Tuesday, 27 March 2018

What is Pre-Menstrual Dysphoric Disorder?


What is Pre-Menstrual Dysphoric Disorder?
(Trigger warning: Suicide section)

What is PMDD?

Pre-Menstrual Dysphoric Disorder (PMDD), is a hormonal mood disorder which causes disabling psychological and physical symptoms. It is a cyclic condition which onsets between the ovulation and menstrual period (1-2 weeks) before each period. It effects about 3-8% of menstruating women and is often self-diagnosed. It is found to disrupt women’s social, personal and work lives. There is no cure but there are treatment options.


 [Image 1]

History and Classification of PMDD

PMDD was identified relatively recently (1994), and was only added to the Diagnostic and Statistical Manual of Mental Disorders in 2013, and to WHO’s International Classification of Disease index in 2010 [1].

The AIFC summarised PMDD from the 2007 UNS Health Care Newsroom as [2]:

“Women who have PMDD were found to have variants in the oestrogen receptor alpha gene catechol-O-methyl transferase) which is responsible for regulating proper function of the prefrontal cortex, an area of the brain that controls moods. PMDD has been found to predominately lower a woman’s serotonin levels, a neurotransmitter connected with learning, sleep and mood. The tests proved that PMDD is an endocrine mood related disorder causing severe symptoms surpassing the harshest psychosomatic symptoms of PMS.”

In Australia, PMDD is recognised by the Therapeutic Goods Association, but is SSIR treatments are not reimbursed by the Pharmaceutical Benefits Scheme. (Wikipedia)


[Image 2]

Symptoms

PMDD is a form of PMS. Although, everyone’s experience of PMDD is different, common symptoms include [3]:

-          Depression with feelings of hopelessness and despair
-          Suicidal thoughts
-          Uncontrollable Crying fits
-          Social Withdrawal
-          Insomnia
-          Longer periods of sleep due to heavy fatigue
-          Loss of interest/energy for usual activities
-          Difficulty concentrating – confusion
-          Appetite changes – overeating, food cravings, weight gain
-          Headaches & migraines that can last for days
-          Extreme irritability
-          Uncontrollable anger or rage
-          Physical symptoms, swelling, breast tenderness, soreness of joints, abdominal bloating

Burden

These psychological and physical symptoms have been found to regularly disrupt social and work lives. Inability to perform regular work and social activities, places further social, economic and emotional burden on individuals.  

Yamada & Kamagata (2017) conducted self-report task to calculate the mean loss in Quality Adjusted Life Years for PMDD sufferers. The self-report task asked PMDD sufferers to measure their mobility, self-care, usual activities, pain/discomfort and anxiety/depression on a 3-point scale. They calculated the expected mean loss in QALY as 0.14 years. Although, the methodology of this study uses subjective self-reporting measures of comfort, it still shows an average loss QALYs showing the need for further awareness and research. [4]


[Image 3]


Treatment

Unfortunately, there is no cure. But there are forms of treatment/management:

Medical

Selective Serotonin Reuptake Inhibitors (SSRIs) – Are the first line medication in America (Contraceptive pills are first-line in Australia). They are only taken during symptoms. Relief is often felt in 1-2 days. [5]

Contraceptive Pills  Suppress ovulation by controlling sex hormone fluctuations during the luteal phase. Lowers levels of estrogen. These often have some side effects e.g. migraines. (Wikipedia)

                                                                                                                                 
   [Image 7]

Psychotherapy
Cognitive Behavioural therapy – This has been found to help some in dealing with the condition, others have said it has not helped at all. Suggested to work alongside medication.

Surgery
Hysterectomy – Removal of the ovaries and uterus have an immediate cure on the condition as the hormones are no longer being produced by the organs. It is often followed by low dose estrogen therapy. It can also prevent future issues with endometriosis or Polycystic Ovarain Syndrome, which is common for PMDD patients [NB: Unable to have children post-surgery]

Non-medical/surgical
NB: Although it is not suggested to only take-up only non-medical treatments, some alternative therapies are found to help, alongside the use of medication/therapy. These may include:
Reduce caffeine consumption - Coffee, tea, energy drinks and other caffeine based foods should be reduced/eliminated from diets [6].
Alcohol consumption - Reduce/eliminate
Regular Exercise – Increased dopamine along with social aspect and feelings of accomplishment (Although many argue that it is difficult enough getting out of bed during an episode, let alone go for a run)
Pregnancy – Although this is not used as a treatment, symptoms are found to disappear during this time as there are no periods. But, PMDD women have higher chances of post-partum depression.


Stigma and awareness

There are several reasons for the stigma against PMDD:
-          Pre-existing stigma against mental illnesses
-          Medical sexism (which has long existed in the medical field)
-          It is a newly recognised mental disorder
-          Rare (3-8% of women that have periods)
-          Little existing research and medical acceptance

Some stigmas and myths include:
-          It is not real
-          It is just bad PMS
-          Women just get crazy every month


Suicide and PMDD

For every man that dies by suicide, four women will attempt it.                                                                   – Gia Allemand Foundation

15% of people living with PMDD will attempt an act of suicide in their lifetime [8]. Although data has found that most women do not complete the act, there are still many whom experience self-harm and suicidal ideation each month and deserve to receive access to proper service and support. This starts with public awareness!


[Image 4]


Misdiagnosis

Doctors often misdiagnose people with PMDD. PMDD patients are often initially diagnosed with bipolar disorder or MDD. [7] Hence, are prescribed the wrong medications, resulting in possible side-effects. Panay and Fenton (2015) suggest that it is time for a new approach in addressing PMDD Awareness. They focus on awareness in primary care facilities, as a response to these high rates of misdiagnosis.


April is PMDD Awareness Month! Get involved!

Next week is PMDD Awareness Month, it is time to get involved. The Gia Allemand Foundation is one of (or the only) PMDD specific foundation I have found in my research. They started PMDD Awareness Month as a time to re-blog, share online, and tell friends about in real life because it is expected that many more women suffer from PMDD without their own knowledge. Awareness opens them up to the option that they may have it.

PMDD Awareness is not just a justice to people that suffer PMDD, but is a justice to all people whom are stigmatised for having mental illnesses and all women whom suffer forms of PMS.

What you can do:

-          Draw images, write poems, share stories of and/or for women suffering PMDD (especially if you suffer from it yourself)
-          Share online articles
-          Write open letters/posts to anyone organisation/individual whom does not believe/accept PMDD
-          Donate to local Mental health organisations and/or PMDD specific foundations such as Gia Allemand here


Do you have PMDD?

If you are reading this and it sounds like you may fit some of these descriptions, then it is important that you should know that its ok, people are here for you and its not your fault.

Next you should act on it, by going to the doctors and doing your own research. PMDD is usually self-diagnosed, so I suggest that you suggest the condition to your doctor directly (instead of waiting for them to diagnose you with it), because it is rare, and doctors may often forget, (or maybe not even know) about the condition.


                                                                               [Image 5]

It may take a few months for you to find the right medications/treatments for you. Be patient, you will find the right combination eventually. And tell your family and friends – it is important they know about it so they know to be supportive and when to check up on you. Because they want to be there for you especially in times of need.


Do you know someone with PMDD?

If you know someone that has PMDD, or seem like they may have it. It is important you talk about it with them, take them to the doctors and be with them during every step of the process.

It is important to be empathetic, patient and loving. Know that this time is extremely stressful for them and don’t give up on them, because they usually do want to get better.

It helps to read or watched some articles and videos on women talking about their experiences with PMDD. (I will link some down below).


[Image 6]

Personal Stories and Articles from People with PMDD
Women’s PMDD journey – Here  [9]
PMDD sufferer who got a hysterectomy – Here  [10]
Headspace blog thread - Here  [11]
Gia Allemande Foundation Youtube channel - Here  [12]

Useful numbers
LifeLine 13 11 14
Beyond Blue 1300 22 4636
Sane Australia 1800 187 263
Suicide call back service 1300 659 467
Headspace website http://www.headspace.org.au/

Written by: Patricia Chaar



References
[1] http://apps.who.int/classifications/icd10/browse/2010/en#/IV                                                                           
[4] https://link.springer.com/article/10.1007/s11136-017-1642-1  QALY

Images
5


Tuesday, 20 March 2018

Film Review: Mary Magdelane



Note: review tickets provided by Transmission Films. Review contains mild spoilers.


I have to start this review by saying I am not religious. I may have missed the meaning of some scenes/themes as I know very little about religious stories and figures, but I was interested in how they would reimagine such an old story, e.g. Jesus’s crucifixion, in what’s being lauded as a feminist version.

Basically, Mary Magdalene is a fictional story set around the time Jesus is rocking about performing miracles and being crucified, mainly from the perspective of Mary Magdalene.

Before researching for this review, I thought Mary was a repentant sex worker, but this is apparently false, and the movie goes to lengths to tell us that this rumour was started and perpetuated by the church. That a woman, or woman figure, was slandered (at least in the eyes of those at the time) and revisionist history minimised her role and relegated her to the sidelines does not exactly surprise me but here we are.

We start with Mary (Rooney Mara) being the emotional rock for a woman, possibly her sister, who has to be "ripped open" during childbirth, setting the tone for the entire movie.

Mary lives in a small fishing village and her family see her as a walking womb, ready be married off so she can pump out some sons. Mary’s disturbed by the idea she’ll be forced to fill a role she’s uncomfortable with, and when she mentions she’s not up for being married and having babies her father tries to expel the demons he believes are inside her by almost drowning her in the sea.

When she gets sick, either depressed or sick from almost being drowned in the sea, her family send for a healer that’s in town: Jesus.



Mary hangs around wide-eyed while Jesus (Joaquin Phoenix) pontificates to the villagers about real purpose and a new world and, overcome by watching Jesus and his apostles gently and joyously baptise people in the sea she was almost drowned in, decides to join the apostles who follow him and find a greater purpose for herself.

Her sister follows her escape in the early morning and plants the seed that the church will later sow: that if she travels around with Jesus’s crew, she’ll bring shame on the family and no man will ever want her because of assumed misdeeds. Mary basically gives that a big old whatever and defies her expected gender role by stoically walking away to become a revolutionary with Jesus and his crew.

Mary becomes Jesus’s confidante over a few hillside deep and meaningfuls where Mara and Phoenix stare wistfully over the (beautiful) scenery. The other apostles are either wary of Mary breaking up the band Yoko Ono-style or jealous of her, especially as she grows closer to Jesus.

As they grow closer, Mary counsels Jesus to include women in his sermons and he listens. Ignoring his apostles who want to take him to the temple in Cana to preach to men, he talks to a group of women doing washing. As an aside, all the women we see in this movie are doing manual labour, either bearing babies, putting out meals, fixing nets, doing laundry, while the men aren’t doing much of anything and I’m sure that wasn’t a careless choice.
But in this awareness of women’s roles at the time is where the movie stumbles with a feminist message. Jesus’s sermons of humility, tolerance and forgiveness seem to fall flat when juxtaposed with harsh reality. A washer woman angrily tells a story of female subjugation, in which one of their friends, a woman, was raped and then drowned as punishment for having an affair. Jesus says, paraphrasing: "you’ve got to let that shit go if you want to be happy, don’t carry hate with you". Which, is fine, I guess, but a part of me knows that angry women who don’t let shit go are the ones that started the chain of revolutions that allow me to live as I do. Angry women free us. Jobless Jesus sitting down telling working women to be kind and forgive their oppressors is a blind alley. Tolerance of subjugation is not exactly an empowering message; however there may be a message of religious importance that I’m not keen enough to grasp.

This movie pushes the idea that Mary gets it, that she among the apostles is really truly in tune with Jesus. She’s special. She’s the first to decipher his beliefs after his crucifixion, she humbly stands her ground when the other apostles try to force her to their beliefs and I welcome that.

But In trying to reinterpret Mary from what’s she’s been relegated to in history, a "reformed prostitute", the movie may have fallen into the trap of promoting the idea of the gentle woman stereotype, the heart of the group, who acts as an emotional sounding board for the hero on his quest. To be clear, there is nothing wrong with that type of character, it’s just not anything new.

The idea is there: she’s a woman who rebels against the ideals of the time she was born to. But the story never really seems like it’s her story, but maybe that’s not the point of it. Maybe it was just to rework the figure of Mary from sex worker to confidante, a slightly emboldened accessory to the bigger story of Jesus’s crucifixion. If that was the goal, I say it achieved it.

Mary Magdalene releases on March 22nd 2018.

By: Tee Linden
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Wednesday, 14 March 2018

Bi-Radical


Alienation and delegitimization of queer identities within the LGBTQ+ community is nothing new. From isolating members who are not ‘gold-star’ lesbians or gays, to doubting the legitimacy of transsexuality and genderfluidity, and completely ignoring the identities of asexual or agender people. And these examples do not even address the extending layers of oppression that people from intersectional backgrounds face.
Bisexuals (focusing on but not ignoring the others), unlike monosexuals, suffer stereotyping from both within and outside the queer community. This is unique to other subgroups of the LGBTQ+ community, because dominant stereotypes which exist in straight or hegemonic narratives, also oppress individuals within the queer community. Some stereotypes include: bisexuals are confused, promiscuous, opportunistic, ‘actually’ gay or ‘actually’ straight and carry STI’s. These ideas create suspicion and doubt of bisexuality and mistrust of individuals identifying as bi.
This biphobia has led to activism that speaks out against these stereotypes, but that in turn has also seen that a “myth busting” approach is taken up. This involves the denial of stereotypes against bisexuals. Examples may include, “No, we are not confused!”, “We are monogamous” or “We do practice safe sex”. Although well-intentioned, this creates a mirror image of the previously ‘extreme’ image of the imagined bisexual. As it moves away from confused, unfaithful and infectious it reaches an aura of certainty, faithfulness and safety. In reality, bisexuals may indeed be confused, unfaithful, promiscuous or HIV positive, and this may create self-hate or guilt for being a ‘bad’ bisexual or contributing to these ‘bad’ bisexual stereotypes. These binaries of ‘good versus bad’ or ‘real versus fake’ bisexuals can alienate people who are still learning about their sexual identities. It can go against an individual’s prior understanding of themselves resulting in them feeling like they are not legitimate or ‘real’ bisexuals.
So why do bisexual advocates, whose only wish is to defend the bisexual image, immediately take up this myth busting/rejection approach when debunking stereotypes? If we look at the nature of these stereotypes, they denote similar sexual behaviours which are considered immoral even in the dominant heterosexual sphere. So, it would only seem obvious that if bisexuals were to partake in these similar sexual activities, they would be received as even less moral than the average ‘immoral’ heterosexual (who may participate in polygamy, BDSM and female domination etc.). And so, in defence, bisexuals are not only defending themselves against oppressive structures against queers and bisexuals, but also, the overall oppressive patriarchal structures which dictate human sexuality. The radical bisexual activist, Shiri Eisner, referred to monogamy as one of these oppressive structures, and states that it, both historically and currently is used as a capitalist and patriarchal tool for controlling women.
Hence again, we see how the overarching matrix of economic and patriarchal hegemony work to dominate, oppress and control the minority. We see how oppressions become internal, invisible and emotional. We become so desperate to save our people from the oppressions of society that we try to fit ourselves into existing structures, rather than building up new, accepting and non-oppressive ones. So be free, be slutty and be the true bisexual you are, and accept other bisexuals going through their own honest bisexual journeys.
I’ll end this post with a quote from the lesbian activist Dorothy Allison, in hopes of bringing radical bravery into the lives of every marginalised queer.
“I want to have adventures and take enormous risks and be everything they say we are.”       - Dorothy Allison
 By Patricia Chaar

Tuesday, 6 March 2018

Why do feminists always bang on about periods?




When I was asked that exact question, I laughed. I truly laughed out loud. A man posed the question and I laughed because he just seemed so bloody confused about the whole thing, about the constant vocal discussion from people about having periods.
Not to take anything away from him, I mean, it’s true: a lot of feminists want to talk about menstruation.

So, why is that?

I can only answer for me. Feminism means different things to different people, and everyone’s focus for their feminism can be different, made up of a multitude of beliefs. So, the reason I talk about periods is because people don’t want me to talk about them.
Though I suspect others feel the same.  
It’s the shame, you see, it’s the shame that’s attached (as if with sticky wings) to the forced silence about the topic. The shame is multi-layered and strangling and it comes from a variety of reinforcing sources. It’s definitely getting better, but when I was going through puberty menstruation was seen as something disgusting, and to a degree still is.
Menstruation was coded as shameful or gross in jokes told by men (though these days the jokes I see most often are women and girls making light of their experience which is brilliant).



(https://www.scoopwhoop.com/bloody-hilarious-period-jokes/#.rnovwckwl)

It’s coded shameful in some religions because it’s coded as unclean. Women and girls are sometimes removed from certain religious interactions while they’re menstruating.
The shame is often demonstrated by women. An example from my workplace: a woman I barely knew once hid my box of tampons (I had bought and placed them on my desk, out of the way, and had left for a cuppa) so that “no one would see”. She said it so conspiratorially too. As if they were something illicit- something very shameful to have on my desk.
The shame used to even extend to the way the products we use were sold to us. In the 90s it was always in cool toned commercials with menstrual blood manifested as light blue water, which always made no sense to me as it was not even the right consistency.



Don’t get me started on pads that were perfumed with sickly-sweet fragrances. Luckily there’s less of this now, though granted I don’t watch a lot of commercials these days.
Menstruation is coded as gross: I’ve heard men, even now, say they’re uncomfortable seeing tampons. Just tampons. Sitting in their box. Wrapped up.
And all I can think is that I don’t know what will happen to their delicate sensibilities the first time they have to shit next to a pad bin in a unisex bathroom.

There’s a cost to silence. We lose knowledge. We, (read: men) use bad judgement. Like the infamous example of Sally Ride. Sally Ride was the first US woman in space.


(https://en.wikipedia.org/wiki/Sally_Ride#/media/File:Ride_on_the_Middeck_-_GPN-2000-001081.jpg)

When Sally was preparing for her trip aboard the shuttle, engineers asked her if 100 tampons would be the right number to pack. For a 7 day trip. Her response was: That would not be the right number.

If we don’t talk about it, you’ll see policy that makes no sense, like the Arizona prison policy to only issue 12 pads a month to inmates. (http://metro.co.uk/2018/02/12/female-prisoners-get-just-12-sanitary-pads-month-periods-7306847/) or the fact some women and girls right here in Australia can’t afford pads and tampons, and that our tampons and pads are still taxed as a luxury item. On that, one of my favourite groups, Share the Dignity is running #axethetax , you can find out more below.

A feminist writer in Scotland, Vonny Leclerc, recently asked her followers on Twitter to describe a time when their periods caused them shame. The responses are amazing, from stories about women and girls being laughed at or women being asked why they can’t just “hold it in”, to women being told by partners that using tampons was weird.
(https://twitter.com/i/moments/962815523347156997)

Feeling shame about something your body naturally does, doesn’t do anything good for women and girls. Menstruation is healthy and necessary.

If menstruation is coded as shameful, some women will even hesitate to speak to one another about their periods and accompanying symptoms. There are women suffering with endometriosis, for example, who maybe don’t realise what they’re experiencing isn’t the norm.

And endometriosis isn’t uncommon. I thought it was a rare condition but I’ve only recently realised that it affects 1 in 10 women. That’s an alarmingly high number for something that is frequently misdiagnosed and doesn’t have proper funding for research focused on treatments let alone a proper cure.
And why have I recently realised? Because women are talking more about periods and reproductive care!

Endometriosis Australia’s hashtag is literally #EndTheSilenceOnEndo – this is a good thing. This is why we should encourage and nurture discussion about periods, period pain and basically all things related.

And what I’ve written about here are just our first world problems, in other parts of the world menstruation affects women and girls even more so. Just examples from one country: 65% of Kenyan women and girls can’t afford sanitary items (https://www.theguardian.com/global-development-professionals-network/2017/jan/05/having-a-period-is-unaffordable-in-kenya-yet-no-one-wants-to-talk-about-it), and because there is no education around menstruation (because of the stigma) some don’t even know what’s happening when they experience their first period. A 2015 study revealed the infuriating statistic that “1 in 10 Kenyan 15 year olds are having sex to get money for sanitary ware”. (
https://www.theguardian.com/global-development-professionals-network/2016/may/28/we-dont-know-enough-about-menstruation-and-girls-are-paying-a-price) And the stigma affects girls so much they sometimes miss school during their periods or give up entirely.
This shouldn’t happen for a naturally occurring, healthy bodily function.

Why do feminists always bang on about periods?
Because we need to end the silence and the shame. Silence and shame do absolutely nothing for us.





Also: If you have money and/or time to spare, you could consider one of the below!

https://www.thecup.org/ - distributes menstrual cups to underprivileged girls worldwide and provides them with education about sexuality and reproductive rights.
https://www.endometriosisaustralia.org/endomarch-high-tea - Endometriosis Australia is running a series of high tea events in March to help raise awareness, provide education and to raise funds for research.
https://www.sharethedignity.com.au/axethetax/ - details of the Share the Dignity initiative to axe the tax on feminine hygiene products.

(Note: I'm aware non binary people and trans men may have to deal with menstruation as well but I can't speak to their experiences - if you know any good perspectives, please share!")

By: Tee Linden

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