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Petition title: Health Education & Improvement Wales to make PMDD a mandatory CPD module in postgrad medical teaching. Text of petition: Premenstrual Dysphoric Disorder (PMDD) is a hormone-based mood disorder affecting 1 in 20 menstruators causing severe mental, emotional, and physical symptoms in the 2 weeks before each period with symptoms devastating each aspect of a sufferer’s life. There is no cure, only symptom management. The lacking awareness and poor education within the medical community means that sufferers frequently receive suboptimal care, waiting an average of 12 years before receiving a diagnosis, thus appropriate and safe treatment.
To enable timely diagnosis and safe management for those with PMDD, requires medical professionals to have knowledge of identifying the cyclical pattern of symptoms, a current barrier throughout the healthcare system. There is no mandatory teaching on PMDD, however those wishing to specialise in menstrual disorders may opt to take a CPD module. RCPsych offer one combined module on hormones and mental health, and both RCOG and RCGP offer limited education on PMS only.
Equipping post-grad students with knowledge of PMDD will:
· Enable them to identify early warning signs of the link between mental health and the menstrual cycle. · Allow students to provide support and encourage women/AFAB individuals to track their cycles when presenting in mental health crisis, noting any cyclical pattern of symptoms. · Ensure a timelier diagnosis. · Ensure all those practising have up to date knowledge of the treatment guidelines for PMDD. |
According to the National Institute for Health and Care Excellence (NICE), premenstrual dysphoric disorder (PMDD) is:
a severe form of PMS (premenstrual syndrome) defined in the Diagnostic and Statistical Manual of Mental Disorders (…) as occurring when a woman suffers from at least five out of 11 distinct psychological premenstrual symptoms, one of which must include mood.
The International Association for Premenstrual Disorders (IAPMD) say that symptoms can include depression, anxiety, mood swings, irritability, and often suicidal ideation as well as physical symptoms such as breast tenderness and bloating.
IAPMD estimate that PMDD affects 5.5% of women and AFAB (assigned female at birth) individuals of reproductive age. The Women’s Health Wales Coalition estimate that around 53,445 of women in Wales are living with PMDD.
An IAPMD global survey in 2018 showed that patients in the UK waited an average of 12 years for an accurate diagnosis and saw 11 healthcare providers in the process.
Sufferers of PMDD have previously called for it to be compulsory for medical students in Wales to learn about PMDD.
In July 2022, the Welsh Government issued a Women and Girls’ Quality Statement It describes what health boards are expected to deliver to ensure good quality health services to support women and girls. Annex A lists specific health conditions that relate to women and girls that are often overlooked, such as menstrual problems. The Minister for Health and Social Services (“the Minister”) said the quality statement “is the important first step in our plans to transform the care received by women in Wales” and would be followed by the publication of a 10-year women’s health plan in Autumn 2022.
The Minister tasked the Women’s Health Implementation Group to develop a Women’s Health Plan for Wales to be undertaken in three stages. The “discovery phase” (the first stage), resulted in the publication of a Discovery Report: Foundations for a Women’s Health Plan in November 2022. This report outlines the next stages in producing a Women’s Health Plan, including establishing a Women’s Health Network to take this work forward.
In November 2023, the Chair of the Senedd’s Health and Social Care Committee asked the Minister for an update on the Women’s Health Plan. The Minister said this is ”now an NHS health plan, so this is not going quite as quickly as I’d hoped”. She added that “I do the quality statement, they do the delivery”.
On 8 March 2024, the Minister provided a progress update on improvements being made to women’s and girls’ healthcare in Wales. Welsh Government also announcedthe appointment of Wales’ first ever clinical lead for women’s health who will lead the National Clinical Strategic Network for Women’s Health in developing the Women’s Health Plan for Wales.
In response to this petition (11 March 2024), the Minister said:
We recognise the need to raise awareness of the existence and symptoms of PMDD and the devastating impact it may have on those who suffer from it. However, decisions about the content of training for healthcare workers, including postgraduate medical teaching, are the responsibility of the relevant professional bodies and not something in which the Welsh Government may intervene.
She also confirmed that Welsh Government:
· Is working with the NHS Executive to explore expanding online menstrual health information and guidance, inclusive of PMDD.
· Has funded pelvic health and well-being coordinators in each health board to signpost women to appropriate services.
Health Education and Improvement Wales (HEIW) is a special health authority and is the strategic workforce body for NHS Wales. HEIW also develops and delivers a range of Continuing Professional Development (CPD) events and online resources to support the needs of the NHS Wales workforce. A learning event webinar on PMS/PMDD is advertised to take place on 24 April 2024.
In December 2021, the Health and Social Care Committee (“the Committee”) published its strategyfor the Sixth Senedd, which identifed women’s health as a priority issue.
In March 2022, the Committee held an evidence session with the Women’s Health Wales Coalition to explore the health inequalities experienced by women and the evidence for a women’s health plan. Following this session the Committee Chair wrote to the Minister (25 March 2022) asking her to consider the key issues from the evidence sessions when developing the women and girls’ health quality statement and implementation plan. In her response, (11 May 2022) the Minister confirmed she had commissioned a women and girls’ health quality statement.
There was a Plaid Cymru debate on women’s health in Plenary on 18 May 2022.
On 19 July 2022, the Minister answered a written question asking what consideration had been given to including PMDD awareness and support as part of the women and girls’ health plan. The Minister said:
it will not focus on specific conditions, although I anticipate that it will reflect care for women experiencing gynaecological conditions such as premenstrual dysphoric disorder more broadly.
On 26 April 2023, Sioned Williams MS made a statement in Plenary to mark Premenstrual Disorder Awareness Month and to raise awareness of PMDD.
There was a short debate in Plenary on 7 June 2023 on support for women in Wales who suffer with PMDD. Replying to the debate, the Minister said:
So many women just put up with it. And it's not something that you need to put up with, and it is something that you can seek support and help for. But, actually, people need to be told it's not normal to have to put up with this (…) So, I think we have to make sure that there's better training and awareness about the condition, including amongst practitioners that, perhaps, hinder early diagnosis and treatment.
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