Women’s Health

Why is physical, emotional, psychological well being important for women?

A women’s role is pivotal in every home, family, community and society at large.Every one would agree that a women’s role is irreplaceable considering the juggling act a woman does on a day to day basis. Managing house hold chores, taking care of family, parenting or maintaining cultural traditions, speak about some of the visible responsibilities a woman conducts through out her life. For working women, managing work and home is an addition to the long list of responsibilities. Although, women multitask routinely, the stress of the carrying out these duties can cause ‘Role strain’ especially if no proper support is available. So, it’s all the more important for women to take care of their physical, emotional and psychological well being to be productive in their lives.

Women in general are more vulnerable cross culturally for being prone to stress and depression much more than men. Epidemiological data around the world indicates that depression is twice common in women than in men. A host of social factors [poor coping styles, abuse, life stressors]; biological factors [reproductive events such as pregnancy, postpartum, menopause] contribute to the increased prevalence of depression in women compared to men. Depression in women is under-diagnosed and under- treated as the stigma of reporting emotional and psychological symptoms exists even in the midst of the advances made in various domains.

Biological differences especially reproductive cycle related hormonal fluctuations predispose women to depression. Here are some of the following events in a women’s life cycle, where the risk of developing depression increases compared to other phases of life.

Pre- menstrual Phase: Women may experience increased appetite, irritability and anxiety symptoms [PMS – pre-menstrual syndrome], before the onset of menstrual cycle, subsiding after the onset of the cycle. In some cases PMS can worsen leading to [Pre-menstrual dysphoric disorder] depressed mood, mood fluctuations, increasing anxiety which persists for longer part of the menstrual cycle. These symptoms should be recognized and addressed, especially if they are interfering with the woman’s functioning during these phases.

Depression during pregnancy: Women with previous history of depression are more at risk of developing depression during their pregnancy. In addition, psychological, social factors such as unwanted pregnancy, marital conflicts and poor social support increase the risk of developing depression during this phase. If depressive symptoms are unrecognized or unaddressed, this can interfere with the bonding of the new born and overall parenting, child development and behaviors in the long run. Treatments such as

psychotherapy [counseling], medications [anti-depressants] are considered depending on the previous history of depression and the intensity of symptoms.

Post-partum Depression: After delivery, there can a period of mood fluctuations normally referred to ‘Post- partum Blues’. The fluctuating hormonal levels after delivery contribute to the mood symptoms. Usually, these symptoms subside within a week to 10 days. However in some women, the mood changes can persist leading to further worsening of mood, sleep, appetite disturbances and anxiety symptoms. These symptoms should be reported, identified and treated accordingly. Anti-depressant medications used for treating other depressive episodes are used for this condition as well. As most of these medications [SSRI – Serotonin-reuptake inhibitors] are mostly in the undetectable ranges in the breast milk, breast feeding usually does not pose a problem. However, these medications should be used under professional guidance and follow up. Psychotherapy [counseling] can help mother’s to identify and cope with stressors such as adapting to a new role, expectations, bonding, breast feeding and other stressors during this phase. In very few cases, psychosis develops during post partum period, which requires hospitalization, as this condition poses a safety risk both to the mother and the new born.

Menopause: While transitioning to the menopausal phase, women experience hot flashes, night sweats, vaginal dryness, sleep disturbances, weight changes and fatigue. Increasing intensity of these menopausal symptoms, lower estrogen levels and previous history of depression are risk factors for developing depression during this phase. While estrogen replacement therapy can address the symptoms, in some cases antidepressants are considered. Women should be aware of these biological changes and seek professional guidance to address the issues discussed above.

WHO estimates depression as the 4th most disabling illness and by 2010, it reaches to be the 2nd most disabling among all the other disorders. Left unrecognized and untreated, this poses a huge impact on the overall functioning, productivity and quality of life of the individual. Addressing this public health concern by increasing the awareness in the community via education, screening programs and by appropriate identification, treatment by the medical professionals, can reduce the burden of the illness not only on the individual but also the society at large.

Dr. Yesheswini KamarajuM.D. PsychiatryFellowship in Child & Adolescent PsychiatryDirector, The Reach Clinic, KoramangalaBangalore