Optimizing quality of life through sex steroids by their effects on neurotransmitters

Abstract

Menopause-related symptoms such as hot flushes, night sweats, weight gain, and decreased sexual functioning all have negative impacts on quality of life and affect daily activities such as sleep, work, and leisure activities. During the menopause transition, neurotransmitters, neuropeptides, and neurosteroids undergo important changes as a consequence of the failure of gonadal hormone production, at a time when many central nervous system activities deteriorate. Sex hormones have been implicated in neurite outgrowth, synaptogenesis, dendritic branching, myelination, and other important mechanisms of neural plasticity. Knowledge of interactions between sex steroid hormones and the dominant neurotransmitters, such as serotonin, dopamine, GABA, and glutamate, will give women and health providers an important tool for improving their health and well-being. From the concept of neurosteroids derives another treatment strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach has so far been hampered by lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by the peripheral gland or with exogenous steroids. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neurosteroids in postmenopausal women and their impact on quality of life.

Chinese abstract

更年期相关症状, 如潮热、盗汗、体重增加和性功能下降, 都会对生活质量产生负面影响, 影响睡眠、工作和休闲活动等日常活动。在绝经过渡期, 神经递质、神经肽和神经类固醇由于性腺激素分泌失败而发生重要变化, 而此时许多中枢神经系统活动恶化。性激素与轴突的生长、突触形成、树突状分支、髓鞘形成等神经可塑性的重要机制中发挥着重要的作用。了解性类固醇激素与主要神经递质(如血清素、多巴胺、GABA和谷氨酸)之间的相互作用, 将为妇女和保健人员改善其健康和福祉的重要工具。神经类固醇的概念衍生出另一种治疗策略:使用药物制剂增加神经系统内内源性神经类固醇的合成。迄今为止, 由于缺乏关于神经类固醇生物合成途径的调控及其与由外周腺或外源性类固醇产生的性类固醇的关系的知识, 这一方法一直受到阻碍。本文综述了一些现有的临床和实验结果, 支持神经类固醇在绝经后妇女中的关键作用及其对生活质量的影响。

Keywords:

• Menopause
• quality of life
• sex steroids
• neurosteroids
• dehydroepiandrosterone
• allopregnanolone
• neurotransmitters