Victor Boyhan (Independent)
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The Minister of State is very welcome to the House. I thank her for her time. We greatly appreciate her coming to the House to take this Commencement matter.

Patricia Stephenson (Social Democrats)
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I am very happy the Minister of State is here today. It is great to have a Minister from the Department answering in response to a Commencement matter.

I will use my time to highlight an urgent and deeply neglected women's health issue, premenstrual dysphoric disorder, PMDD. It is a severe hormone-based mood disorder affecting an estimated 6% to 8% of women. It is debilitating and recurrent but, crucially, is treatable. Yet, in Ireland, many women have never received a diagnosis, let alone received appropriate care. PMDD is a condition that has been hidden in plain sight for far too long. It is a cyclical hormone-based disorder that affects a significant number of women. It can cause overwhelming distress and depression, often with no explanation offered by medical professionals. For many, these symptoms begin for adolescents long before they are equipped with the language or knowledge to understand what is happening to them and to their bodies.

I acknowledge specifically the courage of one young woman. Her name is Shauna Halpin and she has spoken publicly about her experience. I had the privilege to meet Shauna recently and she has given me her permission to tell her story today. After years of severe symptoms, which started suddenly in her teens, including severe anxiety, depression and extreme fatigue, she started to self-harm and experienced suicidal ideation. Even though Shauna knew she did not want to die, she needed the mental suffering to end, such was the severity of her condition. In the absence of answers, she admitted herself into psychiatric healthcare, believing that was the only way to get answers. All Shauna wanted was to feel well again and to live her life again. However, she now describes this as the worst decision of her life. While in psychiatric care, she was medicated so much she could not feel anything but numbness.She was misdiagnosed with several things, including unstable personality disorder. Eventually she left psychiatric care and for the next five years she spent three weeks out of every four each month floored with symptoms. Shauna undertook her own research online where she discovered she was experiencing undiagnosed PMDD. PMDD has 15 symptoms and one needs a minimum of five of them for a diagnosis. Shauna had all 15 of those symptoms. Despite this, she got no help from the public system. She was simply given the pill, which did nothing for her. I am sure women across the country can talk about being prescribed the pill by a doctor as some sort of magic tool and it does not work. It was only after going private that Shauna got help in the form of hormone replacement therapy, HRT. I believe it is completely unacceptable that she had to go through this unimaginable suffering for ten years. I am very happy to note that Shauna is now doing incredibly well after getting HRT treatment through a private clinician but her story resonates beyond one person. It shines a light on what many women have been navigating silently and that is the question of medical gaslighting. It is an issue I have spoken about before in this Chamber. Unfortunately, we hear almost daily of women who have not been believed about the pain they are living with. Shauna's story is simply one more example of that. We are simply not meeting the needs of women in relation to diagnosing and treating painful conditions.

Today, I am speaking about PMDD but this could extend to things like endometriosis as well as many other conditions where women's pain is minimised and has gone untreated for years by a healthcare system that does not believe them. Despite the severity of PMDD, many clinicians in Ireland receive little or no structured training in recognising or treating it. There is a complete training gap that urgently needs to be filled. I have raised this issue today to seek an update on how Ireland is currently diagnosing and treating PMDD and on the clinical training and guidance across women's' health and mental health services for this specific condition. I am also asking for an update on the public awareness plans around PMDD, including work with the Department of education, so that young people can learn about PMDD in school in an informed and sensitive way because what we see now is girls and young women who are having to navigate this experience by themselves with no information and it is absolutely harrowing. We have made some progress around women's health but PMDD remains a significant gap. What women want and what everyone deserves is clear information, a clear pathway and a health system that understands their condition and meets their needs with compassion and knowledge.

Victor Boyhan (Independent)
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I thank the Senator. Before I call on the Minister of State to respond, I welcome, as guests of the Ceann Comhairle, Tammy Darcy and Michelle McGuirk. They are very welcome.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank the Senator for bringing this matter to our attention. In particular, I thank Shauna, who has spoken very publicly on her challenges and what has happened to her. That is really important for all of us. I again thank Senator Stephenson for raising Shauna's case today.

Today gives me an opportunity to update the House on the ongoing work to improve women's health outcomes and experiences. The Minister for Health has previously said that we cannot be satisfied with anything less than a health service that provides true equality of care and treatment, where gender is not a barrier or a disadvantage. The two women's health action plans, along with the significant investment, have resulted in important improvements to women's health services in Ireland. The women's health task force and these action plans have increased awareness of many women's health issues among the public and healthcare professionals.

The Minister, Deputy Carroll MacNeill, recently approved funding for the development of a menstrual health awareness campaign which is currently being developed by the national women and infants programme in the HSE. She is developing that at the moment. The first phase of this campaign will involve a comprehensive evaluation of current attitudes and knowledge of all related topics. The campaign will aim to balance information regarding what is normal versus what could be abnormal. It will focus on a range of menstrual health disorders and associated conditions. One of the results of the research phase will be the development of a communications strategy with communications for areas requiring focus. The 2022 Healthy Ireland survey included a module on this issue in health and period poverty was the other issue. The results indicated that 51% of women had missed daily living activities on occasion because of period symptoms and that 24% had experienced period poverty. Healthy Ireland and the HSE national social inclusion office teams have recently set up linked websites on the topic of menstrual health and period dignity.PMDD can have a significant impact on mental health. It is characterised by debilitating emotional symptoms occurring between ovulation and when a period begins. It is associated with an increased risk of problems, including depression and anxiety. Treatment for mental health impacts can include talk therapy and counselling, as well as medication. Both have been found to have a beneficial effect and it is important that anyone suffering with PMDD can access support in a timely way. Women with PMDD can also access a range of mental health supports in the community.

Mental health services are provided by the HSE across community and hospital settings. There is a nationwide network of adult mental health teams which provide multidisciplinary supports. The teams provide specialist supports to those who require more supports than their GP or primary care psychology can provide. GPs are the key pathway for anyone with PMDD who needs support with a mental health problem, including referral to secondary care. GPs also have access to mental health resources at primary care level and can refer patients to counselling services such as SilverCloud. A GP may also refer somebody for more expert input, if he or she feels that is needed.

The national counselling service provides free counselling to those with medical cards. Beyond this, community and voluntary organisations are funded to provide mental health services and supports, including talk therapy, counselling, suicide bereavement services, helpline and crisis support services.

The Senator spoke about education. Female and male health education in schools is supported through the social, personal and health education, SPHE, curriculum. The HSE has resourced developments to resource and update the junior cycle SPHE curriculum, which include developments in supporting, teaching and learning about male and female reproductive systems.

Victor Boyhan (Independent)
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I thank the Minister of State. I appreciate there was a lot to get through there. I am reading it as she is delivering it.

Patricia Stephenson (Social Democrats)
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I thank the Minister of State and appreciate her commitment to this. It is brilliant that Shauna has spoken out publicly about this but it should never take women having to expose such personal things in public to get action. Will PMDD specifically be in the HSE campaign the Minister of State mentioned? While I recognise GPs are the first port of call and pathway for many people, the reality is many GPs across the country do not know this condition in detail and are not treating women or outlining the right pathways.

I also want to link that to the question of psychiatric care. Maybe that will work for some but psychiatric care is not necessarily the best step for hormonal imbalance, which is what PMDD is. The idea of institutionalising someone with psychiatric care, or even of them referring themselves to an institution, seems absolutely obscene. It is not getting the point. It is an outdated form of medicine that does not respond to the modern needs of women. That is why I mentioned HRT. I would love if the Minister of State would take that back to the Department for it to be taken seriously as a pathway we should explore. HRT works amazingly for certain things. Postnatal depression can also be treated with HRT.

On SPHE, is that a new update in the school curriculum? PMDD is mentioned in that curriculum but the section on it is minute and does not provide enough to young girls experiencing this. It is about having an open conversation. Between 6% and 8% - almost one in ten women - suffer from this.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Senator and I want to thank Shauna. Today was just about guidelines for information. The Minister has approved funding for an awareness campaign, which is being developed through the national women and infants programme in the HSE. I will get the Senator more information on that.

The Minister and the Government share the Senator's commitment to providing women in Ireland with a healthcare system that is responsive to the issues raised today. Women account for 51% of our population. We need to make sure we have the conversation, the awareness and the information. The Senator spoke about how well Shauna is doing now and we commend her. We need to make sure we have all the services there that are needed, work around them, have an awareness campaign and work with GPs. GPs play a huge role in this as well.It is also about all of us working together. The framework for the women's health action plan protects our ambition. It commits to listening, investing, delivering and repeating the process for growth for women's health. It is about all of us working together. I will come back to the Senator with that information. It was really good to talk about this today because it is vital we raise awareness and work on it together.