Women are unique in more ways than one, especially being endowed with a fascinating conundrum of hormones and biology that even modern, sophisticated research is yet to completely decipher. Menstruation is the earliest marker of biological maturation that signifies the transition of a girl into womanhood. But just as any normal biological function can be wrought with pathology so can be menstruation. Women’s periods are rarely seen as something that can cause true mental or physical distress. It’s time that we change our dismissive, ignorant attitudes towards acknowledging it. It’s also time to stop trivialising the distressful psychological and physical symptoms that menstruation might bring with it, especially so when symptoms are unbearably impairing. Women have been always expected to deal with it, ignore it or just ‘snap out’ of it. This ignorance suppresses the very idea that for some women, something much more is seriously going on.
About 75% of women experience what is called the ‘Pre Menstrual Syndrome’ (PMS) which refers to a cluster of physical and behavioural symptoms that occur in a cyclic pattern, at the same point of the menstrual cycle each month. Common symptoms include tender breasts, bloating, fatigue, acne, irritability and mood changes. Symptoms show up after ovulation and intensify as the period draws near to a degree that usually overwhelms the sufferer. They then begin to subside during the first or second day of bleeding and the patient eventually begins to feel normal again. But this cycle of normalcy and being symptomatic during the second half of the menstrual cycle keeps recurring over and over again, thus hampering the quality of life of the sufferer. A graver counterpart or rather a serious extension of PMS is the Premenstrual Dysphoric Disorder (PMDD) which affects about 8% of women. PMDD refers to predominant mood changes that accompany the pre-menstrual symptoms. The symptoms of PDD are severe and life altering. After a thorough evaluation to rule out physical or other co-occurring psychiatric disorders, a definitive diagnosis of PMDD would be made if the sufferer has at least five of the following symptoms.
- Marked mood swings
- Marked irritability or anger
- Markedly depressed mood
- Marked anxiety and tension
- Decreased interest in usual activities
- Lethargy and marked lack of energy
- Overeating or specific food cravings
- Oversleeping or insomnia
- Difficulty focusing and concentrating
- Feeling overwhelmed or out of control
- Severe physical manifestation of PMS symptoms like tender breasts, cramping, bloating, muscle pain and weight gain
Premenstrual Disorders are thought to be a brain chemistry malfunction that is triggered by ovulation. Individual variations in sensitivity to hormonal changes triggered by the ovulation process explain why not all women suffer from PMS. These disorders cause significant distress not only to the sufferer but also to those who share their lives and home with them. It is thus important to gain awareness, validate the illness and seek professional help when warranted.
Medications play a definitive role in alleviating the symptoms. A group of medications called Selective Serotonin Reuptake Inhibitors (SSRI) have been proved to play a definitive role in symptom management. It is imperative to maintain a stable treatment process by adhering to a proper drug regimen as prescribed by your doctor. Sometimes it takes two or three cycles to figure out if a treatment works. During that time, the patient and family can make changes to make the symptoms more bearable.
Lifestyle changes can help get rid of some of the factors that can intensify PMDD symptoms. Turning to a healthy diet, starting an exercise regimen are just a few things that can help. Obesity, sedentary lifestyle patterns and poor diet can compound the disorder. Pursuing soothing hobbies, practising relaxation techniques taught by a mental health professional can help keep under control the anxiety and tension those surfaces after ovulation. Keeping a journal helps to understand the condition and to identify triggers. A supportive and accommodating family environment can help the sufferer tide through the difficult days. Thus it’s time we looked at the psychological misfiring of menstruation not as ‘just those bad days’ or ‘the need to reach out for a chocolate bar’ but as an entity which requires meticulous preparedness and management.
Bid Good Bye to your Calendar Woes. Good Luck.
Article by Dr. Yamini Kannappan DPM, DNB Psychiatry
Consultant Psychiatrist, Kauvery Hospital, Chennai
