Woman's Day article about your period and flares..

Discussion in 'Fibromyalgia Main Forum' started by debbiem31, Aug 21, 2003.

  1. debbiem31

    debbiem31 New Member

    Is Your Period Making You Sick?
    It can trigger flare-ups of all kinds of health conditions

    By Stacey Colino
    Photographed by Jenny Acheson

    Do you frequently suffer headaches, asthma attacks or deeper bouts of depression during the week or so before your period? As if premenstrual syndrome (PMS) alone weren’t unpleasant enough, doctors have now recognized a phenomenon in which a woman’s physical condition and/or emotional state may actually worsen premenstrually. It’s often called premenstrual magnification or premenstrual exacerbation, and it adds insult to misery: a double-whammy of premenstrual discomfort compounded by a flare-up of an underlying health condition.

    “Everything, from physical illnesses to emotional struggles and mental disorders, really does get worse premenstrually,” says Diana Dell, M.D., an assistant professor of psychiatry and obstetrics/gynecology at Duke University Medical Center in Durham, North Carolina, and coauthor of The PMDD Phenomenon. “This happens to some degree with all women, but for those with severe premenstrual symptoms, the level of exacerbation can make a normally manageable disorder unmanageable.”

    “For many of these conditions, the exact mechanism behind the effects isn’t known, but the common denominator is likely to be the trickle-down effects of various hormonal fluctuations,” explains Diana Taylor, R.N., Ph.D., director of the PMS Symptom Management Program at the University of California, San Francisco and coauthor (with this writer) of Taking Back the Month: A Personalized Solution for Managing PMS and Enhancing Your Health. “When a woman has both PMS and premenstrual worsening of an underlying health condition, it’s as if the two conditions are superimposed on this phase of her menstrual cycle, meaning she’ll feel worse than if she has either condition alone.”

    The only way to tell if magnification is aggravating an underlying health condition is to track your symptoms throughout the month: noting when they occur, how severe they are and how long they last. Once you’ve done this, you can bring any patterns to your physician’s attention. What follows are various conditions that can worsen during the luteal phase (or second half) of your menstrual cycle and how to cope with the symptoms.


    Research suggests that approximately 40 percent of women with asthma experience more severe and frequent attacks during the premenstrual phase, according to Dr. Dell. “Two factors that could play a role are immune system suppression and increased anxiety during the premenstrual phase.” Another theory is that changes in the level of progesterone, which increases steadily after ovulation, then drops abruptly before menstruation, may make the airways more reactive to irritants than usual, notes Allison Case, M.D., a reproductive endocrinologist at Royal University Hospital in Saskatoon, Canada.

    What you can do: Talk to your physician about whether you need to increase the dosage of your usual asthma medications or have rescue medications readily available during this time. For women with severe premenstrual asthma attacks, suppressing the menstrual cycle altogether, with birth control pills or other medications, may be an option, Dr. Case says.

    Most women with insulin-dependent diabetes describe problems with controlling their blood sugar during the premenstrual phase. “It could be due to a change in the metabolism of carbohydrates that is associated with hormonal changes or to altered eating patterns such as bingeing on sweets and carbs,” Dr. Case says.

    What you can do: Discuss these changes with your doctor, and be aware that changes in your premenstrual eating habits may require adjustments in your insulin dosage. In the rare cases where women have severe insulin reactions that coincide with specific phases of the menstrual cycle, they often benefit from suppressing the cycle altogether.

    Digestive Problems
    In a study of women with various digestive disorders, including ulcerative colitis, Crohn’s disease and irritable bowel syndrome, researchers at the University of Chicago found that the vast majority reported a premenstrual increase in diarrhea, abdominal pain and constipation. The most dramatic changes often occur at the start of a woman’s period, when progesterone levels plummet and prostaglandins, which stimulate contractions of the bowel, increase.

    What you can do: If diarrhea is the primary problem, avoid alcohol, caffeine and dairy products premenstrually or until symptoms have subsided, Dr. Taylor suggests, and be sure to drink lots of water and eat potassium-rich foods (such as bananas) to replenish your body’s fluids and electrolytes. Also, taking a nonsteroidal anti-inflammatory drug, such as ibuprofen, at the start of your period can help reduce contractions of the bowel, Dr. Dell says.

    “If constipation is a problem, consume lots of fiber to form bulk in the intestines to ensure regular bowel movements,” Dr. Taylor says. If these measures don’t help, talk to your health care practitioner about whether you should try an antispasmodic, promotility or laxative agent.


    Eating disorders
    Overeating (or binge eating) and bulimia often flare up during the premenstrual phase. “There’s a whole group of people who binge or purge only premenstrually,” Dr. Dell says. This may be related to a premenstrual drop in serotonin, the feel-good brain chemical, which can lead to carbohydrate cravings. “And if a woman gets bloated premenstrually and already has a distorted body image, she may be vulnerable to self-criticism, which can trigger bingeing or purging,” Dr. Taylor says.

    What you can do: Ask your doctor whether you might benefit from taking a selective serotonin reuptake inhibitor (SSRI) during the premenstrual phase or all month long. “Increasing serotonin will block the carbohydrate cravings and the binge-eating that occur during that time,” Dr. Dell says. If you’re already taking one of these drugs, it might help to increase the dosage premenstrually.

    Up to 50 percent of women with epilepsy experience an increase in seizures during the premenstrual phase, a pattern that’s referred to as catamenial seizures. These seizures are believed to stem from hormonal fluctuations as well as changes in how anticonvulsant medications are metabolized by the body premenstrually, according to Dr. Case.

    What you can do: Talk to your doctor about whether you need to tinker with the timing or dosage of anticonvulsant medications during the premenstrual phase. In addition, progesterone pills or injections have been found to be beneficial in some women with this seizure pattern, Dr. Case says.

    By some estimates, 60 percent of women with migraines link their attacks to the few days before their period or the first few days of menstruation. In this case, the cause is well established: estrogen withdrawal. “As estrogen levels fall in the late luteal phase, the blood vessels in a woman’s head constrict, which can trigger migraine,” Dr. Dell explains.

    What you can do: Try to pinpoint what triggers your headaches—stress, fatigue, certain foods and beverages (such as chocolate, nuts, aged cheese and red wine), bright lights—and make an effort to avoid these factors as best you can during the second half of your cycle, Dr. Taylor says.

    If these steps don’t help, talk to your doctor about whether you should use preventive medications such as ergotamine. “For some women, wearing an estrogen patch for a few days before their period can block migraines by providing a low, steady dose of estrogen,” Dr. Dell explains. But not all women can or should take estrogen, so ask your doctor if this is an option for you.


    Mood disorders
    Either full-blown or low-grade depression can worsen during the premenstrual phase; so can anxiety disorders. These effects could be due to premenstrual changes in brain chemicals like serotonin and norepinephrine, which can trigger various forms of mood instability in those who are susceptible to them, Dr. Taylor says.

    But these premenstrual changes can occur even in women who are already taking medication for depression: “Whether it’s because we’re barely treating depression and a woman has breakthrough symptoms or because of another mechanism, we just don’t know,” Dr. Dell says. “But women with depression are more likely to be hospitalized for it premenstrually than at any other time.”

    What you can do: If your symptoms are mild, try to minimize stress, set limits with other people and steer clear of emotionally charged issues during the premenstrual phase, Dr. Taylor says. Also, reduce your intake of caffeine and alcohol during the second half of your cycle. If you’re suffering from full-blown depression or anxiety and your premenstrual mood swings are severe, talk to your doctor about whether you’d benefit from increasing your medication dosage premenstrually, Dr. Dell says.

    Pain Conditions
    Arthritis and fibromyalgia attacks can occur during the premenstrual phase, leading to increased pain, stiffness and discomfort. This could be because as progesterone levels increase during the second half of the cycle, the body’s inflammatory response is raised, which can trigger flare-ups, Dr. Taylor explains. But emotional factors may also contribute: “We know that if a person gets depressed, whatever physical condition she has will get worse,” Dr. Dell says.

    What you can do: Ask your health care provider if you need to increase your medication dosage during this time of the month, Dr. Taylor says. Using a heating pad or soaking in a warm bath for 30 minutes a day can also help, as can swimming or doing aquatic exercises. “Avoid physically demanding activities when you’re experiencing pain,” Dr. Taylor advises, “and do more stretching and gentle yoga.” If these measures don’t help, keep this in mind: “With rheumatoid arthritis, fifty percent of women will get better if they’re put on an estrogenic birth control pill,” Dr. Dell says. Talk to your doctor about whether this is an option for you.


    What’s in a Name?
    If you’ve seen the ads for antidepressants designed to treat premenstrual dysphoric disorder (PMDD), you might think the name for PMS had been changed, but it hasn’t. The two conditions are actually distinct entities along the same spectrum.

    Premenstrual syndrome (or PMS) is a term that’s used to describe recurrences of distressing physical symptoms (such as bloating or breast tenderness), emotional symptoms (such as anxiety or irritability) and behavioral symptoms (overeating or sleep disturbances) that typically occur during the week or two before a woman’s period. PMS affects up to 40 percent of women of reproductive age, according to Diana Taylor, R.N., Ph.D., at the University of California, San Francisco.

    By contrast, PMDD is a more severe form of PMS, affecting up to 8 percent of menstruating women. It’s so severe that the symptoms, primarily mood-related, interfere with a woman’s ability to function and with her personal, social and work relationships. “The difference is really a matter of degree,” Dr. Taylor says.

    A Troublesome Period for the Heart?
    Women with heart problems may be more vulnerable to heart attack during the first few days of their periods, according to a study at Beth Israel Deaconess Medical Center in Boston. Researchers found that 52 percent of premenopausal women who had suffered heart attacks had done so early in the follicular phase (the first week) of their menstrual cycles. Another study at St. Thomas’ Hospital in London found that premenopausal women with existing heart disease suffered angina (chest pain) more frequently while exercising during the early follicular phase.

    What’s the connection? During the early follicular phase, a woman’s estrogen levels are at their lowest point in the cycle. And that can be problematic because estrogen helps protect a woman’s heart. “Blood-vessel tone is affected by types of estrogen, so we might expect that during a phase of the menstrual cycle when estrogen levels fall, the protection that estrogen provides falls as well,” says Ann Bolger, M.D., an associate professor of medicine at the University of California, San Francisco School of Medicine.

    “But this isn’t something women should worry about as their periods approach,” Dr. Bolger adds. “The most important thing is to take steps to modify your risk all month long.” Quit smoking, lose weight, control diabetes, exercise regularly and manage your cholesterol.

    PMS Help
    If you’re unlucky enough to have PMS and a health condition that flares up premenstrually, the two need to be treated in tandem, says Diana Taylor, R.N., Ph.D., director of the PMS Symptom Management Program at the University of California, San Francisco. One easy strategy for managing PMS is to increase your water consumption during the premenstrual phase and reduce your intake of caffeine and alcohol, Dr. Taylor says. Downing more water will help reduce bloating, while cutting back on java and alcohol will help prevent mood swings.


    EZBRUZR New Member

    Very interesting stuff.

  3. Plantscaper

    Plantscaper New Member

    I have not read much of this article, but at a better time I will..My CFS/FM gets much worse before and a little way into my period every month..which I had indicated to some on this board..it is good to have an article that supports that fact..This is difficult to explain to those who don't have the experience...


  4. amytx5

    amytx5 New Member

    my cycle. Just before thru mid-cycle , I get the extreme exhaustion and my legs can barely walk up steps w/o me dragging them. Obviously the headaches are more prominent and the stiffness and joint pain worsens.

    I feel like I have the flu, instead of just my period.

    I also have PCOS, so I was blaming the extra symptoms on that instead of the Fibro. Thanks for the article.

  5. EllenComstock

    EllenComstock New Member

    It's great to see more and more articles on women's health problems, especially ones that for years were assumed to be "all in our heads". I figured out some time ago that my fibromyalgia was definitely worse about a week before my period starts and is better after I start my flow. My husband and I try not to schedule any vacation during that time so I know I won't be up to doing very much.

    Ellen Comstock