“Women make up half the population, yet we still do not treat women’s mental health as a priority.”
Today, women’s mental health is a balance between what we know, what we ignore, and what we treat as optional. It exists in a landscape where society continues to find increasingly sophisticated ways to misunderstand it. When women speak, the world often responds with a polite, “Hmm, are you sure?”
I came to psychiatry after training in obstetrics and gynecology, only to realize that despite their deep connection, women’s mental health remains overlooked. Gender roles and expectations are taught so early that many women are hesitant to talk openly about their bodies or their mental health. Women’s mental health is often misunderstood, underdiagnosed, and minimized across every stage of life, from puberty to pregnancy, through menopause, and all the hormonal shifts in between.
Most complaints like endometriosis pain, PCOS-related fatigue and weight changes, and adenomyosis are dismissed as “stress” or “hormonal,” all while real, treatable conditions go undiagnosed for years. Trauma survivors are told they are overreacting. Sexual assault victims are misunderstood and undermined. Domestic violence victims are blamed for “not leaving.” Miscarriage is minimized, recurrent pregnancy loss is shrugged off, infertility grief is met with “don’t stress,” pregnancy complications are “just nerves,” postpartum anxiety is “jitters,” postpartum depression is “just baby blues,” postpartum rage is “only hormones,” and psychosis is a taboo to discuss. Perimenopause mood shifts are dismissed as “attitude,” menopause brain fog is reduced to “aging,” working mothers facing burnout are told they are “not fit for the role,” and women of color are dismissed more often than others.
The cultural script is ruthlessly clear: Women’s ailments are not perceived as real but are only expected to prove stamina. Their actual mental health condition disappears behind the forced performance of coping, resulting in a catastrophic delay in diagnosing mental and medical conditions.
Psychiatrists can be part of the solution. Some of the challenges are due to inadequate training during residency and the insufficient number of fellowships available. Despite women’s mental health being so complex, it is still not considered essential enough. Not only is there a treatment gap but also an academic and teaching vacuum. How will residents ever develop curiosity, expertise, or nuance if they are never exposed to the full spectrum of women’s psychiatric needs?
It is essential to train clinicians to keep hormonal interplay in mind and not just as an afterthought. Hormones not only influence mood and diagnosis but also impact treatment plans, responses, side-effect profiles, and long-term risk, especially when psychotropics themselves can drive metabolic syndrome or disrupt reproductive health. Very few psychiatry residencies offer formal rotations or structured teaching in women’s or reproductive mental health. When the topic appears, it is often confined to postpartum depression or basic psychopharmacology in pregnancy, ignoring the broader continuum. Many programs rely on self-study or scarce mentorship, leaving graduates feeling unprepared. Without structured teaching, fear replaces facts, which eventually fuels myths.
Women were long excluded from research, and it was only in 1993 that the NIH Revitalization Act mandated their inclusion. This made some impact, but research on women’s mental health still remains limited by short-term studies, confounders, and misinterpretations.
Untreated perinatal mental illness affects more than one generation, quietly influencing bonding, child development, brain structure, and emotional resilience. This shapes whether intergenerational resilience is built or lost. Overlooking this undermines holistic, equitable psychiatric care. Residency programs should improve training for women’s mental health, expand mentorship and research, and fund initiatives that translate passion into practice.
Jincy Rajan is a psychiatry resident.
