Regarding the symptoms during the post-natal cycle Dr. Ruth Sagovsky writes: "The third category of puerperal psychiatric problems is post-natal depression. It is generally agreed that between10 to 15 percent of women become clinically depressed after childbirth. These mothers experience a variety of symptoms but anxiety, especially over the baby, irritability, and excessive fatigue are common. Appetite is usually decreased and often there are considerable sleep difficulties. The mothers lose interest in the things they enjoyed prior to the baby's birth, and find that their concentration is impaired. They often feel irrational guilt, and blame themselves for being 'bad' wives and mothers. Fifty percent of these women are not identified as having a depressive illness. Unfortunately, many of them do not understand what ails them and blame their husbands, their babies or themselves until the relationships are strained to an alarming degree."
"... Making the diagnosis of post-natal depression is not always easy. Quite often the depression is beginning to become a serious problem around three months postpartum when frequent contact with the health visitor is diminishing. The mother may not present with depressed mood. If she comes to the health centre presenting the baby as the patient, the true nature of the problem can be missed. When the mother is continually anxious about the baby in spite of reassurance, then the primary health care worker needs to be aware of the possibility of depression. Sometimes these mothers present with marital difficulties, and it is easy to muddle cause and effect, viewing the accompanying low mood as part of the marital problem. Sometimes, only when the husband is seen as well does it become obvious that it is a post-natal depressive illness which has led to the deterioration in the marriage."
Again there is a need to study the effects of the menopause about which very little is known even to this day. This phase in a woman's life can start at any time from the mid-thirties to the mid-fifties and can last for as long as 15 years.
Writing about the pre-menopausal years, C.B. Ballinger states: "Several of the community surveys indicate a small but significant increase in psychiatric symptoms in women during the five years prior to the cessation of menstrual periods... The most obvious clinical feature of this transitional phase of menstrual function is the alteration in menstrual pattern, the menstrual cycle becoming shorter with age, and variability in cycle length become very prominent just prior to the cessation of menstruation. Menorrhagia is a common complaint at this time, and is associated with higher than normal levels of psychiatric disturbance."
On the phenomenon of menopause in an article in Newsweek International, May 25th 1992, Dr. Jennifer al-Knopf, Director of the Sex and Marital Therapy Programme of Northwestern University writes: "...Women never know what their body is doing to them... some reporting debilitating symptoms from hot flashes to night sweat, sleeplessness, irritability, mood swings, short term memory loss, migraine, headaches, urinary inconsistence and weight gain. Most such problems can be traced to the drop-off in the female hormones oestrogen and progesterone, both of which govern the ovarian cycle. But every woman starts with a different level of hormones and loses them at different rates. The unpredictability is one of the most upsetting aspects. Women never know what their body is going to do to them..."
Then there are the psychiatric aspects of infertility and miscarriage. On the subject of infertility, Dr. Ruth Sagovsky writes: "Depression, anger and guilt are common reactions to bereavement. In infertility there is the added pain of there being nobody to grieve for. Families and friends may contribute to the feeling of isolation by passing insensitive comments. The gynaecologist and GPs have to try to help these couples against a backdrop of considerable distress."
On the subject of miscarriage the above article continues: "Miscarriage is rarely mentioned when considering abortion. However, miscarriage can at times have profound psychological sequelae and it is important that those women affected receive the support they need. Approximately one-fifth of all pregnancies end in spontaneous abortion and the effects are poorly recognised. If however, the miscarriage occurs in the context of infertility, the emotional reaction may be severe. The level of grief will depend on the meaning of pregnancy to the couple."