Lifestyle Choices

The pre-menstrual syndrome is a group of symptoms which occur regularly before menstruation and during early menstruation. After menstruation you are, by strict definition, entirely free from symptoms.

The symptoms are variable, ranging from migraine, backache, joint pains, asthma, tension, irritability, pimples and blotchy skin to swollen breasts, swollen ankles, bloatedness and tiredness. If the symptoms include the triad of tiredness, depression and irritability, this is called pre-menstrual tension. To find out whether you are susceptible to pre-menstrual depression or tension, it is useful to record accurately the timing of symptoms in relation to the menstrual cycle. This means using a diary or a chart every day for several months, and recording the presence or absence of symptoms and the presence or absence of menstruation. Only if there is a regular correlation and if the symptom disappears after menstruation, can you be sure of the diagnosis.

Whether physical and mental changes are monitored or not, many women are very well aware that their mood is different premenstrually. A study in Los Angeles showed that half the suicide attempts by women occurred in the four days immediately before, and during the beginning of, menstruation. The majority of violent crimes committed by women are carried out during the pre-menstrual week. On a more everyday level, most women feel different during this time. A 34-year-old woman said:

“I feel fat, worthless, everything’s twice as much effort. I lose my sense of humour. I want to cry but I can’t. I get spots, I get really puffy, my eyes get baggy and I feel ugly. My fingers get puffy. I get cranky with the kids and I have to stop myself from being hard on them. I forget it has anything to do with my period and wonder ‘what’s the point of living ?’Then my period starts and I think ‘oh, that’s what it was’, and I suddenly feel OK.”

Hormonal changes during the menstrual cycle

The pre-menstrual syndrome occurs when there is normally a rise in the hormone progesterone in the menstrual cycle. Women with pre-menstrual syndrome tend to have a lower than usual level of progesterone in the second half of the menstrual cycle.

Hormonal changes are responsible for the retention of water in the body pre-menstrually, which may lead to a feeling of being bloated as well as aches and pains, including headaches. Pre-menstrual loss of potassium may make you feel weak and lethargic, while changes in blood sugar may make you feel hungry, faint and irritable. If things at home or at work have not been going well, the symptoms feel worse and the mood change may be greater.

Infection

Any infection that is serious enough to tax your body and deplete your energy will make you feel physically depressed, quite apart from any reaction you may have to being temporarily incapacitated.

However, some viral infections seem to have a very definite depressant effect, which often lasts longer than the physical symptoms. This is more commonly true of influenza, glandular fever and viral hepatitis (infection of the liver). It is quite common to feel low for several days after a bout of “flu”. After glandular fever or viral hepatitis it is possible, though not usual, to feel depressed for months.

Sometimes depression or emotional stress is a causative factor in becoming infected. For instance, a study on streptococcal throat infection in families, measured by culturing the bacteria and estimating levels of antibodies, showed that the onset of illness was related to incidents of family stress, such as children’s examinations. Heart attacks are more common in the six months after being bereaved of a spouse. Emotional stress and depression may create susceptibility to any infection.

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