Ask any woman with regular cycles about her periods, and she will tell you how much she dreads them. Any girl right from puberty meticulously schedules her travel, holidays and activities around her periods. Indeed, this monthly cycle takes us for a ride, and there is not much getting around it.
But today, I will not be speaking about periods but rather the problems that accompany them. Most of these effects are related to the hormonal changes that all women experience during their fertile years. The first day of your monthly cycle is considered to be the beginning of the period. During menstruation, your reproductive hormones are at their lowest point, which causes the shedding of the inner lining of the uterus as vaginal bleeding.
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If you go back by about two weeks, the hormones estrogen and progesterone are at their peak, causing ovulation to occur. At this time of the month, your skin glows, you are more attractive and more energetic. However, as the next two weeks pass and there is no sperm to fertilise the egg released during your ovulation, the hormone levels start to dip. This, in turn, can lead to irritability, lower energy levels and a temporarily depressed sex drive, which brings us to the first annoying side effect of periods--PMS.
The week before the actual periods can be arduous on most, if not all, women. There is the moodiness, the carb craving and a general feeling of ill-being. It's easy to get stressed and, at times, even break down. This weepiness does not mean we are demons waiting to unleash our fury. The dip in estrogen is the cause of this temporary shift in the woman's mindset and tolerance. Estrogen promotes the action of the happy hormones: dopamine and serotonin. So, when the production of estrogen wanes in the absence of pregnancy, so does our mood.
We crave carbs due to the same reason. Our body is not getting the hit of serotonin, so it craves an external factor for the feel-good hormone production, which happens in the form of sugar. In addition, physical symptoms such as painful and enlarged breasts and bloating are a part of PMS. The bloating and breast tenderness is not caused by the direct action of the reproductive hormones. Instead, the dropping levels facilitates a group of hormones prostaglandins to act and drive all the water retention in your body, adding to the irritability that inevitably accompanies PMS.
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Some women face a more severe form of PMS with fewer physical symptoms and more emotional effects. Despairing thoughts, suicidal ideation, anxiety and extreme moodiness, which resolve with the start of the period flow, can be diagnosed as premenstrual dysphoric disorder (PMDD). Women suffering from PMDD often also face problems in their relationships due to their emotional volatility. It may need to be addressed with clinical guidance by a medical practitioner if the symptoms affect you and those around you a lot. Treatment includes counselling, cognitive behavioural therapy and, if necessary, medication.
And yes, skin breakouts are also linked to your period. The last few days before the start of the period are marked by the appearance of the very unwelcome guest, the period pimple. The hormonal culprit that causes it is testosterone. Even though testosterone is touted as the male hormone, females have it in smaller quantities in their body too. During the month, estrogen, progesterone and testosterone act together in the reproductive cycle. But as the period approaches and the female hormones wanes, testosterone gets a pretty free rein to wreak havoc on our skin. It's relatively high level when it acts on our oil glands in the presence of bacteria causes our skin to break out. Vigorous cleaning will not do much good, so stick to your regular skin hygiene routine. And don't pop that pimple, no matter how tempting. It will get resolved on its own.
As we move ahead in the cycle, the physical symptoms start to appear. Breast swelling and abdominal bloating, as I mentioned, are caused by locally acting hormones called prostaglandins. These hormones reach their highest level on the first day of your period and are the main culprit causing period cramps. The effect of prostaglandins is to constrict the blood vessels of the uterus and cause its inner lining to start shedding. The constricted arteries reduce blood supply to the uterus, and the lack of oxygen causes painful cramps. It also causes the uterus muscles to contract and push the lining out.
A less spoken about after effect of the local action of prostaglandins is the infamous period poop. Unformed and gassy stools during the first two days are quite common and it is often difficult for the woman to distinguish the period cramping and diarrheal cramps. Quite often, using the bathroom mitigates the severity of the cramping. A simple remedy to tackle the cramps and bloating is to apply a hot water bag to your lower abdomen. The heat helps relax your muscles and the increased blood supply due to the heat application helps flush out the pesky local hormones that are causing the symptoms.
Another thing that can help manage your period better is staying away from coffee. Caffeine has the opposite effect on blood vessels and can worsen cramps; opt for herbal teas instead. In addition, you may crave sweet treats during your period. While it is okay to have a chocolate or two, it is better to opt for natural sugars such as fruits to satisfy your cravings. Finally, anti-spasmodic medicines such as mefenamic acid are often beneficial for severe cramps, and it is a complete myth that you cannot take it every month. It is not addictive, and it will work in the future too. But if you need to reach out for more than two pills in each cycle for your cramps, then it is better to get evaluated by your gynaecologist for a serious underlying cause for the severe pain.
Dr Farah Adam Mukadam is a Bengaluru-based family physician and author of the book Newborns and New Moms. She vlogs on Instagram and YouTube as Dr Farah_Momstein