WOMEN AND MENTAL

HEALTH

MERIN SOLOMON
VIJAYA COLLEGE OF NURSING

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 INTRODUCTION

Many women experience changes in their bo

dies or mood before their menstrual flow begin
s. However, if a woman has moderate or severe
symptoms that make it hard for her to function,
she may have premenstrual syndrome (PMS) or
a more severe condition, premenstrual dysphori
c disorder (PMDD
PROBLEMS RELATED TO MENSTRUATION

1. MENARCHE
Menarche is the first menstruation that occurs at puberty. The m
ajority of girls (95%) reach menarche between 11 and 15 years o
f age, the average being about 13 years. The onset of menarche i
s considered as a girl attaining maturity. It is understood that wit
h attaining of menarche, girls psychological, social and cultural
maturity takes place, thus preparing them for the roles and respo
nsibilities of women hood. Symptoms of menarche are mood sw
ings, irritability, feeling tense and sad, feeling bloated due to wat
er retention in the body, slight headache, backache and lower ab
domen pain.
2. PREMENSTRUAL SYNDROME
A constellation of mood, behavioral, and/or physical sy
mptoms that have a regular cyclical relationship to the l
uteal phase of the menstrual cycle, are present in most i
f not all cycles, and remit by the end of the menstrual fl
ow with a symptom-free interval of at least one week e
ach cycle.”2 The essential characteristic of PMS is the t
iming of the symptoms, with the severity occurring pre
menstrually and a symptom-free interval after menses.
• Prevalence
Surveys indicate that PMS is among the most c
ommon health problems reported by women of
reproductive age, and up to 40% of menstruati
ng women experience some difficulty with the
symptoms.
 Etio log y

• Biochemical factors
• Genetic factors
Symptoms
Cognitive
• Loss of interest
• Indecision
• Difficulty concentrating
• Memory impairment
• Obsessional thinking
• Confusion
• Feel unreal, like in a dream
• Poor judgment
Mood
• Mood swings
• Anxiety
• Depression
• Cannot cope
• Feel insecure
• Suicidal thoughts
• Guilty thoughts
Predominant symptoms of PMS

Mood Behavioural Physical

Irritability Sleep disturbances Swelling

Mood swings Appetite changes Breast tenderness

Anxiety/tension Poor concentration Aches

Depression Decreased interest Headache

Feeling out of control Social withdrawal Bloating/weight gain

• Diagnosis
Premenstrual syndromes are diagnosed on the basis of the timin
g of the symptoms, which cross emotional, behavioral, and
mood domains. For a diagnosis of PMS, the symptoms must oc
cur during the 2 weeks before menses and subside during the m
enstrual flow. With remission of the symptoms, a symptom-free
period occurs in the follicular phase between menses and ovulat
ion. Clinically significant PMS is determined by the patient's se
eking treatment and/or report of impaired functioning in relatio
nships, work, or other activities. There are no hormonal measur
es, other laboratory tests, or physiologic measures that identify
PMS.
 Treatment
• Nutritional Supplements
• Health Behaviours
• Pharmacologic treatments
3. PREMENSTRUAL DYSPHORIC DISORDER

• Premenstrual Dysphoric Disorder (PMDD) is a

condition in which a woman has severe depres
sion symptoms, irritability, and tension before
menstruation
Etiology
The exact causes are still not fully understood but some p
ossible factors are:
• Being very sensitive to changes in hormone levels.
Genetics.
Some research suggests that this increased sensitivity to
changes in hormone levels may be caused by genetic vari
ations. Some other research has shown that in some cases
PMDD may be linked to stressful and traumatic past eve
nts (such as emotional or physical abuse
Symptoms
• Markedly depressed mood or feelings of hopelessness
• Marked anxiety or tension, feeling keyed up or on edge
• Marked shifts in mood (suddenly tearful, overly sensitive)
• Persistent, marked anger or irritability, increased conflicts
• Loss of interest in usual activities (e.g., work, hobbies)
• Difficulty concentrating and focusing attention
• Marked lack of energy, feeling very easily tired out
• Marked change in appetite, overeating, or food cravings
• Sleeping too much or having a hard time sleeping
• Feeling overwhelmed or out of control
• Physical symptoms (e.g., breast tenderness/swelling, headache, joint/muscl
epain, “bloated” sensation, weight gain).
DIAGNOSTIC CRITERIA ACCORDING TO DSM-5

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of mense
s, start to improve within a few days after the onset of , and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present: Mood swings, Marked irritability or anger or increased inte
rpersonal conflicts, Marked depressed mood, Marked anxiety
C. One (or more) of the following symptoms must additionally be present:
• Difficulty in concentration
• Easy fatigability
• Change in appetite
• Sleep Disturbance
• overwhelmed or out of control
• Physical symptoms
• Criteria A-C Most Menstrual Cycles Preceding year
D. Clinically significant distress or interference work schoolrelationships Social Activities
E. The disturbance is not merely an exacerbation of the symptoms of another disorder.
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.
G. The symptoms are not attributable to the physiological effects of substance or another medical condition.
Treatments
Antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs change serotonin level
s in the brain. The Food and Drug Administration (FDA) approved three SSRIs to treat PMDD:4
• Sertraline
• Fluoxetine
• Paroxetine HCI
• Birth control pills. The FDA has approved a birth control pill containing drospirenone (droh-SPIR-u
h-nohn) and ethinyl estradiol (ETH-uh-nil es-truh-DEYE-ohl), to treat PMDD.
• Over-the-counter pain relievers may help relieve physical symptoms, such as cramps, joint pain, h
eadaches, backaches, and breast tenderness. These include:
• Ibuprofen
• Naproxen
• Aspirin
• Stress management, such as relaxation techniques and spending time on activities that enjoy
• Making healthy changes, such as eating a healthy combination of foods across the food groups, c
utting back on salty and sugary foods, and getting more physical activity, may also help relieve so
me PMDD symptoms.