Women's health: Trapped in a cycle

It does not always have to be a painful period

For women whose lives are controlled by the Pre-menstrual Dysphoric Disorder (PMDD), a severe form of Pre-menstrual Syndrome (PMS), there are ways to make it less painful. The condition affects women physically and mentally, with different symptoms for at least seven to 10 days before menstruation, but available treatment options and simple lifestyle adjustments can now break this predictable pattern.

Most researchers believe that PMDD is caused by hormone changes related to the menstrual cycle. “The disorder is called PMDD only when the woman is diagnosed with psychological symptoms. In most cases women visit a gynaecologist… and there is a proper diagnosis criterion for it,” says Karachi-based psychiatrist, Uzma Ambreen. There are three typical stages of life when women are more prone to developing the psychiatric disorder, she explains. It can either be before menstruation starts, after the birth of a child or around the time of menopause.

According to an estimate, approximately 30% to 40% of women may have some symptoms of PMS, but PMDD is diagnosed only when they fulfill the psychological symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, says Ambreen, adding that the condition is surprisingly more common among women than major depressive disorders. But, Hafiza Jindaddi, a gynaecologist at Aga Khan Hospital, Karachi, disagrees, saying that other factors such as neuropathic weaknesses, caused by a type of nerve damage, also play an important role in triggering depression. “If a woman has [a] psychological tendency [towards depression], her condition might get worse if the disorder goes untreated,” says Jindaddi.

Living in denial

PMDD is common across the globe but in Pakistan, most women dismiss the symptoms as a normal part of menstruating, says Ambreen. “They do not consider it a disease that should be treated or addressed. They take all psychological symptoms for granted and think it is period time, so it’s going to happen,” she adds. Most women approach a general practitioner or a gynaecologist when their depression lasts for longer periods and they find it hard to get out of bed or even function properly, causing a strain on their relationships.

The damaging effects of PMDD

If the psychological symptoms go untreated, they can get worse and not only impact mental and physical health, but also affect workplace productivity and damage relationships. Working women, in particular, need to opt for self-assessment and consult a doctor if they feel bothered by the symptoms, suggests Jindaddi. “In a number of cases the duration of PMS increases if it goes untreated. The PMDD symptoms start three days ahead [of menstruation], but with time, this can extend to up to five days or a week and then 10 days,” adds Ambreen.

Coping with the condition

If the condition presents extreme psychological symptoms, it can be treated with anti-depressants, says Ambreen. Medicines are prescribed according to the symptoms urges Jindaddi, adding that evening primrose oil, widely available at pharmacies, can help reduce the pains. Simple lifestyle adjustments, such as regular exercise, can also help minimise the symptoms. Cutting back caffeine can help reduce anxiety and irritability.

Common biological symptoms

Acne

Weight gain

Dizziness

Headaches/migraines

Constipation

Bloating

Breast tenderness and swelling

Tiredness

Nausea

Common psychological symptoms

Depression

Anxiety and tension

Mood disorder

Irritability

Insomnia

Hypersomnia (excessive daytime sleepiness)

Suicidal thoughts

Ishrat Ansari works at The Express Tribune Karachi desk. She tweets @Ishrat_ansari

Published in The Express Tribune, Sunday Magazine, August 24^th,  2014.