Why PMS, PMDD and hormone-related mental health is a serious clinical and scientific problem
It may be easy to overlook PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder) as just buzzwords or convenient labels. They stand, however, alongside a spectrum of hormone-induced mental health conditions, such as gestational depression, postpartum depression, and menopause-induced anxiety, to name a few. In my journey over the past two years to enhance treatment avenues for those grappling with these conditions, I am lucky and perplexed by some of the insights I have come across, which highlight the misunderstanding of these issues among clinicians and scientists alike.
First and foremost, let’s set the record straight: PMS, PMDD, and other hormone-induced mental health conditions are real. Their clinical codes are GA34.4, GA34.4Y and GA34.4Z for PMS and F32.81 (ICD-10) or GA34.41 (ICD-11) for PMDD, respectively. It’s disheartening, if not downright alarming, that numerous doctors (while often not gynaecological or psychiatric specialists) remain oblivious to the fact that these are bona fide, diagnosable conditions. This type of ignorance isn’t just academic or performative; it has tangible repercussions on the lives of countless individuals, whose experiences are dismissed every day.
As a neuroscientist working on these conditions, I found that the most effective way to draw people’s attention to the impact PMS and PMDD have on our mental health is by showing them scans of premenstrual vs follicular brains of women. This visualisation of how drastic the changes in brain activity are, and how similar those changes are to brain scans of depressed patients, has been a surefire way to discuss the condition being ‘real’. However, there are actually very few scans showing how brain activity changes across the menstrual cycle, and even less so — how that is impacted by age, health practices, previous pregnancies and the like. Given this, there is tremendous value in what we can learn from people speaking about their experiences, as they are a proxy to the underlying brain activity. Which, more often than not, has left me wondering — why is it that we need to point to a brain scan to validate a woman’s experience? Why aren’t her words, her symptoms, her pain taken at face value?
For the scientific minds perusing this, let’s delve a bit deeper. Conditions intrinsically tied to hormonal states, coupled with individual predispositions, provide a golden opportunity to unravel the mysteries of mental health disorders, particularly anxiety and depression. My foray into women’s mental health was a natural progression from my research on depression treatments. The enigma of depression, its selective affliction, its unpredictable severity across individuals, remains largely unsolved. Yet, conditions like PMDD offer a tantalising glimpse into the brain’s workings. Observing the same brain during the luteal phase, when symptoms are rampant, versus the follicular phase, when they’re subdued, is a researcher’s dream. Imagine if you could clearly isolate the mechanism by which the changing menstrual phase (and associated hormones and neurotransmitters) triggered symptoms of low mood and anxiety, so common in those living with PMS and PMDD; how much closer would the clinical community be to finding the more generalisable triggers that lead to low mood and anxiety symptoms which may eventually develop into major depressive and generalised anxiety disorders?
Now, here’s the controversial bit: If PMDD and its counterparts weren’t predominantly women-centric conditions, would they have garnered more scientific and clinical attention? All historical trends in research indicate so. The sheer scientific complexity these conditions present should have propelled them to the forefront of research, yet here we are shrugging mood swings off as women being women.
In spotlighting these issues, my hope is twofold: to urge the medical community to shed its biases and to galvanise researchers with the allure of uncharted scientific territory. Let’s approach these conditions not just with the seriousness they warrant, but also with the curiosity that moves medical advancements forward. Imagine if you could clearly isolate the underlying mechanisms by which the changing menstrual phase (and associated hormones and neurotransmitters) triggers symptoms of low mood and anxiety. How much closer would the clinical community be to finding the universal triggers that lead to low mood and anxiety symptoms? And taking that a step further, how much closer would we be to finding the triggers of depressive and generalised anxiety disorders?
After all isn’t that why we became scientists to begin with?
