A 29-year-old human resources executive, who prefers not to be named, remembers the anxiety she grappled with for ages. Her concerned gynaecologist suggested some lifestyle changes and a consultation with a therapist, both of which she kept putting off. “It was only when I started having crying spells that I decided to meet that therapist,” says the executive. She had noticed the connection between her reproductive health and mental health but had delayed getting help till things escalated.
This appears to be a common phenomenon among Indian women, as a study conducted by speciality hospital chain, Motherhood Hospitals, last month indicates. A countrywide survey of 225 women between the ages of 27 and 42, found that most women delay prioritising their reproductive health, which impacts their mental health and overall well-being.
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Women are, in general, more prone to anxiety and depression, thanks to the complex interplay of biological, social and cultural factors. Add the fact that women have always existed at the periphery of the healthcare system—men are still the default subjects in medical research and for treatment protocols—and it’s clear that their mental health is often neglected. Clearly, there is a need to integrate mental health services into reproductive health, a lacuna in the healthcare system that doesn’t get enough attention.
Why hormones matter
Dr Sireesha Reddy, a senior consultant obstetrician and gynaecologist, Motherhood Hospitals, Hebbal, Bengaluru, says that women deal with hormonal changes all their lives, and these affect their emotions and moods. Menstrual disorders like premenstrual dysphoric disorder (PMDD), polycystic ovary syndrome (PCOS), premenstrual exacerbation (PME), endometriosis, and adenomyosis lead to both physical and psychological symptoms. For example, patients with PMDD may experience irritability and tension fairly regularly.
Her opinion is mirrored by Dr Ketoki Mazumdar, a Mumbai-based consultant psychotherapist who has worked extensively with women. Mazumdar, a perinatal mental health expert from Postpartum Support International, says the intersection between reproductive and mental health is obvious in a number of situations, including childbirth, violence, physical abuse, instances of miscarriage, traumatic birth procedures, PCOS/PCOD, endometriosis, menopause, premenstrual dysphoric disorder, surgical procedures involving the removal of reproductive organs, menopause and infertility.
Pregnancy and postpartum in women are known to be especially vulnerable periods for women when it comes to mental health. “The peripartum period is considered a high risk one for women with a history of major mood or depressive disorders,” she says. Biological, cognitive and psychosocial aspects could also trigger mood and anxiety disorders.
As the World Health Organisation points out, one in five women from low and medium-income countries develop significant mental health issues during pregnancy and the postpartum period. “Indian women are in a vulnerable position to develop maternal mental disorders due to various social risk factors such as early marriage, poverty, domestic violence, lack of social support,” she adds.
Gender biases in the industry
The gender biases present in the medical profession show up in multiple ways, including the continuous gaslighting of women. Microaggressions don’t help the narrative. Even that common habit of asking a woman if she is about to get her period if she appears angry or upset is deeply problematic. While female hormones do play a role in mood regulation, hormones are not the only thing that makes women anxious or upset.
Ask this 33-year-old mother-of-two based in Ahmedabad, whose husband attributes any irritation or anger she displays to hormonal fluctuations. “He keeps pointing out how everything gets worse during my periods,” says the woman, who is seeing a therapist on the sly. Through therapy, she discovered that she had other personality and familial issues that needed attention, she explains.
Dr Mazumdar, who has worked with different cohorts of women, observes that women often place themselves last on the list of priorities, which unfortunately means that their health and well-being score very low in their own lives. “The reality of a woman’s general lack of control over her sexuality and reproductive health concerns in both developing and developed countries is strikingly real,” she says.
She points out that although gynaecological health services are more accessible today and there have been improvements in maternal morbidity and mortality, there is a long way to go. “The socially prescribed norms of the feminine quality of sacrificing one’s needs for family and lack of time for herself due to the existing gendered division of labour causes hindrances in their help-seeking behaviours,” she adds.
Traditionally, women end up waiting longer than men for medical help, which can be partly attributed to their reluctance to disrupt their house that runs like clockwork unless they become debilitated, she says. Apart from this, there is a hierarchy of diseases too, which leads to gender inequalities in health and healthcare services. “Women’s illnesses are viewed as less important,” she says, pointing out that conditions like fibrositis, which occur more frequently in women than men, garner less attention in general.
Understandably it can be hard to know what is ‘normal’ and when to seek help, and what are the potential signs of risks one should be aware of when it comes to one’s sexual and reproductive health and mental health concerns.
“It is important to remember that your healthcare provider has possibly seen and heard most of these concerns before and is trained to handle them adequately,” says Dr Mazumdar, adding that one should try and approach professionals who are open and non-judgemental. “It is okay to bring up issues of painful periods, sexual discomfort, swellings and aches in your body parts, urinary discomfort, low libido etc., with your healthcare provider,” she says.
Things every woman should do
Have regular PAP smears
A preventive test for screening for cervical cancer. If anything abnormal is found, it can be treated early
Test for STDs
Sexually transmitted diseases pose a serious risk. Some viruses can lay dormant and are only caught with testing
Opt for proper prenatal care
Sign up for prenatal to ensure that everything will go well with pregnancy. Care can include testing and taking certain vitamins
Seek treatment for menopause
Seek menopause treatment as soon as one becomes perimenopausal to deal with symptoms like hot flashes, insomnia, anxiety, mood swings
Have regular age-wise screenings
Have age-wise screenings for blood pressure, routine blood checks, pelvic exams, clinical breast exams, cardiology screening and so on
