Premenstrual dysphoric disorder (PMDD) and Hormonal Treatments by Professor Jayashri Kulkarni
Professor Jayashri Kulkarni became a Fellow of the Royal Australian and New Zealand College of Psychiatrists in 1989. As the first Associate Professor/Director of Psychiatry to Dandenong Hospital in 1994, she founded and directed the Dandenong Psychiatry Research Centre (DPRC) and the Monash University Research Centre for Women’s Mental Health. She was Director of Psychiatry of Dandenong Area Mental Health Service (DAMHS) for eight years and directs a large psychiatric research group in her current appointment as Professor of Psychiatry, The Alfred and Monash University.
In our in-patient units [Australia] to this day, we have sexual assaults on women patients. This is completely unacceptable in this day and age that a woman who is admitted to a public hospital for treatment is at risk of being assaulted.
So again, the issues [increasing rate of abuse of girls in Australia] are multiple, but nonetheless, the figures are really concerning and that comes back to us as psychiatrists.
Premenstrual Dysphoric Disorder (PMDD) is a real, major depression that is crippling, that presents for about one week to 10 days in the month. But unlike the textbook picture of a woman who has a 28-day cycle with perfect ovulation at day 14…it doesn’t happen like that – I haven’t met those women yet.
Summary and slides
She presents a startling account of the mistreatment of women in psychiatric wards, and how legislation adopted in the UK may be one answer to at least some of the problems associated with sexual violence in psychiatric wards.
Moving on to biological impacts on women’s mental health, Prof Kulkarni presents an overview of hormonal impacts and specific mental illnesses in women associated with reproductive events.
She presents an account of how to treat PMDD and shows options for 2nd, 3rd, and 4th line treatments which are when symptoms are so serious that clinical menopause needs to be considered.
This video excerpt ends with a look at the causes of PMDD and how it varies with individuals. A progesterone biomarker blood test is currently under development.
Take Home Points
- Gender-segregated wards in psychiatric hospitals are necessary to end sexual violence against women in-patients.
- Hormonal PMDD treatments are important to try as first-line therapy such as Zoely and can be stopped quickly if not effective, without withdrawal. (read more about oral contraceptive pills and impact on mood)
- Many women with PMDD have associated early life trauma.