A winding care pathway for women suffering from premenstrual disorders: where we are and how we can improve in future?

Research problem and specific questions: Premenstrual disorders (PMDs) are defined by psychological, behavioral, and somatic symptoms occurring few days prior to menstruation.

Although these disorders are common and negatively impact women on mental and physical quality of life, they remain understudied and less recognized by healthcare providers. This lack of awareness may result in delays in diagnosis and limited access to quality care management.

The aim of this study is to explore the healthcare utilization and clinical trajectories of women before and after diagnosis to identify potential patterns and gaps in care management, and estimate the cost of PMDs for society.Data and methods: This project will be based on several Swedish registers, including inpatient and outpatient visits, prescribed drug dispensing, primary care and specialists visits, death, sociodemographic and family information.

These registers will provide high quality and detailed information on a large population, with more than 75,000 women diagnosed with PMDs between 2003 and 2019.

Pre- and postdiagnosis care pathways will be described and compared to care utilization for women from the general population, women with a gynecologic condition, e.g. polycystic ovarian syndrome, and women and men with a mental disorder, e.g. depression. The number of visits, type of care and trajectories will be considered.

Additionally, the direct and indirect cost of PMDs for society will be estimated using medical visits, medication expense, sick leave, and disability pensions. Societal relevance and utilization: This project will be the first to study the healthcare pathways of women with PMDs. It will also be the first to assess the economic burden of PMDs on society with objective and recent data.

By estimating the cost of these disorders and identifying some patterns in care utilization and potential gaps in care management, this project aims to provide a support for prioritizing public health strategies to improve diagnose timing and quality of care.Plan for project realization: I will conduct this project over three years at Karolinska Institutet, responsible of study design, data analyses, interpretation of the results and finding dissemination.

With a multidisciplinary approach, I intend to involve patients, care providers and public health authorities, for a better impact on society.