Pukning Pothasang : Women Mental Health

Dr. Mona Nongmeikapam *

A family friend was complaining how his wife "lost her marbles after her menopause". It is also quite common amongst family or friends to mutter not to mess with someone around "that time of the month" because they tend to be very moody.

So is this true? Do women tend to be moodier at certain phases? Is it all the "woman hormones" creating havoc? And isn't that a woman thing, why does everyone to be aware about something that is isolated to only a section of the population.

It would certainly be nice to be aware. We (and I speak on behalf of my gender) are definitely aware of lot of things starting from where your favourite socks are to what you are going to eat for your next meal and all your health concerns and what you should and should not be eating! We even anticipate what would make you happy and what might tick you off. So not trying to start off a debate here, let us look into a few mental health concerns pertaining only to women:

Pre-menstrual Syndrome (PMS):

It is a fairly common and overtly used diagnosis. PMSing is a term that has become part and parcel of the modern-day lingo. From aches and pains associated with the menstrual cycle, ache break-outs to mood-swings, PMS may also involve exacerbation of pre-existing medical conditions like migraine, asthma or depressive symptoms.

The cause would be the sudden drop in the female hormones during the menstruation period. And because PMS is a self-remitting condition, care should be taken not to over-diagnose PMS before ruling out something more serious (example, Thyroid disorders or mood disorders).

Few key points to clinch the diagnosis would be:
o Symptoms starting five days before the menstrual cycle,
o Symptoms end within four days,
o Symptoms return for at least three menstrual cycles.

Premenstrual Dysphoric Disorder (PMDD):

The symptoms of PMDD are very severe and can prevent one from routine daily activities. Some symptoms could be: Mood swings, low mood or feelings of hopelessness, anger issues, stress and irritability, decreased interest in usual activities, difficulty concentrating or tiredness, change in appetite, sleep disturbance, bodily aches and pains and hot flashes.

PMDD is diagnosed if:
o at least five of the symptoms listed above are present,
o symptoms start 7 to 10 days before the period,
o symptoms disappear shortly after the period starts.

However if the symptoms don't improve after the menstruation starts, maybe we are looking at something more serious and that needs to be thoroughly looked into.

Baby-blues or Maternity blues:

New mothers often experience mood changes in the form of irritability, tearfulness, fear even depressive symptoms in what is supposed to be the happiest times of their lives. Baby blues are reported in up to 80% new moms so we are not dealing with any rare condition. It can be called the mildest form of post-partum depression and is self-remitting.

The causes can be umpteen- the hormonal changes, the bodily aches and pains, the many demands of having a fragile precious life in your care and not knowing how to cope, add to it the many societal dos and donts and you have a ready-made cocktail for depression. We as a society can be very patient with the new mothers and offer them empathy. And when things seem slightly exaggerated, be prompt in guiding them to seek mental health support.

Post-partum depression:

The incidence ranges from 20-40% and feature classical depressive symptoms starting within 4 weeks after delivery and lasting for at least two weeks. This needs immediate medical attention and improves dramatically with anti-depressants or even supportive therapy and psycho-education. Simply put, the sadness decreases on just telling the new moms that is ok to be sad, it is common and you are not a bad mother!

Post-partum Psychosis:

It is thankfully a rarer condition occurring in one of every thousand child-births or so. Feelings of harming self, negative thoughts about the child, fearfulness and hearing or seeing strange things are classical features. This is a Psychiatric emergency needing immediate Psychiatric attention due to the risk involved to two lives at least- the mother and the little baby.

Peri-menopausal symptoms:

This is the transition phase just before or during menopause. This is tough period for the ladies with irregular menstrual periods, fluctuations in hormone levels, lack of sleep and unpleasant hot flashes. Many times there could be initiation or exacerbation of existing depressive symptoms. The likelihood of these women developing depression is supposed to be 2-4 times as high as compared to other age groups.

If so then they may need long-term treatment for their depressive symptoms in the form of pharmacological as well as non-pharmacological management. It might be just a phase that may subside in some months or progress into something more dangerous.

I can name at least 10 men who cannot tell you the name of a single medication they are on for several years without consulting the Missus. Then when she "loses her marbles", I am sure even she deserves a little empathy and attention.

Women spend their lives trying to be a good daughter, a good wife and a daughter-in-law, a good mother, so on and so forth and meet the societal norms while at the same time trying to also do what you are doing: get a education, have a career and have a life. Some amount of understanding and compassion would definitely be nice.

To leave you with a quote:
"Women are half of the society. You cannot have a revolution without women. You cannot have a democracy without women. You cannot have equality without women. You cannot have anything without women."- Nawal El Saadawi