Reproductive Psychiatry: the branch of psychiatry dedicated to the evaluation and treatment of mental health issues related to female reproductive function. Specifically, this specialty is focused on psychiatric disorders related to the menstrual cycle, pregnancy, and menopause.
PMS and PMDD
Most women have some mood changes sometime during their menstrual cycle. Usually these symptoms are mild. For women with depression or anxiety, symptoms can worsen with the approach of the menstrual cycle. In about 5-8% of women, premenstrual symptoms are disabling and can cause a disruption in their daily lives leading to Premenstrual Dysphoric Disorder, or PMDD. As women age, symptoms related to the menstrual cycle can worsen.
Women with a history of psychiatric disorders or women on medication who are contemplating a pregnancy may be concerned about the effect a pregnancy may have on their condition. Women taking medications may worry about possible risk to their unborn infants. A Reproductive Psychiatrist can provide a treatment plan that includes education about the relative risks of medicines in pregnancy and strategies to prevent the onset or recurrence of illness during pregnancy and beyond.
Psychiatric Disorders During Pregnancy
Some women may develop mood or anxiety disorders during pregnancy. Women who discontinue psychiatric medications before becoming pregnant can be particularly at risk. The nausea and vomiting of pregnancy can occasionally be so severe that medical and/or psychiatric treatment is required. Loss of a pregnancy, whether through miscarriage or termination, can also be accompanied by psychiatric symptoms.
Postpartum Depression is an umbrella term for the different types of psychiatric syndromes that 10-15% of mothers will experience sometime during the first year after childbirth. At times, the postpartum onset of a mood or anxiety disorder is the first time a woman will have experienced such symptoms. Women with pre-existing psychiatric conditions may find their symptoms are worsened postpartum. In rare cases, 0.1% women develop postpartum psychosis which is a condition that requires immediate medical attention. Many women do not realize that these symptoms can be treated and that suffering of this nature need not accompany the arrival of a new baby.
Women requiring psychiatric medication while breastfeeding may worry about the risks to their infants. In general, the risk of adverse events in the nursing infant is low, but in infants who are premature or otherwise impaired great care must be taken. Occasionally, women develop anxiety or mood symptoms in relation to breastfeeding such as anxiety triggered by milk let-down. Postpartum depression and related symptoms can affect milk supply. Weaning, especially when abrupt, can be accompanied by changes in mood.
Fertility and Assisted Reproduction
Infertility can deeply affect the psychological well-being of women. Treatment for infertility and assisted reproduction can be stressful both physically and psychologically. Studies have shown that a significant percentage of women seeking infertility treatment may be suffering from clinically significant depression (50%) or anxiety (28%). Occasionally, clinical depression can contribute to problems with fertility. A Reproductive Psychiatrist can provide assistance in diagnosing and treating these conditions.
Sometimes sexual dysfunction can be related to a woman’s past experiences, hormone levels or psychiatric problems. A Reproductive Psychiatrist can provide a thorough assessment of sexual history, attitudes, and associated emotions. Treatment of any associated psychiatric disorders can aid in restoring natural sexual functioning.
The menopausal transition, or peri-menopause, is typically heralded by the presence of physical symptoms such as hot flashes and night sweats, but can also include the recurrence of a psychiatric illness or the onset of a new one. Hormonal change can affect mood, cognition, memory, and a women’s sense of well-being.