Menstrual & Pre-Menstrual Tension

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EVERY SO OFTEN along comes a natural communicator and broadcaster, who immediately builds up a worthwhile relationship with the listeners and viewers. Such a man is Jan de Vries. I have worked with him on various Radio 2 and television programmes since 1984, and the mailbag or phonelines have regularly been bursting with medical queries, which he has dealt with in excellent professional terms.

However, what has clearly emerged is the number of Well Woman medical problems. Therefore, as a result of the many questions on my programmes, Jan has embarked on the Well Woman series, starting with premenstrual and menopausal conditions, to be followed with books on the subjects of childbirth and pregnancy, mother and child, skin and hair conditions, and women’s cancers. These books will answer in depth the many queries that we have had on the programmes and I do hope that this series of books will be of help with many of the presently common conditions.

IN RECENT YEARS I seem to have been consulted more and more frequently by female patients seeking relief from physical and mental symptoms which are the direct result of menstrual or premenstrual tension. I wonder why so many women nowadays admit to suffering from these phenomena. Is it an urge to be in vogue by joining the ever-increasing number of sufferers or are these problems indeed more prevalent nowadays, or could it be that the taboo has finally been lifted and women, realising there is no longer any stigma attached to suffering menstrual and premenstrual tension, have become more inclined to discuss their symptoms openly? I have come to the conclusion that the answer is most likely a combination of the above assumptions. I am pleased that more women feel able to discuss these personal problems and no longer feel the need to repress them. I do not believe that menstrual or premenstrual tension can be regarded as a syndrome which has begun to occur only recently; it is far more likely that these symptoms are as old as humanity, but earlier generations would not discuss such problems, regarding them as essentially female and private.

The monthly cycle is dreaded by many women, and more than likely by equally as many husbands. There is little doubt that the family as a whole can suffer when the wife or mother is feeling out of sorts. Because she feels uptight, she is likely to be less tolerant towards the members of her immediate family and probably, as a direct result, her children will become more recalcitrant. Here we have all the makings of a confrontation, while the same circumstances at any other time of the month may not have caused any problems whatsoever.

From an article in a national newspaper I learned that menstrual tension supposedly affects 74 per cent of women of child-bearing age. Many women freely admit to a diminished sense of co-ordination and, to quote one example, volunteer that this is quite apparent in their driving ability at a certain time of the month.

It is acknowledged that marriages can come under stress because of tension at this time of the month, and unexpected aggression varying from a mild bad temper to violent outbursts are not unknown. Admittedly, these are some of the more extreme symptoms, which fortunately do not occur too frequently. On average, most women suffer a degree of irritability, depression, anxiety, inability to cope, bloatedness, and often a craving for sugar, even though these may be out of character at other times of the month. There are more symptoms that have been ascribed to this particular condition, symptoms that vary before, during and after menstruation. It is hardly surprising that such conditions account for an increasing number of psychiatric admissions and suicide attempts, many of which take place during the premenstrual phase.

However, let me be very clear. I do not want to create the impression that all extreme female emotions may be blamed regardlessly on a certain time of the month. Nor does it mean that women can claim indulgence for uncontrollable tempers on the ground of menstrual tension. Menstrual or premenstrual tension are phenomena that have been used by some as an excuse to include any kind of quarrelsome or obnoxious tendencies. Having said this, it may well be that such tendencies do only occur at certain times of the month, in which case some extra consideration will be required from the other members of the family. It is only too common for women to act uncharacteristically during periods of hormonal imbalance or change.

Let us take an overall look at the years of the average female fertility cycle. Menstruation usually starts during the early to mid teens and continues for approximately thirty to forty years. During this lengthy period the hormonal balance passes through various stages, according to age and circumstances. It is fairly common for periods to be irregular for teenagers during the early stages of menstruation. The cycle will regulate itself in the late teens or early twenties. A major hormonal change takes place during pregnancy, which is followed by a further change when the new mother is breastfeeding her baby. After such an experience the hormone level will eventually balance itself, naturally and in its own time. Towards the end of their fertile period many women experience a greater or lesser degree of irregularity in their menstrual cycle. This condition is called the menopause, and its onset indicates the end of the reproductive years.

Menstrual tension is often the result of undue pain experienced prior to or during menstruation and it is important to realise that much can be done to alleviate such side-effects. From the contents of this book you will learn that there is little or no need to suffer unduly during this time of the month.

Period pain — dysmenorrhoea — can be primary or secondary in nature. Primary dysmenorrhoea usually starts within a few months of a teenager’s first menstruation and this condition is therefore most common among the under-25 age group. Abdominal cramps and pains can result in severe backache which can, however, be eased in a variety of ways. Please remember that there is no need to suffer such symptoms unnecessarily; so often women shrug their shoulders and say that it only lasts one or two days anyway, so why bother about it. Never forget that this condition can be avoided and effective relief can be obtained from some simple forms of alternative medicine.

Secondary dysmenorrhoea usually starts in later life, possibly caused by a dislocation of the vertebra, or a pelvic imbalance, or a narrowing between the discs. The result can be heavy menstrual bleeding — menorrhagia. It is estimated that an approximate blood loss of 80 ml is considered normal, but occasionally the bleeding can be excessive to the extent that the person concerned becomes anaemic. If such heavy blood loss occurs, every effort must be made to discover the cause, so that something can be done to remedy the situation.

Nothing is to be gained from overlooking the fact that although menstrual periods are a perfectly natural part of the female life, the female body is also designed for enjoyment and happiness. This may not be appreciated by the young teenager, who regards her first period as an awkward occurrence and a painful and bothersome curtailment of her physical freedom. This early stage can have a tremendous impact and sympathetic and sensible guidance is desirable, preferably given by the mother. She can try to approach this by pointing out the wondrous ways of nature, touching on fertility and pregnancy, and so explaining the essential and unavoidable monthly eruptions.

In this way the young girl will come to appreciate that the menstrual cycle and the changes that take place in a woman’s body are perfectly normal and natural. They are a spontaneous and realistic biochemical and hormonal process which trigger physical and emotional responses. Because this topic was rarely discussed at home, and even less at school, it was shrouded in mystery by our parents’ and grandparents’ generations and it was often suggested that the side-effects were all in the mind. Nowadays, attitudes have changed and this taboo has been lifted, with the result that many aspects of menstrual tension have come to light.

In all fairness, therefore, it cannot be claimed that there has been a considerable increase in menstrual and related problems. At the same time, our increased knowledge on the subject enables us to alleviate and even eliminate many of the symptoms of these problems.

The myths surrounding menstruation are thankfully diminishing. During the Middle Ages it was believed that menstruation was a sign of sinfulness. It was inter-preted as a sign of female inferiority and in certain religious groups women were forbidden to take part in church services for the duration of their menstrual periods. In some civilisations this was an unwritten law, while the laws of other cultures were more specific as to the restrictions placed upon women during their period of “uncleanliness”. Diverse rituals were adhered to throughout the world, stipulating how menstruating women should be isolated while they were “unclean” and subjected to all sorts of restrictions which affected their equality. Some of the effects were even attributed to witchcraft.

The medical profession has to take some of the blame because it previously refused to recognise these symptoms as the physiological effects of a natural occurrence. Fortunately, recent research has shown that it is quite possible for women to undergo a temporary but radical change in character as a result of hormonal changes. Within a short space of time some women can turn into aggressive, overpowering and bullying females, occasionally even with criminal tendencies. Some women will ashamedly admit in the privacy of my consulting rooms that they have beaten their husbands or that they have thrown crockery about, which under normal circumstances would be totally out of character. A chemical change in the hormones, prior to or during menstruation, is now recognised as being able to trigger a significant change in personality, causing a mercurial change in moods.

The effects are not only restricted to mental changes, since many more women report physical side-effects, such as asthma attacks, backache, tiredness, and even epileptic fits if there is already a tendency. When I try to explain such phenomena, women sometimes respond tritely: “Who are you to talk, because men get off scot-free!” I appreciate that it is sometimes difficult for a man to understand because the male sex hormones, which are also chemical messengers, remain on a much more even keel, whereas the levels of the female sex hormones, i.e. the luteinising hormone (LH) and the follicle-stimulating hormone (FSH), fluctuate greatly throughout the month. A slight imbalance of these hormones can cause problems. In Chapter 3, which looks at hormonal control, I will go into this in more detail, but at this point I can say that the pituitary gland — one of the smallest endocrine glands — is meant to stimulate the correct levels of oestrogen and progesterone production. These are two specific sex hormones, whose function is a strong contributory factor to menstrual problems.

It would be interesting to discover how nutrition affects the menstrual cycle and menstrual tension. In fact, we should look at the individual’s whole lifestyle if we aim to improve control over the symptoms that can result from menstrual tension. We would do well to realise that although the effects of menstrual tension in the past were often considered as a curse, in reality they constitute a natural cyclic process that takes place in a woman’s life. The average woman spends nearly half her lifetime in the menstrual cycle — anything between thirty and forty years between puberty and the menopause. This is the period that indicates fertility or the ability to conceive. In order to be able to produce children, a woman has to go through these phases and although fertility levels vary, according to statistics it has been calculated that approximately one pregnancy occurs per 900 cases of sexual intercourse.

The actual period of menstrual bleeding should never be too long. In fact, the average period should not exceed four or five days, and if it is longer medical help may need to be sought. Although there appears to be an increase in the incidence of menstrual problems, it has also become easier to curb or control excessive or critical effects, which was not possible for previous generations. The results of modern research and the removal of any stigma has given us the opportunity to counter any problems as and when they become apparent.

My primary reason for writing this book on the different kinds of menstrual stress is to explore some of the many methods that are now available to alleviate certain conditions. For instance, spasmodic dysmenorrhoea may be helped by specific exercises, as it is important to decrease the prostaglandin output and this can be achieved quite effectively with certain exercises. When a cell is damaged, chemical prostaglandin is released and in cases of spasmodic dysmenorrhoea it is important to prevent the excessive production of these chemical substances. Congestive dysmenorrhea usually occurs spontaneously and is characterised by severe abdominal pain which can persist for up to a week. At one time it was thought that water retention was an influential factor, but it is now thought that stress, worry and emotional upset are more likely to be the disturbing influences. It all comes down to hormonal imbalance.

Fybroids, abnormal tissue and possibly misplaced cells can all contribute towards menstrual tension. Such possibilities need to be checked and if there is any reason to suspect that such influences may exist you must seek the help of a qualified practitioner in order to obtain a correct diagnosis and treatment for any irregularities.

PREMENSTRUAL TENSION or premenstrual syndrome — PMT or PMS — is a hormonal imbalance which manifests itself through a variety of symptoms. Physical, mental and emotional problems can be experienced through symptoms such as fatigue, emotional instability, aggression, anxiety, depression, stress, tension, lack of concentration, confusion, fluid retention, headaches and asthmatic sinus problems.

Perhaps understandably, PMT is sometimes described as a “Jekyll and Hyde” condition and the only way to find out if PMT is at the root of the problem is to carefully record any symptoms together with the dates on which they occurred. If the symptoms recur in a cycle, it is fairly safe to conclude that the person concerned is subject to PMT.

Research suggests that 30–40 per cent of menstruating women suffer premenstrual tension and, indeed, some women experience very severe symptoms. Premenstrual tension may manifest itself at earlier or later stages in life, but for all who experience it, the diagnosis is the same — a hormonal upheaval. To learn more about the personal problems related to menstrual symptoms requires careful consideration. The timing of certain symptoms, and how this relates to ovulation and menstruation, should be monitored, if for no other reason than to understand what is happening in the body and mind. In this way at least the sufferer can be forewarned and will be better able to cope. It is no good losing confidence or shutting yourself away. Although premenstrual tension can be a very debilitating problem it can be overcome. Nothing is to be gained by denying its existence; it is much more sensible to recognise the problem and then look for help.

Some people still attach a stigma to premenstrual symptoms, yet they affect all women irrespective of class, age or colour. The media has helped to counter this by drawing greater attention to this previously almost unacknowledged syndrome. It is generally thought that nine out of ten women will at some time experience such symptoms; part of the problem is that the range and degree of patients’ symptoms vary enormously.

I remember one patient who hesitantly informed me of tenderness and swelling of the breasts and then, gaining courage, she continued by listing weight gain, insomnia, abdominal bloating and greatly variable patterns in her sexual appetite. She desperately wanted me to agree that all these symptoms could not possibly be ascribed to PMT as her doctor had diagnosed. She was convinced that this was impossible and that there must be another cause. At the end of the consultation I had to tell her that I was in full agreement with the diagnosis her doctor had reached. I had no doubt that her problems were due to PMT. Together, we worked out a course of treatment which she followed carefully, and afterwards she admitted that both her doctor and I must have been right in our diagnosis, because the positive results of the treatment programme were clearly evident. Women should not worry that by acknowledging these problems they will be labelled a hypochondriac, because premenstrual syndrome has very real physical and psychological symptoms.

Many women would find it beneficial to spend a little more time and pay a little more attention to themselves during these times. Some positive consideration and understanding of how our bodies work will often reduce the symptoms almost immediately.

It should go without saying that health is and will always be a major issue and that without good health it is impossible to live and enjoy life to the full. I read some interesting facts and statistics in a report produced by the manufacturers of “Ladycare” products. From this report I learned that 48 per cent of the total British population and 42 per cent of the British workforce is female. The aim of this report was to demonstrate the living conditions for some women, how they conduct their lives, and the pressures to which they are subjected. I was rather surprised to learn that 92 per cent of the women surveyed believed that they should take responsibility for their own health, 33 per cent were worried about breast cancer and 30 per cent live in fear of cervical cancer. Medication alone was not considered an effective solution to health problems and 58 per cent actually agreed that too much medication was taken.

MENSTRUAL & PRE-MENSTRUAL TENSION