Mental illness is the red sock that turns a load of white towels pale pink—it colors everything, every aspect of your life.

Less visible than newly pink laundry, mental illness can be confusing, leaving you to question how you feel. You may even wonder if it’s serious enough to reach out for help.

Addressing mental illness, though, is an act of bravery, and finding care is easier than you may think. Start with providers you already know and trust, even if they’re not a therapist or counselor.

We sat down with Dr. Kristen Caldwell, an OB-GYN with Kettering Health, to discuss the common mental-health issues women experience and how a woman’s OB-GYN can help.

If a woman thinks she’s struggling with her mental health, is it OK for her to bring it up to you?

Absolutely. As OB-GYNs, we are fortunate that we have continuity with our patients; we establish a really great relationship with our patients throughout their lives. That relationship is something we can utilize to help women bring up topics they may not be comfortable talking about with other people.

Sometimes women hesitate to bring up that part of their health because they think they just come to us for a mammogram or a pap smear, the more physical portions of the examination. But women’s health really does encompass every aspect of health.

Even if you’re unsure what you’re dealing with, an OB-GYN office is a great place to initiate that first conversation.

Conversations about women and mental health often revolve around postpartum depression. Are there other instances in which mental health is affected by women’s health issues?

A lot of focus is placed on postpartum care, but mental health reaches many aspects of a woman’s life.

For example, a large majority of women with chronic pelvic pain have some type of underlying mental-health condition that contributes to their pain. In fact, sometimes, when we start evaluation and testing, we find underlying depression or anxiety. And once that part is addressed, the pain improves—the physical manifestation is alleviated.

When women go through infertility, the extra stress levels can lead to a lot of anxiety and depression.

Menopause is another time that mental health becomes crucial, even outside of what people think about true menopause-type symptoms. As estrogen levels decrease, you see a major effect on cognition. These can present as anything from memory issues and cloudiness to changes in mood, thought process, energy, and sleeping patterns.

Alternatively, women who are already being treated for mental-health issues with medication may notice significant side effects that affect sexual health, libido, and relationship interactions.

There are so many female-related conditions where mental health plays such a big part, and those are commonly overlooked in women’s health.

What risk factors for mental illness do women face?

Women are at higher risk for mental-health disorders such as anxiety and depression compared to men. Genetics, medical conditions, social factors, and environmental triggers all can contribute to risk for mental illness. One factor is age. A lot of these symptoms start in younger women, which can commonly be overlooked as what typically changes through puberty.

Social and economic factors put women in the U.S., specifically, at a higher risk for poor mental health than men across the board.

We do see certain races have an increased risk for anxiety, depression, and self-harm relative to those social and economic factors. Specifically, Black women in the U.S. are at higher risk for certain mental-health conditions.

Suicide rates, as far as attempts, are typically higher in women as well.

What are the signs that indicate a woman may need to ask for help?

It can be a number of things. The “typical symptoms” like crying, sadness, isolating yourself—those can certainly happen.

Sleeping patterns can be a big sign—wanting to stay in bed or not being able to sleep. Fluctuations in weight and appetite. Feeling overly emotional one way or the other, whether it’s feeling happy to the point you can’t control that or overly sad.

It doesn’t have to be the extremes, either. Small changes can be that first instinct that you may need to bring up how you’re feeling to your provider.

I typically ask my patients, “How are you doing? Not just in the medical sense but in your day-to-day quality of life. Do you feel like yourself? How is your family? Your partner?”

Those questions can give us as providers clues to changes that the patient may be hesitant to share.

What kind of treatment or resources can you offer a patient who is struggling?

It’s really dependent on what the patient is most comfortable with. A luxury that we have now in the world of COVID-19 is we have access to a lot of alternatives that people typically may not know about beyond face-to-face therapy and medication.

There are a lot of different types of therapists. We have specific therapists for things like postpartum care, menopause, and pelvic pain. Our support groups in those areas offer a space for women who feel more confident in a group setting and enjoy that interaction.

We have local services within the community, including people who will come directly to the patient if they’re not comfortable in a clinical setting. And of course, inpatient care, if necessary, is there for more extreme cases.

Beyond the counseling setting, we can set women up with one-on-one support from someone who has been in a similar situation or has a similar condition and can help in a mentorship capacity.

These resources are becoming a bit more abundant and readily available than what they have been in the past.

What advice would you give to a patient who is scared to bring up their mental health?

The typical answer would be, “Don’t be scared,” but obviously, that’s not going to be a solution for a lot of people.

I think people have to be met face-to-face with their anxiety, and I just try to reassure my patients that what we talk about is between us. I really encourage them to include things that they may not think are a big deal.

Find a provider you feel comfortable with and trust. The first, most important step is finding that person you feel comfortable with. It’s hard to take down that barrier of anxiety sometimes, but we want to make sure women know the OB-GYN is there to do more than just their pap smear.

For those reading this who may recognize some of these signs in a loved one, how can they offer support?

Generally, just being there and being present is so important. Providing that first initial foundation for that conversation is key.

Everyone is so different as far as what kind of support that entails. But recognizing those changes in the women that we love is the first step.

Be there, listen, and then ask them how you can help.

Bring it up

If you’re not feeling like yourself, start the conversation with your OB-GYN. Or find an OB-GYN if you don’t have one.