My period makes me moody

Dear Dr Mitchell,

I am a 32-year-old female who was diagnosed with fibroids and ovarian cysts in 2006. The problem I am having now is that whenever it is near my period, I get extremely moody and at times out of control. My regular personality is nothing like this harsh person I become. It has affected my personal and social life. This behaviour happens at least a week and a half before my menses. Is it that my hormones are imbalanced? Is there any help out there for me?

The problem that you are experiencing is a common problem in women in the reproductive age group. This is called pre-menstrual syndrome (PMS). It involves emotional, physical, psychological and mood disturbances. It occurs typically after ovulation (day 14 to 21) and ends with the onset of the menstrual flow.

The most common symptoms are depression, irritability, crying and mood swings which alternate between sadness and anger. Most women also suffer from fatigue, bloating, breast tenderness and changes in appetite with unusual food cravings.

In its severe form this pre-menstrual syndrome can cause severe depression, irritability and anxiety. This may be so severe to lead to loss of function and inability to cope with regular activities. About 80 per cent of women experience some symptoms suggestive of pre-menstrual syndrome (PMS). Only about two to six per cent of women have the severe variant of PMS.

The exact cause of pre-menstrual syndrome is unknown but it is thought to be related to interactions between sex hormones and brain chemicals called neurotransmitters. The diagnosis of PMS is usually made from the menstrual diary which documents physical and emotional symptoms as they occur over several months. The changes usually occur around the time of ovulation (mid cycle) and lasts until the menstrual flow begins. The menstrual diary helps to promote a better understanding of your own body and moods and helps you to cope with the symptoms.

Conditions which present in a similar manner to PMS should be ruled out. These include depression, chronic fatigue, low levels of thyroid hormone (hypothyroidism) and irritable bowel syndrome.

There is usually no symptom in the period after the menstrual period starts and just before ovulation. If symptoms persist throughout the cycle then the condition is not pre-menstrual syndrome. The diagnosis can be made by using drugs to stop the menstrual cycle or prevent ovulation. If the symptoms are relieved then the diagnosis is PMS.

Treatment of PMS can sometimes be somewhat challenging. This includes dietary changes and exercise. Emotional support from family and friends is extremely helpful during this time. Dietary changes such as avoiding salt before the menstrual period, reducing intake of caffeine, alcohol and refined sugars help. Smoking worsens the symptoms so women who smoke should quit smoking.

Regular intake of Vitamin B6, Vitamin E, calcium and magnesium supplements have been shown to be beneficial. You should choose a multivitamin that contains these and take this daily. Medications that have been used to treat different symptoms include diuretics (reduce bloating), painkillers, oral contraceptive pills and other drugs that suppress ovulation, and antidepressants. Antidepressants are usually useful in treating the mood swings. In most women, a combination of diet, medication and exercise is necessary to obtain the best outcome in relief of symptoms of PMS.

There is really no cure for PMS but proper diet with food supplements, exercise and lifestyle changes can lead to a healthy and productive life.

The uterine fibroids and ovarian cysts need to be properly evaluated and managed. If they are large or cause symptoms such as painful periods or heavy periods then the fibroids should be removed. If they are small and there is no need for surgery then you should probably consider using the oral contraceptive pill for relief of your symptoms due to PMS. The use of the low dose oral contraceptive pill will also help to suppress cyst formation in the ovaries.

Consult your doctor who will advise you further.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor or other professional health care provider.