Our Bodies, Ourselves by Boston Women's Health Book Collective Read Free Book Online Page B

Changes Through the Menstrual Cycle
    The menstrual cycle is governed by hormones that rise and fall in rhythmic patterns. These hormones influence the physical and emotional changes you may experience during your cycles. Some women notice few changes; some experience increased energy and creativity; others experience mood changes (some positive, some negative) and body changes (swollen breasts, for example). Some women have cramps, while others do not. One woman reports happily:
    I wasn’t the biggest fan of my period, but then I discovered that I have the most incredible orgasms while I’m menstruating!
Premenstrual Changes
    Women can have a variety of physical sensations and emotional experiences for several days before menstruation and sometimes during the first few days of menstrual flow. These are caused by the normal hormone fluctuations of the menstrual cycle and are not a sign of a hormone imbalance. Among the more negative changes are mood swings, fatigue, depression, bloating, breast tenderness, and headaches. Sometimes these premenstrual experiences are mild, but sometimes they disrupt our lives significantly.
PREMENSTRUAL MOOD CHANGES AND DEPRESSION
    I get upset—sad about simple things—when I get my period.
    Some of us experience mood changes before our periods, including some level of depressionand emotional irritability. Some of us find that issues that have been with us all along become more pronounced at this time. Others see our moods as authentic expressions of feelings we don’t usually feel able, comfortable enough, or secure enough to show. Some women are able to cope with premenstrual mood changes, while others find the intensity of the symptoms and frustrations intolerable.
    For some women, certain self-care and nonmedical techniques can help with mood changes. Approaches that have proved useful in a few studies include exercise, calcium, vitamin B6 supplementation (although too much B6 can have serious side effects), and the herb
Vitex agnus-castus
(chasteberry). Approaches that have worked for some women and are still under study include dietary changes such as limiting salt, sugar, caffeine (especially coffee), red meat, and alcohol; massage; reflexology; chiropractic manipulation; biofeedback; yoga; guided imagery; photic stimulation; acupuncture; and bright light therapy. 7
    A small but significant number of women do experience extreme premenstrual depression that interferes with work, social interactions, and general well-being. In these instances, recognition and care are critical. If premenstrual depression interferes noticeably with your daily life (you don’t want to get out of bed, you miss work, or you have suicidal thoughts) and nonmedical approaches are not helpful, seek advice from your primary care provider, your ob-gyn, or a mental health professional.
    Medical treatments for premenstrual depression include using hormonal contraception continuously, so that there is no menstruation, or taking antidepressant medications called SSRIs. However, there are questions about the effectiveness and safety of SSRIs. (For more information, see “Depression and Other Mental Health Challenges During Pregnancy.” )
Severe Cramps (Dysmenorrhea)
    Women experience many different levels of menstrual-related cramping, from no cramps to severe ones. A particular constellation of symptoms, including cramping and often nausea and diarrhea, may be caused by excess production and release of prostaglandins. 8 (One form of prostaglandins, which are hormonelike chemicals found throughout the body, causes contractions of both the uterine and the intestinal muscles.) With too many prostaglandins, the usually painless rhythmic contractions of the uterus during menstruation become longer and tighter at the tightening phase, keeping oxygen from the muscles. It is this lack of oxygen that we experience as pain. Anticipation often worsens the pain by making us tense up. It’s not