I read an article here, in my own language, that I found relevant. And wanted to summarize.
It said:
The way we use APs is based on research on men. Mostly.
One issue: dosing strategies are based on what is good for men. Not women.
There is evidence that it works differently for women.
One: we often need lower doses than men. Lower than they use now.
Thus, because they give us male doses, we have more side effect problems. And damage.
Also, the stable dosing strategy that is good for men, does not seem the best for women. Our cycle makes us often more sensitive to psychosis before our period, and less in the period when estrogen is high, which is protective.
Thus, a fluctuating dose during the month, may be better for many women.
In short: it would be great if medical research and doctors should learn that a woman is not a man. And things like hormones matter.
While I’m sure there has been testing done on both sexes, many fields— healthcare included— remain predominantly oriented towards the male experience.
There are inherent biological differences between male and female sexes, and further research needs to be conducted in order to create a more equal and knowledgeable dynamic in mental health care.
Research is done on women too. But men are seen as the starting point. E.g. excluding women or women of childbearing potential at first. Hormonal fluctuations seem to be seen as disturbing the research, often. When…they are not. They add to your research’s validity. Because, surprise: I have them. And they matter. A lot.
I am in contact with a psychiatrist who specialized in menstrual psychosis. He says women’s topics are very much ignored. A customer of his, a teen girl I believe…she recently died. Because psychiatry refused to believe and treat her hormonal problems.
I have menstrual psychosis. I can be happy all month. Then get extremely depressed and anxious for a few days. Then floridly psychotic on the day before menstruating. Then automatically clear up completely at the exact moment my period starts. Sometimes within minutes. I had a male psychiatrist tell me: that does not happen. My research says PMS does not exist. I said: then your research is wrong. Come sit at my couch for a few days. He refused to treat it.
Also, knowing it would often clear up by itself, I spit out medications in the ward. My doc said: oh wow, the meds work great on you. You cleared up so fast. I said: I often do. I did not use your medications. She did not want to believe me. Current doc is great now…it took me 3 years to convince him…but he turned around completely…even printing PMS articles for me. So sweet.
I did a course in gender studies at uni. At the time I found it a bit vague. Now I want to send herds of gender study majors to my psychiatrists.
It gets even worse when you try to connect different fields of medicine.
Dear psychiatrist, I have a myoma, is there a relationship to my menstrual psychiatric problems? (probably yes)
If my gynaecologist wants me on estrogen blockers for it, does this influence my psychiatric problems and needed haldol? (probably yes, estrogen protects)
If my womb is removed or I go through natural menopause, does this influence psychosis and meds? (probably yes)
I think haldol causes thrombosis in me. What now? Can I use a medicine for my myoma to stop my bleeding? Or would that worsen this haldol problem?
I think food intolerance causes menstrual psychiatric problems in me. Can you test me? Does diet help?
Etc.
I get a very confused blank stare. And a literal: how am I supposed to know? I researched it myself. But.
Professor jayashri kulkarni is doing some interesting research on this. Because of the estrogen hypothesis in the age of personally medicine you will see more endocrinology stuff in treatment. Good point that women probably don’t need the same dosage. Varying dosage with your menstrual cycle would be really difficult and a lot of trial and error. Also expensive if you wanted pharmaceutical formulation that is basically a slightly different milligram everyday in the cycle. Women tend to have a better prognosis and different presentation. You should act as an advocate for yourself in the regard. The reference ranges exist but at the end of the day the dosage you need is still personal so I don’t see much of an issue where you fall within the normal range only where you need a lower the minimum dosage. The same is true for basically all scientific literature the trials have mainly been done in white males to date
I think the best thing we can do as women, is to participate in national studies about medications and their benefits for women. This will help scientists to better understand women with various illnesses. Usually you don’t have to pay, they sometimes pay for your participation. I really think participating in these studies will help scientists better understand women’s health.
I think variable dosages is quite possible, if one has insight. I have done it in the past. There is no need to be very precise. An example for me would be: no meds during the good period. 0.5mg during the bad week. 2mg on the worst day. They do the same with SSRI’s for PMS/PMDD. Women here would only use the SSRI for one week a month, for example.
I suspect the minimum and maximum dosage should be changed for women. I use children’s dosages. I also think…here at least, doc’s go by severity of symptoms a lot, to decide on dosages. Not differentiating between m/f. They have sometimes overdosed me tremendously, because they went by symptom severity, rather my individual profile (female, non-smoker, sensitive to meds, etc).
I think that is very relevant. I also think every woman who is capable, should be assertive to their doc, about such issues. Also for those who cannot.
I was like a stubborn, pitbull-like pain in the ass for my doc. To his annoyance. But now he changed his complete outlook on this topic. And even sends ME articles, rather than the other way around. And checks for it with his other patients.
My pdocs have all been open about how periods can affect mental health. But I have been lucky with my last 3. The first private pdoc I had was a real jerk, I almost quit looking for help because of him.
However, physical med doctors have not been as good. Most recent issue was I was placed on aspirin therapy to hopefully avoid stroke. The ER doc, primary, and neurologist did not mention how aspiron would affect my period. And 2 are female! My first period on it was awful and terrified me. It also went on for 12 days.
That is good, that they were so understanding, your pdocs. Maybe this also varies by country. Don’t know.
Sorry the other docs were so ignorant. I feel “crossovers” between different specialisms are difficult to many docs. And you have to be alert. Here the ER doc was great though recently.
Because of the hyperbolic dose response curve there is a need to be accurate at lower dosages.
Coming off all together and the going back on is probably going to be jarring in practice because withdrawal periods and adaptation to side effects.
Yeah well dosage probably should change with body size. Here they have different limits for alcohol because they say it effects men and women differently. Symptom severity and individual profile aren’t mutually exclusive when determining a dosage. A bad pdoc will not take the time to understand your individual profile. I am likewise sensitive to medication.
Current doc is great now…it took me 3 years to convince him…but he turned around completely…even printing PMS articles for me. So sweet.
