Objective: Oestrogen withdrawal has been hypothesized as playing a causal role in puerperal psychoses. However, oestrogen withdrawal exists in conditions others than puerperium. We searched the published case reports where a decrease in oestrogen levels not occurring during puerperium was associated with a psychotic disorder, in order to evaluate the relevance of this hypothesis. These cases were defined as oestrogen withdrawal associated psychoses.
Method: A systematic research of the literature was conducted for the period 1960-2000.
Results: We identified 26 observations reporting an association between a psychotic disorder and a phase of oestrogen withdrawal. Psychotic episodes were short and reversible with recurrences reported when oestrogen withdrawal recurred. Puerperal psychosis was frequently reported in the history of patients.
Conclusion: The oestrogen withdrawal hypothesis can be extended to certain psychotic episodes not occurring during in puerperium. This provides an additional argument for the clinical relevance of oestrogen withdrawal in puerperal and related psychoses.