Women's Health: Psychiatric / Behavioral Health

Premenstrual Syndrome

Cluster of physical, behavioral, and mood changes with cyclical occurrence during the luteal phase of the menstrual cycle

-Presentation: 5+ sx must be present in the final week before the onset of menses and improve within a few days after the onset → affective lability, marked irritability, marked depressed mood, anxiety, decreased interest, difficulty concentrating, lethargy, change in appetite, hypersomnia, feeling overwhelmed, and breast tenderness

-Symptoms must be recorded for at least 2 cycles

-Sx relieved within 2-3 days of the onset of menses and are absent during the follicular phase

-Tx: lifestyle modifications, NSAIDs, SSRI, OCP

PMDD

Severe PMS with functional impairment

-Presentation: 5+ sx must be present in the final week before the onset of menses and improve within a few days after the onset → affective lability, marked irritability, marked depressed mood, anxiety, decreased interest, difficulty concentrating, lethargy, change in appetite, hypersomnia, feeling overwhelmed, and breast tenderness

-Dx: Must have 5 sx and rule out underlying cause with TSH, hCG, CBC, and FSH

-Tx: SSRIs + lifestyle

Sexual Assault

Defined legally as any genital, oral, or anal penetration by a part of the accused’s body or by an object, using force or without consent

-Estimated ¼ women are sexually assaulted in their lifetimes

-Types: marital, date, and aggravated criminal sexual assault

-Presentation: chronic pelvic pain, dysmenorrhea, menstrual cycle disturbances, and sexual dysfunction

-Initial evaluation: women advised to come straight to hospital and not eat, drink, smoke, douche, clean, urinate, or defecate

STI testing, PrEP

In addition to obtaining informed consent and offering emergency contraception, what are two things that should be addressed when seeing a patient who was sexually assaulted?

Rape Trauma Syndrome

Similar to a grief reaction, where a patient is unable to think clearly or remember things such as past medical history and is afraid of being perceived as “crazy” by others

-Acute Phase: distortion or paralysis that may last for hours to days, loss of emotional control in a typically well controlled individual

-Delayed Phase: flashbacks, nightmares, phobias, somatic and gyn symptoms

Domestic Violence

Violence perpetrated within the context of family or intimate relationships

-Physical abuse should be suspected with any evidence of injury to head or neck, which is more common during pregnancy

-Screen for RF: younger women in long difficult relationships, history of violence, pregnancy, relationship in transition, overly attentive partner, STDs, and substance use disorder

-RADAR Model: remember to ask routinely about DV, ask directly about violence, document information, assess your patient’s safety, and review options with your patients