by EK Wills
Women experience mental health issues with much higher rates of depression and seasonal affective disorder (4-6 times more than men) and they can have co-existing anxiety or panic disorders as well as eating disorders.
Depression in women is often longer, with more physical symptoms and more atypical symptoms such as eating and sleeping too much in winter, weight gain, and physical symptoms of migraines and chronic fatigue syndrome.
Eating disorders occur mostly in women and regularly have comorbid depression.
Bipolar Disorder, with extreme up and down moods, appears more as the down phase for women and is more changeable, more quickly.
Stages of Life:
Different stages of a woman’s life highlight specific issues to these times.
Adolescence:
Depression appears twice as often in girls as boys in adolescence. Changes during this phase appear to predispose women to depression.
Para-menstral:
We all know the infamous “PMS” with minor mood changes, breast tenderness, bloating and headache. There is another classification called PMDD (pre-menstral dysphoric disorder) with more severe symptoms of irritability, dysphoria, tension and mood changeability around this phase of the cycle.
In some cases, pre-menstral exacerbations occur, especially in bipolar disorder.
Many report migraine, epilepsy, asthma and IBS linked to para-menstral phase of the cycle.
Menstral psychosis is when transient psychotic symptoms appear in sync with the menstrual cycle but is, thankfully, pretty rare. This can involve confusion, delusions, hallucinations, stupor and mutism or manic syndrome.
Pregnancy:
There are high rates of disabling depression and adverse bipolar outcomes around this period.
At the time of pregnancy, anxiety disorders can start such as OCD initial episodes and these disorders can co-exist with others such as depression.
Postpartum:
There are higher rates of mood disorders at this time than any other in a woman’s life (baby blues, post natal depression, psychosis). Often symptoms of exhaustion, hopelessness, guilt, fear and sadness can precipitate or contribute to mental illness after the birth of a child.
Menopause:
The peri-menopause transition can be associated with depression and there are high rates of mood disorder at this time. Symptoms can emerge such as sleep disturbance, changed libido, flushes, cycle irregularity, pain during sex.
There are a range of theories as to the burden of mental health issues for women and include psychosocial, biological, and brain-gut impacts.
Both estrogen and progesterone can affect mood and behaviour:
Part of the biological theory involves hormones and the impact of cyclical changes as well as stages of life.
Progesterone has been shown to have anxiolyic (calming) effects. When progesterone is high, just like when pregnant, it has a calming effect.
Estrogen is thought to be responsible for sex-specific differences in cognition, memory and learning. Very simply and generally, studies show improved memory, learning ability and cognition at times of high estrogen.
Treatment options:
There are a range of contraception options from the pill to an intrauterine device (IUD) such as the Mirena or an implant such as Implanon.
Ongoing research into women’s health, particularly with an endocrinological approach at Women’s Health & Research Institute of Australia, provide options such as natural progesterone. This is reported to have a lower impact on mood than synthetic progesterone and can be orally ingested or in a topical form. There are contraceptive pills researched to show a more tolerated side effect profile such as Zoely.
Estrogen replacement therapy has been shown to be helpful in the perimenopause period and reduces the risk of osteoporosis. There are estrogen patches and tablets, as well as using other medications options such as antidepressants, blood pressure medication, as well as neuronal agents such as gabapentin that can address hormonal migraines, pain, hot flushes and mood. These all need to be discussed and monitored by qualified medical practitioners with an interest in this field.
There are lifestyle modifications such as addressing caffeine, alcohol and sugar intake. Exercise has multiple benefits including improvement in mood. Calming activities such as meditation and yoga have their place and psychological approaches can be tailored to individual requirements.
Importantly, these issues need to be raised, discussed and addressed rather than minimized by the community.
Conclusion
Women experience mental health issues which can be minimized or poorly understood. While there are multifactorial potential causes, an holistic approach is required.
There are a range of treatment options that need to be recognized and communicated to women and professionals.
Awareness of these conditions, influences and options will help to identify them in order to treat them.
