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RCPsych Wales - Mair Elliott, Menstruation and Mental Illness

I think we can all agree that both mental health and menstruation are topics many avoid talking about, despite the fact all of us have one, and half of us both. What can I say, I’m not one for abiding by social norms and keeping quiet over topics that I feel need to be debated. So, settle in, get comfy, get yourself a cup of tea, and join me in exploring menstruation and mental health.

I have lived with complex mental illness since the age of 14. Now 22, it is a part of my life that I’ve learnt to manage to a certain extent. However, there is one thing that derails me on a regular basis; my menstrual cycle. Each month during the Luteal phase, the span of time between ovulation and bleeding, typically associated with PMS, my illness gets hold of the reins and I descend into the depth of my mental illness. Seeing as I’m always tiptoeing, balanced on a fine line of stability above the chasm of crisis anyway, I have no room for anything that could knock me off balance. For me, PMS isn’t just getting a bit ‘sensitive’, it’s often a mental illness crisis with suicidal ideation, increased hallucinations, rapid cycling mood changes, a complete inability to function including attending to personal hygiene, eating properly, working, etc. Looking back, almost all of my major incidents and hospitalisations have occurred in the week before my period. This is not a coincidence, and it’s not just me.

Exploring my own experiences

Since I have been exploring my own experiences, I have been surprised by how many of my female peers with mental illness also experience this link. I have also been struck by how few of us have brought it up with our clinical treatment teams. I can’t help but ask why this is. I can only speak of my own experiences; I have not in the past realised this link because I had internalised the belief that I just had to put up with issues associated with my period. I didn’t seek help because I assumed being a woman meant I just had to endure. Since I have started to talk about this topic openly, this belief has been evident in many of the women around me. Being told that I’d just have to put up with the monthly hell-weeks, as I’ve termed my luteal phase. Thankfully, I naturally question and challenge most things I’m told, this was no exception. Why should I ‘put up’ with this? It is stopping me from being able to live my life, so why should I keep quiet and accept it as something I must endure? I’m deserving of better, so why would I settle for this? My answer, I would not accept that I simply must endure, I would seek help and treatment.

Alas, I hit another road-block. The professionals whom are part of my care and treatment didn’t know what to do, or how to help me. Some told me to think it away (what?!), or to do ‘nice things’ for myself when in my luteal phase (again, what!?). I cannot control my body’s biological processes, or the reactions my body and mind have to those biological processes. I work very hard to keep myself stable, it is a slap in the face to be told to ‘try harder’, especially when it’s something out of my control. It was decided the best solution was to get an appointment at a family planning clinic and attend with my MH nurse.

The outcome of this appointment; I have a severe form of PMS named Pre-Menstrual Dysphoric Disorder (PMDD). This is a condition recently listed in the DSM and the ICD. In simple terms it’s PMS on steroids, it explains why my menstrual cycle and mental illness are so closely linked – my brain and ovaries are at war with each other. Getting it under control is going to be a systematic process of finding a contraceptive method that stabilises my hormones without aggravating my mental illness. I will continue to get support from mental health services in the meantime to help me manage my mental illness. Upon speaking to other women with the same disorder it may take some time to get things right, but at least I have an answer.

Churning in my mind

The whole experience has been churning in my mind. If women with mental illness are accessing services, why isn’t the menstrual cycle taken into account? As with myself, many women work hard to stay well, the menstrual cycle could be stopping some of us from being able to do that effectively. It could be having a negative impact on our ability to function and quality of life, surely two things services aim to increase. Even women who don’t necessarily have PMDD but do have mental illness, they’re illness can be aggravated by the fluctuations in hormones. Does the belief that women must ‘put up’ with ‘women’s problems’ really run so deep that even healthcare providers and professionals buy into it?

Another issue relating to menstruation is menstrual hygiene and period care for women who are very ill and cannot care for themselves. From my own experience, I can remember being in a psychiatric ward, getting my period, asking a nurse for a pad, and then my request being forgotten. I was too caught up in illness to ask again, turning to toilet paper instead. Another time I was on 1 to 1 (when you require constant supervision from a member of staff, including in the bathroom), a man happened to be assigned to me and I needed to change my pad but there were no women to swap with the male member of staff. If a woman is requiring care as intimate as needing help with personal hygiene, then her period care needs to be considered. It should be done, as with all other care, with dignity and respect, not as an after-thought or as an inconvenience.

It’s time we dropped the embarrassment, stigma and hush-hush over menstruation. In the frame of mental illness and menstruation, it could be affecting women more than we can currently see. If women are experiencing worse outcomes and poorer care because services aren’t able to accommodate menstrual needs, it becomes a health inequality that must be addressed. Women deserve better. It’s time we started to unpack this issue and take a long hard look at how we support women going into the future. I myself feel women’s lives are at risk, including my own, and so will not stand by and participate in nonsensical stigma. I hope others can do the same.

Mair Elliott

Mair is the patient representative on the executive committee of the Royal College of Psychiatrists Wales. She will be working to create a document for clinicians on menstruation and mental health, this will include gathering the experiences and ideas of women. If you are interested in being a part of this work please email Ollie John.

Please put the subject of your email as ‘Menstruation and Mental health’ and, if you are happy, where you are from.

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RCPsych Wales