After a bit of a halting start (the best laid plans of mice and therapists, yadda yadda yadda), we’re off and running with the first of hopefully-more-regular blog posts and reading/resource links as I clear out the extensive backlog of bookmarked tabs.
The link between female menstrual cycles, menopause, hormonal fluctuations, and mental health issues, has long been the butt of unfortunate humour and a vast degree of social dismissal. The Victorians famously had little time for “women’s hysteria”, an attitude that has followed certain streams of psychology and psychotherapy into the supposedly-more-enlightened era.
The better news is, science is finally starting to pay more attention to exploring the connections between hormones and their tidal pull on women both in terms of PMS symptoms, and in terms of the impact of menopause on bipolar, depression and depressive episodes. As always, the research field is divided between whether or not issues most women take for granted around PMS, for example, are real or not, but the fact that research is even happening is the important starting point.
There are a couple of key lines of thought from a psychotherapeutic point of view, ones I often review frequently with my clients for whom PMS or menopausal symptoms are impacting mental health:
1. Whether the evidence is subjective or not, many women suffer some degree of mood swing in conjunction with their cycles. Knowing this, and knowing that it may be hormonally-driven, in no way downplay the fact that they *DO* have feelings. Heightened feeling, but still feelings. And heightened or not, those feelings are still connected to thoughts, observations and perceptions tied to events happening in their lives.
2. Pain makes people (literally and metaphorically) crazy. Being in pain for 3-10 days out of every 28 for 35-40ish years of our lives… that’s going to affect us. Even when we can plot it on a calendar, even when we can medicate it or manage it through a mind-boggling array of medicinal and therapeutic practices, it’s still something we HAVE to manage every month, just like any other form of chronic or recurring pain. And pain has an absolutely-chartable impact on mental health, especially over the long-term.
3. The degree of sexist dismissal enmeshed in our culture is a damnably-difficult thing to counter. The tendency of family or employers to treat hormonal or menopausal impacts on mental health as something that isn’t their concern, renders women largely invisible during those days (or, in the case of menopause, months or YEARS) when we’re at our lowest, simply because our bodies are being dragged off course and out of comfortable, predictable norms, by… our own bodies. But because it’s “a woman’s complaint”, it’s not treated as a real health issue. Because it’s tied to fertility, it’s not treated as problematic when it’s considered — even by women ourselves — as something we’re just to “suck up and deal with” as the price we pay for being born with ovaries and a uterus instead of testicles and a penis. So there is a degree of validation this kind of pain and instability lack, simply because it happens to women, and that also takes a toll on clients who are trying to manage themselves and their place in their own lives, while also dealing with the physical health issues.
Taking The Invisible Conditions Seriously
Some women manage to sail through their fertile years and the transition through menopause without ever succumbing to debilitation. Other women go through the kinds of hell that have them begging the medical establishment repeatedly to remove everything related to the fertility process. Most of us fall somewhere between the two extremes, a true mixed blessing at best. But because the effects of menstruation aren’t consistent, and aren’t consistently visible to others, that might explain why it’s hard for the other half of our species to even see how hard this process can be on women’s minds and bodies. It’s time we start treating our own hormonal-based mental states as something serious to respect, with significant impacts on how we manage moods and perceptions that also have an effect on our relationships.
I often challenge my clients to consider the impact of menstrual mood swings and other mental health challenges through this perspective: if you had a partner who had to deal with diabetes, arthritis or fibromyalgia, or any other kind of persistent or recurrent medical issue or illness, how would you treat them? How would you approach the persistent presence of the condition or disease, especially if it were something in the “incurable diagnosis” category? Consider your answers to those questions, then (especially when dealing with partners or individuals who scoff at PMS or menopause) ask yourself, WHY treat these menstrual issues as any less-valid form of illness or condition? The similarities are inarguable, where things differ most dramatically is in our collective and individual attitudes towards the condition. Why? And what cost does our dismissiveness have on our relationships with those who suffer from these conditions?
All of this to say, cultural change is slow in coming and the science branches that ARE looking into the connections are both new and still divided. But the conditions themselves are very real and need to be managed, emotionally and physically, as valid challenges to the balance and equilibrium of mental health. Keep an eye on this field of research in coming years, and on the grassroots lobby to force changes in (among other things) employment coverage and medical support for this very real, and very impactful, mental health issue.