Professor John Studd, DSc,MD,FRCOG was Consultant Gynaecologist at the
Chelsea & Westminster Hospital, London and also Professor of Gynaecology at
Imperial College. He qualified in 1962 and has worked and trained in
Birmingham. Zimbabwe and London. He was Consultant Gynaecologist in Salisbury,
Rhodesia and Consultant and Senior Lecturer at the University of Nottingham.
His early research was on chronic renal disease and high blood pressure in
pregnancy (MD thesis) but later started the first menopause clinic in Europe in
Birmingham in 1969. This hormone treatment for the menopause was so
controversial at that time that the clinic was closed down for three months
following protests from the BMA. However, the optimism placed in HRT has been
confirmed and John Studd has continued to work on specific treatments for
menopausal symptoms. He pioneered the sequential oestrogen/progestogen
treatment and also the continuous combined oestrogen/progestogen non-bleeding
treatment. He has championed the use of hormone implants for women with
osteoporosis or with severe depressive or sexual problems after the menopause
and as an almost routine route of HRT after hysterectomy. He first described
the use of oestrogen patches and oestrogen implants for the treatment of severe
PMS. He is also shows the efficacy of moderately high dose transdermal
oestrogens for the treatment of hormone responsive depression in women,
particularly post-natal depression, pre-menstrual depression, menopausal
depression and post-hysterectomy depression. He has a D.Sc. for 25 years of
published work on oestrogen therapy in women. He has written more than 500
scientific articles and written or edited more than 25 post-graduate books on
gynaecology. He needs to write one for the public, but that is much more
challenging. He is Founder and Vice-President of the Royal Osteoporosis Society
and has been a Council Member of the Royal College of Obstetricians and
Gynaecologists for 20 years and a Past-President of the Section of Obstetrics
and Gynaecology at the Royal Society of Medicine. In 2005-2007 Professor Studd
was Chairman of the British Menopause Society. He is now in fulltime private
practice and runs the London PMS & Menopause Clinic at 46 Wimpole Street
London W1G8SD. At the same address he has The Osteoporosis Screening Centre for
the assessment and treatment of osteoporosis. In 2008 he was awarded the Blair
Bell Gold Medal of the Royal Society of Medicine which is given every five
years for the obstetrician/gynaecologist who has made the greatest lifetime
contribution to the specialty
The effect of hormones on depression in
women is recognised by most gynaecologists but it is neglected by
psychiatrists. This leads to a greater use of antidepressants or
antipsychotic therapy often of doubtful benefit.
The concept of ‘Reproductive
Depression’ is associated with depression occurring with changes in
ovarian hormones. This is most obvious in menopausal depression, PMT and
PMDD and becomes more troublesome with age. Another example is post-natal
depression which has been shown to improve considerably with oestrogens
compared with a placebo.Later in life this is followed by menopausal depression
which is more severe for the two or three years preceding the cessation of
periods within the years called the ‘menopausal transition’. We thus have
three peaks of depression in women, PMS, postnatal depression and menopausal
depression which often occurs in the same woman throughout her reproductive
life. There are other important aspects of history to consider such as
these women are often well with no depression during pregnancy but develop
postnatal depression. hey are usually well with prolonged breast feeding, and
the postnatal depression now often cyclical only occurs when the breast feeding
stops and when ovulation and the cycles reoccurs. The first challenge is
to recognise the hormonal component of depression by the history and not be
blood tests which are irrelevant .
Treatment consists of transdermal
oestrogens by patch or by gel often with the addition of testosterone.
The ideal dosage would be Oestrogel, three to four measures daily and
testosterone gel in the form of Testogel making one sachet/tube last for a
week. In women with a uterus they should have cyclical progesterone such
as a natural progesterone, Utrogestan 100mgs for the first seven to twelve days
of every calendar month. It should be stressed that these patients
particularly those with PMS are often progesterone intolerant and a short
course of seven day is usually prescribed rather than the more orthodox twelve
days. Ultimately these women may choose to have a hysterectomy and
bilateral oophorectomy with replacement oestradiol and testosterone which
invariably cures premenstrual depression and other aspects of Reproductive
Depression.