Special Considerations for Women’s Mental Health

“Many marriages break up over hormonal imbalance, which is truly sad because it comes from a lack of understanding. When hormones are put back in balance… a woman or man resumes their normal life of feeling good and having days filled with quality.”

Suzanne Somers

I’ll never forget that painful hour I spent listening to a guest lecture in my third-year developmental psychology class. We were listening to a renowned psychiatrist discuss current breakthroughs in treatments for bipolar disorder. It was then that he began to talk about The Pill.

“Remarkably, we’ve found that in women with bipolar disorder, the birth control pill tends to be an efficacious treatment, and often outcompetes standard treatment.” Okay, you have my attention, I thought. “But we have no real idea why it works. The data aren’t clear.”

I remember holding back a gasp, thinking obviously, it has something to do with the cyclical nature of the hormonal cycle. How couldn’t he see that? Instead of interrupting the lecture, I put my hand on my chin and furrowed my brows in an academic, please tell me more, dear professor, kind of way.

Fast-forward to 2020, and research on issues specific to women’s mental health begins to emerge and gain traction. Now, we have the scientific stamp of approval, if you will, to begin to make (what should have been) very clear associations between hormones and mental health.

“When the hormones that affect your brain (neurohormones) are off, you are off. Many of the symptoms associated with hormonal imbalances are similar to those seen in brain health/mental health issues…like anxiety, depression, and even psychosis.”

– Dr. Daniel Amen, The End of Mental Illness

Both women and men are susceptible to hormonal conditions that can have massive ramifications on their mental health. But due to the constant cyclical shift of a woman’s hormones, they deal with frequent and sometimes incapacitating fluctuations in their mental health. Research also shows that some women are more sensitive to changes in their own hormones, and have a stronger biological response to small oscillations throughout the month. A woman who is particularly sensitive to hormonal changes can experience a disorder known as Premenstrual dysmorphic disorder (PMDD), which can mimic bipolar disorder.

All women experience natural shifts in hormones (and consequential shifts in mood) throughout their cycle. Women normally feel their best in the first half of their menstrual cycle (from their period until ovulation), and begin to feel a dip in mood and energy from ovulation until the completion of the luteal phase. A sassy infographic by Dr. Jordan Robertson captures this best:

PMDD goes beyond those typical rises and falls in mood, and manifests as a sharp dip in mood two weeks prior to a woman’s period. Affected women often complain of predictable changes in their mood, oscillating from “normal” to elevated mood in the first two weeks of their cycle (from menstruation to ovulation), to extreme irritability, crippling fatigue, depression, inter alia in the last two weeks of their cycle (from ovulation through the luteal phase). This hormonal disorder parades as a mood disorder, affecting 3-8% of women of reproductive age.

Unfortunately, when these women go to their primary physician to seek treatment, they are often misdiagnosed as having anxiety, depression, or bipolar disorder. These women are then given gold-standard treatments like serotonin reuptake inhibitors (SSRIs), treating the symptom of the disorder and not the actual cause.

It’s like putting a bucket under a leak, and thinking you’ve fixed the roof.

The impairment and lowered quality of life for PMDD is similar to that of dysthymic disorder and is not much lower than major depressive disorder. Nevertheless, PMS/PMDD is still under-recognized in large published epidemiological studies, as well as assessments of burden of disease. It is demonstrated here that the burden of PMS/PMDD as well as the disability adjusted life years (DALY) lost due to this repeated-cyclic disorder is in the same magnitude as major recognized disorders.

Halbreich et al., 2003

For women with PMDD, two weeks each month is riddled with instability in their internal environment. A little quick math unveils a startling fact: PMDD impacts half of a woman’s life during her reproductive years. And what if these women are given the wrong diagnosis, and the wrong treatment, like being told they have bipolar disorder? Well, they can spend their entire lives battling something that they never had to fight.

Let’s look at what we can do to support women’s mental health—because ultimately, the quality of women’s mental health determines the quality of their entire life.

What are the implications of this relatively little-studied area?

  1. “Really bad PMS” is NOT okay! And you don’t have to live with it.
  2. Women need to be educated on how their mental health is affected by their hormones, and learn how to optimize their hormonal health.
  3. Women complaining of psychological issues need a full hormonal workup prior to any psychiatric diagnosis.
  4. Men need to be educated on women’s mental health and hormonal health.
  5. Partners of women with predictable changes in mood need to encourage and support them in seeking care.

Have you experienced “really bad PMS”, or do you know someone who has? Let us know in the comments below!

And don’t forget to share this article with your friends—let’s help as many women as possible.

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