, from the Department of Obstetrics and Gynecology at The Hebrew University - Hadasssah Medical Center in Jerusalem, Israel:

“Around the time of menopause, women with schizophrenia often require antipsychotic dose increases. This is because several changes occur in the absorption and metabolism of drugs at the time of menopause. It has been reported that the variability in drug response that exists among individuals with psychosis increases at menopause and is greater for the oral route that goes through the liver than for intramuscular injection. This may be why, for some women with schizophrenia at this time of life, oral medications appear to lose effectiveness, whereas depot injections of the same antipsychotic continue to be effective.”

When you connect with your doctor, try to make it a collaborative, solution-finding conversation. Consider asking about potential increased adverse effects if a higher dosage of antipsychotic medication is needed too. 

Absolutely! Ask about hormone replacement therapy (HRT), and note how it may either work or react with your existing, personal treatment medication. Uncovering and discovering more information and avenues to better wellbeing during steady, consistent treatment is key.


Same but different

Changes in sleep, mood, and changing body temperatures (both hot and cold flashes) may happen in menopause whether a woman has schizophrenia or not. A sense of loss may be felt with the loss of infertility  and the perceived loss of sexual desirability may compound already-challenging feelings.

There may be additional impacts and challenges if a woman is going into perimenopause or menopause while living with aging parents who require more or different care. Children moving away, parents passing away may also introduce challenges and feelings of loss or grief at this time. 

Staying with your medication and protocol for treatment is important, now more than ever. If you’ve got a sense that it’s less effective or that symptoms are worsening, it’s time for a call to your doctor. Let them know what’s going on: more support (even if temporary) may be really helpful, necessary, and a good source for care and encouragement at this time.


Our Gennev Community Forums may prove both useful and supportive if you’re entering perimenopause or menopause. Learn from other women about their experience and how they are taking control of their menopause. 



Gennev Staff

May 6, 2020

Medically Reviewed By

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