Kettle Partnership

Our report on #Hormonehour

by Leah. Average Reading Time: about 6 minutes.

Report – #Hormonehour

On Friday 11th March, we hosted a tweet hour in partnership with the Maudsley Communications department, Bridget Hargreave author of ‘Fine (not Fine)’ and Dr Michael Craig, who runs the National Female Hormone Clinic at the Maudsley.

We gave the hour the hashtag, #hormonehour, it represented the first public facing activity of a project we are developing, focused on Female Hormones.  We know that hormones affect women in three particular stages: puberty, childbirth, menopause – and throughout each woman’s lifetime there is the constant of the menstrual cycle. But, it can be difficult to find relevant information about their impact and the treatments associated particularly with the three main life stages.   Additionally it is only relatively recently that the impact of hormones on women are being discussed more openly and many women are still not aware of the different medical checks and support services that they can access – and of the effect hormonal changes can have on their mental health. On this basis, we think there is scope for developing a project that disseminates information and creates debate on issues related to female hormones using creative engagement ideas to connect and help support women. Ultimately, we aim to develop an app for women of all ages to use, to help women – and girls – to diarise their hormonal fluctuations and corresponding physical and emotional changes.

We want to ensure our resources are evidence-based, and so far we have been talking to Michael Craig at the Female Hormone Clinic. From these initial conversations we decided to arrange a tweet hour in partnership with the Communications Team at the Maudsley – to promote the Female Hormone Clinic as well as getting an idea about what kind of information/resources on female hormones are needed.

The tweet hour started with a Q&A between Kettle Partnership and Dr Michael Craig and as the hour progressed, people asked their own questions of Dr Craig. Below is the outline of the questions and responses as well as links to some of the resources mentioned.

Twitter accounts: @kettlepartners @MaudsleyNHS @DrMichaelCraig1 @bhargreave

What does PMS mean? What does it cover?

  • Pre menstrual syndrome, first coined by Katharina Dalton in 1953
  • It covers a range of mood and physical symptoms during the premenstrual phase

Why do some women suffer more from PMS than others?

  • Some women suffer more than others and we don’t know why

Is there evidence of a mid cycle change in mood? Say day 13?

  • Some women do report a dip in mood around the time of ovulation

What kind of therapy do patients with PND find most beneficial?

  • Patients with PMS can start with simple treatments like diet and exercise improvements
  • Diet: Important to have less fat, sugar, salt, caffeine and alcohol too and have frequent meals high in starch and fibre
  • Other therapies include CBT, hormonal treatments and complimentary treatments

 What complimentary treatments are suggested?

  • Agnus Castus, Red Clover Isoflavones and St John’s Wort (beware of drug interactions)

Why do some women suffer more from PMS than others?

  • In approx 50% of cases there is a genetic risk

 Can this be tested for?

  • Not at the present time

Does pregnancy/birth change a woman’s PMS symptoms?

  • Many women who come to our female hormone clinic say symptoms became worse post natally

Can women who have had PP experience more PMS or even mild relapse each month?

  • Some women more sensitive to changes in hormones through premenstrual, postnatal and perimenopausal

So those who have had PP should be aware that menopause could bring about changes?

  • Yes it could happen

Is the implant the right contraceptive for those with PMDD & history of PP?

  • The implant contains a form of progesterone that many women with PMDD can be very sensitive to
  • pms.org.uk – is a good source of information for all women with PMS and it has information on contraception & PMDD
  • Note: Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome (PMS).

Are the NAPS PMS guidelines widely known amongst midwives and mother and baby units?

  • Not as well known as they should be
  • Note: NAPS is the National Association for Premenstrual Syndrome: http://www.pms.org.uk/

 Is PMS and PMDD part of these professionals’ training?

  • We are not fully aware of this – are they any midwives who can help with this one?

Will there be more work done with psychiatrists to help them understand the benefits of hormone therapy for some women?

  • We are actively carrying out research into this with the Institute of Psychiatry, Psychology & Neuroscience, Kings College London

What are your views on apps like Clue for understanding our own cycles?

  • Try an app called Professor O’Brien PreMentricS

What is Perimenopause and how long can it last for?

  • It’s the stage women go through when approaching the menopause
  • In most women it lasts for about a year but in some women it can last many years

How long does the Menopause last & how would we know it’s ended?

  • It occurs 12 months after your last period

 What is HRT and how does it work?

  • It replaces the hormones that you ovaries stop producing at the time of menopause
  • HRT has physical and psychological effects…

What risks/benefits are associated with HRT?

  • It’s very complicated but in some women the benefits far outweigh the risks
  • It’s probably the most effective treatment to prevent osteoporosis & may reduce risk of Alzheimer’s amongst other benefits

How do hormones affect someone’s personality/mental state during the Menopause?

  • Most women do not suffer from any significant changes in personality or mental state

 Why is there such a lack of knowledge about pmdd within GP setting?

  • This is a problem, the RCOG has existing and upcoming guidelines for all GPs and healthcare professionals

Do you have an up to date list of nutritional supplements/vitamins recommended for PMDD ?

Is Oestrogen given to women with post natal psychosis?

  • Yes, but this is not a common treatment, it may reduce the dose of anti psychotics needed

Why isn’t it used more? Is it because of professional insurance issues?

  • Probably because more research needs to be carried out in this area

If a specialist is aware of PMDD symptoms prior to pregnancy can post-natal difficulties be managed?

  • A woman would be monitored more closely if she was at risk of developing symptoms

What happens when you go to the National Female Hormone Clinic?

  • First a psychiatrist and gynecologist, working together assess you.
  • The clinic looks holistically at a woman’s problems and considers the right treatment

Can someone go to their GP to get a referral to the National Female Hormone Clinic?

  • Yes but they need to get funding from their CCG – it’s a national service

 How much of teenage girls increasing mental health problems is down to use of progestogen pills and puberty?

  • Some teenage girls are sensitive to progestogen pills so this can be a factor

Is hysterectomy ever and option for extreme PMDD or does that cause more problems?

  • It’s the final stage and is only necessary for a small minority of women

Links & Resources:

Royal Society of Obstetrics and Gynecologists

www.rcog.org.uk

National Association for Premenstrual Syndrome

http://www.pms.org.uk/

National Female Hormone Clinic

https://www.national.slam.nhs.uk/services/adult-services/femalehormoneclinic/