“Hormonal” Emotional Conditions
PMS
Premenstrual syndrome is a general term most people apply to any physical and emotional change that occurs before the start of a menstrual period. Physical symptoms can range from mild to debilitating (i.e. severe cramps which cause the woman to remain bedridden). Emotional symptoms are usually what lead a woman to seek psychiatric treatment. When emotional symptoms cause functional impairment the condition is usually classified as PMDD (premenstrual dysphoric disorder).
The key is that it is a change from a woman’s usual behavior the rest of the month. Symptoms can begin anywhere from one to a few days before bleeding with resolution as soon as the period starts, or in more extreme cases the symptoms can start at the time of ovulation (about half way through the month) and persist until after bleeding stops so that symptoms are present three weeks out of every month. PMS often starts in a woman’s 30’s or after having a baby and usually intensifies as she gets older until she goes through menopause.
PPD (Postpartum Depression)
Similar in many ways to major depression, PPD occurs after the birth of a baby. Onset is often within a few weeks to months of delivery, but it can also occur much later, especially at the time of weaning from breastfeeding. Some women develop depression during pregnancy, which continues postpartum. Anxiety is a common component and often focused on the baby (worry about the baby’s health and/or safety as well as a fear of unintentionally harming the baby). Physical symptoms may be difficult to tease apart from the common experiences of new mothers—lack of sleep, fatigue, and poor concentration—but in a PPD these are also accompanied by other changes such as sadness with tearfulness yet a feeling of guilt for being depressed when she “should” be happy. As a result she can feel like a bad/inadequate mother. Inability to cope and feeling overwhelmed is common. Suicidal thoughts may be present and signal a need for help to prevent thoughts from becoming actions. Infrequently, new mothers may have thoughts of harming the baby, and this should be addressed immediately to get the woman help before a tragedy occurs.
Infertility
When attempts to become pregnant are not successful, a woman can experience many distressing emotions—sadness, disappointment, guilt, anger, fear, grief, etc. If artificial reproductive techniques are used, the procedures themselves can cause distress from the physical discomfort, cost, inconvenience with disruption of normal life activities, lack of spontaneity and fun as what “should” be a pleasure becomes a burden and a chore. The hormones prescribed can often cause significant emotional reactions that can be out of character for the woman or at the least can intensify her normal emotions.
Menopause
Menopause occurs one year after a woman experiences her final menstrual period. The time leading up to that is termed perimenopause and is the time during which most of the emotional challenges occur. Hormonal fluctuations can lead to fluctuations in emotions. If a woman has ever experienced a previous depressive episode, she is at increased risk for development of depression at this time of her life also.Besides the physical changes associated with decreasing hormonal level (i.e. night sweats, hot flushes, vaginal dryness, skin changes, etc.), memory problems become noticeable for some women. In addition to the emotional adjustment of growing older and no longer having the potential to bear children, other issues arise at this time of life as well. The empty nest can bring sadness and/or joy and calls for a re-evaluation of the marital relationship, if present. Aging parents often require extra care with the beginning of a role reversal. Careers take on a new significance as a woman may re-enter the workforce or change an existing career, while other women may begin contemplating retirement. One’s own mortality is more apparent as friends begin to die at a relatively early age. Changes are numerous at this phase of life.
Premenstrual syndrome is a general term most people apply to any physical and emotional change that occurs before the start of a menstrual period. Physical symptoms can range from mild to debilitating (i.e. severe cramps which cause the woman to remain bedridden). Emotional symptoms are usually what lead a woman to seek psychiatric treatment. When emotional symptoms cause functional impairment the condition is usually classified as PMDD (premenstrual dysphoric disorder).
- Mood can be irritable/angry, sad, anxious or quick to change
- Thinking can be irrational at times
- Behavior can range from withdrawn to overtly aggressive
The key is that it is a change from a woman’s usual behavior the rest of the month. Symptoms can begin anywhere from one to a few days before bleeding with resolution as soon as the period starts, or in more extreme cases the symptoms can start at the time of ovulation (about half way through the month) and persist until after bleeding stops so that symptoms are present three weeks out of every month. PMS often starts in a woman’s 30’s or after having a baby and usually intensifies as she gets older until she goes through menopause.
PPD (Postpartum Depression)
Similar in many ways to major depression, PPD occurs after the birth of a baby. Onset is often within a few weeks to months of delivery, but it can also occur much later, especially at the time of weaning from breastfeeding. Some women develop depression during pregnancy, which continues postpartum. Anxiety is a common component and often focused on the baby (worry about the baby’s health and/or safety as well as a fear of unintentionally harming the baby). Physical symptoms may be difficult to tease apart from the common experiences of new mothers—lack of sleep, fatigue, and poor concentration—but in a PPD these are also accompanied by other changes such as sadness with tearfulness yet a feeling of guilt for being depressed when she “should” be happy. As a result she can feel like a bad/inadequate mother. Inability to cope and feeling overwhelmed is common. Suicidal thoughts may be present and signal a need for help to prevent thoughts from becoming actions. Infrequently, new mothers may have thoughts of harming the baby, and this should be addressed immediately to get the woman help before a tragedy occurs.
Infertility
When attempts to become pregnant are not successful, a woman can experience many distressing emotions—sadness, disappointment, guilt, anger, fear, grief, etc. If artificial reproductive techniques are used, the procedures themselves can cause distress from the physical discomfort, cost, inconvenience with disruption of normal life activities, lack of spontaneity and fun as what “should” be a pleasure becomes a burden and a chore. The hormones prescribed can often cause significant emotional reactions that can be out of character for the woman or at the least can intensify her normal emotions.
Menopause
Menopause occurs one year after a woman experiences her final menstrual period. The time leading up to that is termed perimenopause and is the time during which most of the emotional challenges occur. Hormonal fluctuations can lead to fluctuations in emotions. If a woman has ever experienced a previous depressive episode, she is at increased risk for development of depression at this time of her life also.Besides the physical changes associated with decreasing hormonal level (i.e. night sweats, hot flushes, vaginal dryness, skin changes, etc.), memory problems become noticeable for some women. In addition to the emotional adjustment of growing older and no longer having the potential to bear children, other issues arise at this time of life as well. The empty nest can bring sadness and/or joy and calls for a re-evaluation of the marital relationship, if present. Aging parents often require extra care with the beginning of a role reversal. Careers take on a new significance as a woman may re-enter the workforce or change an existing career, while other women may begin contemplating retirement. One’s own mortality is more apparent as friends begin to die at a relatively early age. Changes are numerous at this phase of life.
Treatment for “Hormonal” Emotional Conditions
Treatment for PMS
Goal — Prevent the majority of symptoms with medications when possible or manage symptoms to minimize their impact when medication is not used or is not completely effective.
Steps
Treatment for Postpartum Depression
Goal — Restore normal mood and functioning to allow the mother to return to full health and give the baby the best possible environment for developing.
Steps
Treatment for Infertility
Goal — Minimize the stress of the infertility and its treatment.
Steps
Treatment for Menopause
Goal — Minimize physical and emotional disruptions to life and help with the adjustment to a new phase of living.
Steps
Goal — Prevent the majority of symptoms with medications when possible or manage symptoms to minimize their impact when medication is not used or is not completely effective.
Steps
- Determine if it is “PMS” or rather premenstrual worsening of another underlying condition. Tracking symptoms as they occur can help clarify this if it is not clear initially.
- Minimize factors that can worsen the condition—certain foods (sweets, salty foods, “junk” food in general), caffeine, alcohol, and illicit drugs.
- Add exercise, especially premenstrually, as it changes internal body chemistry and helps alleviate the effects of stress.
- Teach stress management skills to diminish the impact of stress throughout the entire month but especially premenstrually.
- Consider medications—SSRI’s (known most commonly as antidepressants) can be used throughout the entire month or just when PMS symptoms occur because they work by a different mechanism of action when treating PMS than when treating depression and do not require time to build up to become effective. Antianxiety medications can be helpful but are generally used with caution, if at all, because they can become addictive. Birth control pills are generally effective for physical symptoms but less so for emotional ones, and in some cases can worsen the emotional aspect of the condition.
- Vitamins, minerals, other supplements, although frequently recommended, have less data proving their usefulness. These are evaluated on a case-by-case basis.
- Education about the condition is paramount so a woman can know what to expect and how to control and even prevent symptoms on her own.
Treatment for Postpartum Depression
Goal — Restore normal mood and functioning to allow the mother to return to full health and give the baby the best possible environment for developing.
Steps
- Calm down acute symptoms with antidepressant medications if indicated. This can be done with caution while breastfeeding if symptoms are serious enough.
- Evaluate breastfeeding status and if rapid weaning is planned, do it through the” pump and dump” method to avoid exacerbating depressive symptoms.
- Assess menstrual status as many cases of PPD begin just before return of the first postpartum menstrual cycle.
- Mobilize resources from the environment—spouse, family, outside help if possible.
- Teach skills for dealing with the stressors brought on by a new baby.
- Maximize conservative means of improving depression—good diet, exercise, adequate sleep, and socialization.
- After stabilization, discuss long-term treatment. Medications can often be discontinued after sufficient time.
Treatment for Infertility
Goal — Minimize the stress of the infertility and its treatment.
Steps
- Assess the severity and causes of the distress (i.e. hormonal, environmental, relationship strain, normal emotions, etc.)
- Explore the emotions and develop methods to effectively deal with them.
- Teach coping skills (ways to change thought and behavior patterns) for dealing with the external stressors involved.
- Focus on ways to maximize self-care.
- Determine if medications are needed to counter-balance the negative impact of the infertility treatment and coordinate with gynecologist to use safe options if a medication route is chosen.
- Teach ways to deal with other family members, friends and acquaintances when they say or do inadvertently hurtful things.
- Teach pacing techniques and help the woman determine if/when to take a temporary break from treatment or terminate attempts to conceive.
- Identify other options—surrogacy, adoption, no children (or additional children), postpone the decision, and then develop a plan for the chosen route.
Treatment for Menopause
Goal — Minimize physical and emotional disruptions to life and help with the adjustment to a new phase of living.
Steps
- Assess the presence and intensity of physical and emotional symptoms and attempt to tease apart the causes (i.e. hormonal, “brain chemistry”, environmental, interpersonal issues).
- Coordinate with gynecologist on hormone replacement therapy—is it indicated or not, timing, preparation/form/dose to be used.
- Determine the need for an antidepressant (SSRI) to treat anxiety and/or depression symptoms as well as vasomotor symptoms (hot flushes, night sweats).
- Initiate conservative measures—diet, exercise, good sleep, fish oil.
- Explore and deal with any psycho-social issues that may be present.