Research focus: Reproductive Psychiatry

Sadia Mir is a consultant in health and race equity, having built up her experience through PPIE. She has Premenstrual Dysphoric Disorder (PMDD) and has recently been diagnosed with Polycystic Ovary Syndrome (PCOS)/Polyendocrine metabolic ovarian syndrome (PMOS).

In this blog, Sadia Mir reflects on her discussion with Dr Katie Marwick, Senior Clinical Research Fellow, and Honorary Consultant Psychiatrist with NHS Lothian. Dr Marwick specialises in reproductive psychiatry across the life course, exploring topics like: Bipolar affective disorder; Postpartum psychosis; Peri-menstrual exacerbations of psychiatric disorders; Perimenopause and menopause and mental health. 

The rise of research for women’s health

When it comes to research, there is one big question I have always had – when does it get relevant to more than half of our population?

I am talking about women and women’s health research. You don’t have to look far to hear that most research was done on male participants. But now with the rise of research looking into women’s health, from early years to end of life,  I sat down with Dr Katie Marwick to really understand how far along the research journey we truly are.

It would be very easy to ascribe this all to female hormones, but we cannot ignore external factors, like how society treats women (and how this is different to men) and the amount of emotional labour a woman holds. Women are more likely to be the primary care giver of both children and older people. They also carry a greater percentage of domestic responsibilities. Women are also more likely to be in lower-paid roles, working flexibly or in the gig economy. They are also more likely to experience harassment both in the home and at work. 

These factors increase the risk of developing poor mental health. It is important that we are clear that hormones play a role but there are other things that can affect the risk of mental health problems. 

Research is beginning to suggest that most women are not much affected by changes in their hormones, but some are affected a lot. This group of “hormone sensitive” women are particularly likely to experience symptoms associated with their menstrual cycle, childbirth or menopause. 

Dr Marwick explains:

It is not that somebody who has symptoms has levels that are too high or too low of a particular hormone. It is that their brain responds differently to it and particularly during times of change.

When it comes to our environment, things like childhood adversity and trauma, intimate partner violence, shift work, and stress levels can influence the likelihood of menstrual cycle related symptoms and even the age of major menstrual changes like when periods begin, or menopause. 

This sets a great basis for research, but there is not much in this space (if there are any budding researchers looking for something new and to be a pioneer, here is your idea!) In previous centuries research into this area has sometimes vilified hormones and suggested that women are controlled by them: future researchers need to watch out for this.

It was both intriguing and reassuring to be able to talk openly about my own symptoms, my own experiences with PMDD and the co-morbidities (extra health problems that happen at the same time as a main condition) that come with it. 

Being able to talk with someone who researches health of women meant I did not have to explain why I think my physical and mental health conditions might be related, and I appreciated having hear someone listen to me without questioning whether I have really PMDD. 

This is an experience many women can relate to – we are constantly being questioned, brushed off, and ignored. However, having researchers in the field of women’s health, especially menstrual health, means that more conversations can happen, and that they are happening with people who understand what you are going through. 

The future

The hope is that, once there is more research, GPs and other health care professionals will not only diagnose conditions earlier but will also know what to tell you/suggest to you about improving your condition. I would like to learn from a medical professional what I could be doing to improve my health rather than having to do guess work.