Hormonal factors

A variety of hormonal fluctuations during a woman’s life increase the risk of mood and anxiety disorders. These disorders may occur during the fertile/reproductive years of a woman’s life, during or after pregnancy or during menopause. There is also an increased risk of mood and anxiety disorders associated with infertility.

Premenstrual dysphoric disorder (PMDD)

PMDD is a recognised mental disorder which is characterised by exacerbation of physical, cognitive and emotional symptoms in the week preceding menses with full cessation upon menstruation. The cyclical pattern of symptoms should be consistent over at least 3 menstrual cycles. Once diagnosis is confirmed, treatment would entail medication and/or an oral contraceptive to stabilise rapid and dramatic hormonal fluctuations.

Antenatal depression

There is increased awareness of depressive symptoms during pregnancy with as much as 20% of all women reporting low mood in first world countries. Women at high risk include women who are known with a mental illness who discontinued medication upon diagnosis of pregnancy.

Treatment would involve in-depth counselling about the benefits versus risks of medication during pregnancy, the risk of adverse effects on the pregnancy and on the developing fetus, as well as the risk of untreated depression on the pregnancy and developing fetus.

Treatment will also be tailored according to the trimester and gestational period. The first 12 weeks of pregnancy is a time of massive organogenesis when the basis of all organs are laid down. As such, safety of medication increases as one progresses from week 12 onward.

Postpartum depression

Despite increased awareness of this disorder, significant stigma and shame inhibit women from accessing health care. This disorder refers to the onset of depressive symptoms at any time in the 12 month period following childbirth. As much as 85% of all women experience some form of mood disturbance during pregnancy whilst 10-15% of these will meet criteria for diagnosis of a major depressive disorder or manic episode with postpartum onset.

Treatment will again involve in-depth counselling on the risks and benefits of medication during breastfeeding and the need for support and help during the first year of a baby’s life.

Treatment also includes counselling of both parents to increase awareness of the symptoms and facilitate increased family support whilst reducing shame and addressing stigma.

Psychotherapy for the mom is also impactful on prognosis.

Menopause and mental disorders

Menopause is a period of tremendous hormonal and physical changes in a woman’s life. The physical symptoms such as hot flushes and the emotional symptoms of irritability and tearfulness are by themselves experienced as disruptive and distressing. Some women may experience symptom relief with the addition of an antidepressant or anti-anxiety medication.

Fertility and mental disorders

Due to a variety of factors in the last 10-15 years, including delayed age of pregnancy, there is a sub-group of women who develop depressive and/or anxiety symptoms at prolonged time to conceive or infertility.

Medication, psychotherapy and lifestyle changes such as meditation and exercise may improve mental well-being and positively impact on the possibility of conceiving.