Encino Psychiatrists - Therapy for Women’s Health Issues
Encino Psychiatrists Karen L. Vause and Ramzi Kiriakos
Encino Psychiatrists
16550 Ventura Blvd.
Suite 212
Encino, CA 91436
Direct Contact Information
Karen Vause, MD (818) 995-0640
Ramzi Kiriakos, MD (818) 881-8208
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Therapy for Women’s Health Issues

We are both interested and experienced in women’s health issues. Some conditions are more frequent in women and some are exclusive to women. We will address in this section issues that are exclusive to women.

Adjustment to Body Image Changes

Body Image changes can occur for both genders, but generally are more of an issue for women. Physical appeal has been traditionally very important to women for their emotional well-being, their acceptance by the world in general and their ability to attract a mate. Preoccupation with body image becomes excessive commonly during adolescence and young adulthood. Sometimes it persists into middle age. When body image preoccupation becomes excessive, it may lead to anorexia or bulimia.


Anorexia is when the patient’s body weight falls a certain percentage below their ideal body weight determined by their height and body frame. The person will be obsessed with food intake, restricting caloric intake substantially, obsessed with physical exercise and has a distorted perception of their body, believing that their breasts, hips, stomach or legs are too large or an unattractive shape. A good part of their time and energy is spent checking how they look in the mirror and how others see their body. They may spend several hours per day playing with food, rather than eating food or excessively exercising or both simultaneously.


 In this condition, the person may have a low, average or high body weight for their height and frame. The individual may consume very large amounts of food, up to five times the daily caloric requirement for their size. They may be distressed by this behavior and purge the calories by vomiting or laxative use and abuse.  They may use diuretics or avoid salt intake.  Some may purge with excessive water consumption or occasionally water restriction. These behaviors have very destructive effects on the normal body functions. Large shifts in body weight can occur over short periods of time. Metabolic abnormalities can lead to cardiac, digestive and hormonal dysregulation.

Cyclical Hormonal Changes

Healthy women during the active reproductive period of their lives, as well as through menopause, will undergo hormonal changes. This will affect their mood, their level of irritability, their sleep and their body weight.

Premenstrual Syndrome (PMS)

Normal cyclical hormonal changes with periodic cycles are associated with strong changes in mood in 50% of women. This is a normal change that is enough to affect mood and in some individuals their functioning for a period of 7 to 10 days. If it is severe enough, it can be treated with contraceptive pills, antidepressant medication, diuretics and other interventions depending on the individual characteristics of the woman involved.

Perimenopausal Syndrome

This occurs when the ovaries decline in the production of hormones. This in turn will stimulate the pituitary gland in the brain to produce hormones that stimulate the ovaries more aggressively. These changes have an effect on the production of hormones elsewhere in the body. These changes can be mild in many women, are noticed by those women, however, they do not cause distress. In other women, the hormonal changes are experienced as more extreme. These women may have greater hormonal change or greater sensitivity to the changes. As a result, women may feel “different” to themselves, have changes in body shape, changes in mood, cognitive changes, changes in sleep cycle, more irritability, hot flashes late in the day or at night, anxiety, depression, obsessional thoughts and  excessive fatigue without a clear cause. A psychiatrist may be able to help the woman find solutions to some of these symptoms of a normal life change. This help can make the change more comfortable and help the woman to feel more “normal”.

Sexually Transmitted Diseases

Sexually transmitted diseases are very common among sexually active males and females (over 80 % in some statistics). Chlamydia, herpes, HPV and HIV are common STDs. STDs affect sexual practices and intimacy. These illnesses can have a major effect on introducing new sexual partners into one’s life, pregnancy, safe delivery of infants and increase risk of certain cancers in women.  STDs can cause painful pelvic inflammatory disease and increase the risk of infertility and ectopic pregnancies. Discussing these issues with a psychiatrist who is sensitive to the emotions and social complications of these conditions can be helpful to resolve conflicts and manage the issues involved in an adaptive way.

Pregnancy, Depression with pregnancy, Postpartum Depression


Pregnancy and childbirth for a first time mother is the most important life changing event for a woman. All the hormonal changes, body image changes, and identity changes can lead to positive emotions as well as occasionally mental illness. The sensations of a growing abdomen, morning sickness, a child moving inside her, changes in the look and feel of her breasts, increased fatigue and the fantasies about her child are all milestones that can stress a woman’s psychological resources.

Depression with Pregnancy

Depression during pregnancy may occur in one out of 6 pregnancies. Sometimes the depression is severe enough that a woman may have suicidal wishes.  More commonly, a woman could be tearful, lose her appetite, have low energy and have difficulty sleeping. At a time in life when one expects to feel joyful, it can be puzzling to feel these symptoms. Treating depression during pregnancy is complex. Ideally, all medication is avoided during pregnancy, especially during the first 6 months of pregnancy.

Postpartum Depression.

Ninety percent of all women have some depressed feeling post-delivery and this condition is called “postpartum blues”. It usually lasts for 10 days or two weeks as a result of the sudden drop in hormone levels after delivery.  It usually fades on its own.

Postpartum depression or psychosis is a severe form of depression that occurs in about 3% of deliveries. This form of depression is severe. The mother may have the desire to kill herself or her baby. She may hallucinate or be unable to correctly perceive reality. She may be convinced that people around her may want to harm her or hurt her baby. This form of depression has to be treated very aggressively to protect the mother and the baby.

Lactation Issues and Caring for the Newborn Baby

Breast feeding is a new experience for the first time mother. This issue may cause psychological conflict over identity and body image issues that can be addressed in a safe environment. Some mothers may choose to breast feed and others, for a variety of reasons, decide not to do so. Some women find that they have psychological conflicts in making this decision for themselves.

Caring for a newborn infant raises a lot of practical questions for the new mother and psychological issues about one’s competence to care for another helpless human being. Some women find that this new situation raises issues about their own parents that are not completely resolved in their own mind.

Infertility Treatment

After natural methods of attempting to achieve a pregnancy have been unsuccessful, or after loss of a pregnancy, women may feel the need for psychological support during the process of trying to have a successful pregnancy. Hormonal treatment, investigational procedures and multiple pregnancy attempts all have profound effects on mood, self- image, body image, relationships, hopes and dreams.  Infertility investigation and treatment is a life experience that is a psychological roller coaster that can go on for years for some women. It disrupts their relationships with significant others, their work life, their sexual life and their financial life. Furthermore, it may affect their self- esteem, their health, their appearance, their life planning and their hopes for their future. A psychiatrist can be helpful to the woman, as an individual as well as to the couple involved in this emotionally wrenching experience.


Adoption is another solution to creating a family that is an emotional roller coaster. The adoption process, like treatment for infertility, can disrupt relationships with significant others, ones’ work life, sexual life, financial life, self- esteem and self- worth, life planning and hopes and dreams for the future.

Unlike making a family through traditional methods, the family formed by adoption has other issues to consider.  Issues of bonding and threats to the bond between adoptive parent and child (particularly children adopted and born in the US), cultural and racial identity formation, extended family acceptance of the child, unusual financial costs, involvement of the legal system, uncertainty of outcome, prenatal care and drug exposure during pregnancy are all issues that are not usually a concern in families formed by birthparents.  Some individuals and couples find that support by a knowledgeable psychiatrist through such a process, can be an aid in weathering the stress of the adoption process.

Empty Nest Syndrome

For many women, a large part of their adult life is spent “raising children”. This is true whether she is a full time mother or a working woman. When all the children have left home, it requires an adjustment in her identity, her relationships with her children and mate and her use of her time and energy. Often these changes occur during the perimenopausal period when there are all the changes occurring in hormone levels, appearance, energy and identity discussed earlier. Sometimes, depression, anxiety, obsessive symptoms or marital conflict occur for the first time. Professional assistance with a psychiatrist may be necessary and helpful.

Adjustment to Breast Cancer or Uterine Cancer

Adjustment to a diagnosis of cancer is major life stress. The fear of losing one’s life is an immediate concern; however, many people fear the treatment as much as the disease. The various forms of therapies can be painful and disfiguring. For women, the loss of her breast or uterus causes a shift in her image as a woman, her sense of femininity and her attractiveness to her mate. In some women, it can affect their reproductive potential and their ability to raise their children to adulthood. Depression and anxiety can accompany the treatment and changes in body image. Having the help of a psychiatrist can help sort out the best treatment options for any psychological symptoms that may occur. Having this type of help can support both individuals in a couple going through this life stress.

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