Author: Alex Lukey (@AlexandraLukey) - Registered Nurse, Master of Science in Nursing (UBC) and Women's Health Blog Co-Coordinator | Editor: Arrthy Thayaparan, Women's Health Blog Co-Coordinator
Published: December 14th, 2020
This past year has been a time of unprecedented change and constant adjustments. For the Women’s Health Research Cluster (WHRC) a lot of our work has shifted online to better serve our cluster members. In particular, the WHRC’s annual women’s health conference went from a single-day event to a series of 10 monthly sessions.
Originally meant to be held in May 2020, this year’s conference focused on women’s brain health. The purpose of the conference was to highlight how women have unique health needs and are more susceptible to specific brain diseases. The fourth session of the Women’s Brain Health Virtual Conference Series was held on December 4th and welcomed experts to discuss the intersection between women’s health and mental health. A variety of ideas were considered during the session, which our blog coordinator, Alex Lukey, has summarized for our esteemed readers:
Dr. Shau-Ming Wei, NIH/NIMH
Mood disorders during Reproductive Transitions: Circuit and Cellular Substrates of Risk
Many women experience Pre-Menstrual Syndrom (PMS) but for some women, the mood shifts can be so severe that they damage work and family relationships. When this happens what they may be experiencing is known as Premenstrual Dysphoria Disorder (PMDD); a far more severe form of PMS.
Dr. Wei presented research that shows that there may be differences at both the brain and cellular response to hormones in women with PMDD. This early research is exciting because it is evidence that the extreme psychological symptoms that some women experience have a biological basis. This also means that PMDD may be treatable.
The research showed that there were differences in blood flow to an area of the brain (subgenual cingulate) indicated in major depression disorder when exposed to high levels of estrogen and progesterone compared to women without PMDD. This means that the brains of women with PMDD respond differently to the normal fluctuations of hormones than women without PMDD. Early evidence from Dr. Wei also showed that when estrogen was suppressed in women with PMDD that there was as much as a 70% reduction in symptoms.
To treat a disorder we must first understand the biological reasons for the illness. That's why this research is critical for us to better understand how to treat women with PMDD.
Dr. Cindy Lee Dennis, University of Toronto
Mental Health across the Perinatal Period starting Preconception
Perinatal mental health pertains to the period of time immediately before and after mother’s give birth. Research in this area is still in it’s early stages of conception - having only been addressed in the last 30 years. Dr. Dennis presented research that is critical to the effective treatment of perinatal anxiety and depression.
Due to public health efforts, there is an increased awareness of post-natal depression, commonly known as "baby blues." What is less known is that depression and anxiety often start during pregnancy and can last several years after if not treated. According to Dr Dennis, at least a ⅓ of women had symptoms DURING and another ⅓ before pregnancy. Further one of the strongest risk factors for perinatal depression is a previous major depressive episode. Yet, screening and interventions are usually not completed until after the baby is born. Dr. Dennis advocated that screening and interventions must be aimed much earlier for better outcomes.
Anxiety is also not commonly addressed in women both during and after pregnancy. About 1/4 of women reported a major anxiety episode into their pregnancy. There were factors that reduced anxiety and depression according to Dr Davis. Two factors which reduced anxiety and depression in women were partner support and self-efficacy in breastfeeding. Both of these factors can be targeted for intervention.
Partner support is an important component to focus on as well because men also experience increased anxiety and depression. Dr. Dennis highlighted the importance of studying the effects and experiences of men with anxiety and depression during the perinatal period. Risk factors for paternal perinatal mental health issues varied from emotional abuse, financial instability, paternal ADHD, and obesity. Yet there is much less research and support for partners of women.
The main take-away message from this conversation? Perinatal mental health is not exclusive to mothers, but is a family affair. Thus, the imporatance to initiate interventions before pregnancy becomes even more vital. It really is never too early to address perinatal mental health. Especially considering that the first contact with antenatal care is usually too late to target major risk factors.
Dr. Benicio Frey, McMaster University
Mood Disorders and Reproductive Live Events: Translating Research into Clinical Practice
Dr. Frey started his talk with three clear objectives for the audience to understand:
- There are major links between mood disorders getting worse and premenstrual, postpartum and menopausal disorders
- The link between mood and premenstrual disorders is associated with worse clinical outcomes. In extreme cases even increased suicide rates
- Hormonal treatments may be one option to help improve symptoms and clinical outcomes
What do these conclusions mean? For women with serious mood disorders such as bipolar disorder, major hormonal changes such as pregnancy are risky. This could mean a relapse or worsening of their condition. Research also shows that with treatment this risk is significantly reduced. Unfortunately, according to Dr. Frey, hormonal changes as a risk factor for psychiatric emergencies is not widely taught to mental health professionals.
Dr Frey also discussed the connection between PMDD (Prementrual Dysphoric Disorder) and bipolar disorder. A staggaring meta-analysis of 32 papers showed a 26% increase in suicide deaths at menstruation. This is further evidence that the effects of hormones are serious for women with mood disorders.
Dr Liisa Galea asked a follow up question for the women in the audience: What should a woman do if she thinks that she might have PMDD? Dr Frey suggested that women track their symptoms for two cycles using either an app or paper tracker. It is much harder for healthcare providers to dismiss symptoms when presented with a numerical measurement.
Alex’s main takeaways:
The talks although different in focus and topic had a clear message: We have a lot of work to do to understand the causes of mental health challenges in women. The hopeful message is that there are biological mechanisms specific to women that treatments can be aimed at. The talks by Dr Wei, Dr Dennis and Dr Frey are evidence of the immense progress being made in this field. Hopefully in the years to come, these essential conversations will bring to fruition results that will drive change in our understanding and treatment of women’s mental health.