title: The role of estrogen in bipolar disorder, a review.
abstract: BACKGROUND
  It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex hormones, e.g. estrogen, are fluctuating and particularly postpartum there is a steep fall in the levels of serum estrogen. The role of estrogen in women with bipolar disorder is, however, not fully understood.
  
  
  OBJECTIVE
  The main objective of this review is to evaluate the possible relation between serum estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen.
  
  
  METHODS
  A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen.
  
  
  RESULTS
  Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four tamoxifen studies found that tamoxifen was effective in producing antimanic effects.
  
  
  CONCLUSIONS
  These results indicate that estrogen fluctuations may be an important factor in the etiology of bipolar disorder and it is obvious that more research on this topic is needed to clarify the role of estrogen in women with bipolar disorder.
authors.affiliation: Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen , Blegdamsvej 9, DK-2100 Copenhagen , Denmark.
authors.forename: Ninja
authors.initials: N
authors.lastname: Meinhard
authors.forename: Lars Vedel
authors.initials: LV
authors.lastname: Kessing
authors.forename: Maj
authors.initials: M
authors.lastname: Vinberg
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000523:psychology; D004967:Estrogens / Q000502:physiology*; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011644:Puerperal Disorders; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D004967:Estrogens; D013629:Tamoxifen