Every month, Clarisse Uwera (not real name), goes into a state of depression and whenever this happens, it is a sign that her menstrual period is on the way. As a working student, Uwera often resorts to birth control pills to relieve her of her painful menstrual cramps and go about her daily business.

"When they come, I cannot sleep, eat and for some reason I’m always grumpy. What hurts more though, is the excruciating pain I have to endure days before and during my period, as I do daily work,” she shares.

Although many girls and women find menstruation to be reassuring because it is a sign that their body is healthy and functioning appropriately, it can be a daunting experience for many as well, as different girls and women go through the symptoms differently. 

Dr Mohammed Okasha, an obstetrician-gynaecologist, at Legacy Clinics in Kigali, says that hormone fluctuations caused by menstruation have a significant impact on mental health across the lifespan of many women.

Ages 10 to 24 are when most symptoms of mental illness first appear, and intense hormonal fluctuations from puberty may trigger mental health struggles.

On the other hand, the signs of menopause are different for every woman. One may find the symptoms more overwhelming than others, with some women’s mood changing frequently, from sadness and low self-esteem to irritability and frustration.

Research done by Mayo Clinic suggests that women are nearly twice as likely as men to be diagnosed with depression, at any age. This is because some mood changes and depressed feelings occur with normal hormonal changes.

According to the medical institute, hormonal changes alone don’t cause depression but other biological factors, inherited traits, and personal life circumstances and experiences are associated with a higher risk of depression.

They explain that female hormone oestrogen plays a role in the brain and provides a protective effect against mental illness. In times of lower oestrogen levels, either pre-menstrual or around menopause, some women experience significant and real depression, as well as anxiety.

Societal setting is blamed for women’s progressive mental health problems because they are expected to balance home life and their careers. 

Many women do experience mood swings during perimenopause. Happy highs that turn into teary-eyed lows. Cheerful times followed by crabby days. It’s thought that these mood swings are related to the fluctuating levels of ovarian hormones during this transition to menopause. Plus, if a woman is not sleeping well due to night sweats, her mood would no doubt be affected too.

While there are no statistics about the overall mental health state in relation to gender, Dr Jean Damascene Iyamuremye, Director of Psychiatric Care Unit at Rwanda Biomedical Centre, suggests that the triggers for depression appear to differ, with women more often presenting with internalising symptoms and men presenting with externalising symptoms, making the former more prone.

"In most mental health issues, sexual abuse and violence, where women are mostly victimised, emotional abuse can lead to severe depression and trauma that can have long-lasting adverse effects on women’s mental health, especially when these early life traumas in a woman’s life are often ignored in later life.

Additionally, pregnancy and childbirth change hormonal levels, which may also trigger a mood or anxiety disorder, including postpartum depression or psychosis. Hormone fluctuations do affect mood and mental health, in a big way and they can change during menopause, menstruation or even "unnatural” events such as taking birth control pills or going through fertility treatments,” he says.

Liliane Batesi, a mother of two, says that societal setting is to blame for women’s progressive mental health problems because they are compartmentalised, right from a young age, into wife, mother, home caretaker and career woman and are expected to carry out these roles to perfection.

"While women are expected to be strong and superheroes who can do it all, usually there is a psychological cost attached to playing these multiple roles to perfection. In instances of traumatic events like losing a loved one, divorce, separation or infertility, the stress that comes with having to be a high achiever, combined with hormonal changes can leave a woman feeling severely depressed, worse if the woman does not have a partner to support her,” she says.

Dealing with depression

Finding appropriate treatment is key to overcoming symptoms of any mental health or behavioural condition, according to Iyamuremyi. He says that working with a physician or therapist to get therapy and medically prescribed treatment is the foundation for anyone to get the help they need.

"For severe depression, antidepressant medications can be prescribed to correct the chemical imbalance. Hormonal causes of depression in women can be treated by following their patterns as well as psycho social behaviour because women experience so many fluctuations in their hormone levels and the accompanying physical and emotional symptoms. This is why it is important that they seek these therapy services,” he says.

Dominique Alonga, through her podcast ‘Breaking Silences’ has frequently shared mental health related issues and how to deal with them.

She says that while women have to keep up with societal pressure of working hard to meet up standards, at the same time take care of their bodies and mind, they need to take a step back and take care of themselves at all costs.

"Just be yourselves,” she says. "We teach women to always be selfless and that drives their health down. Women have so much societal baggage and we need to start practicing what I call positive selfishness, which means learning to put yourself first without shaming yourself or driving yourself crazy with guilt. It’s important to listen to your needs before others so you can be mentally healthy.”

Batesi adds that women who go through depression tend to keep their feelings bottled up because they trust to handle it all and can cause a breakdown if not dealt with.

"Find a wsupport group with people you trust, or at least stay engaged in social activities and social functions. Also, women who play sports have higher levels of confidence and self-esteem and lower levels of depression,” she says.

How can women be helped to deal with depression?

Annet Agaba, Accountant

Doreen Mutesi, Housewife

Clare Tibenda, Teacher

Ruth Mutesi, parent

editor@newtimesrwanda.com