Many women in their fertile years become moody and tense and feel ‘down’ in the week before their menstrual periods. In about 2-8% of women these changes are severe. They may also feel hopeless and angry, may be easily distracted and disinterested in work, friends and hobbies. In addition, their breasts may feel swollen, their heads may ache, their abdomens may feel bloated, and their joints and muscles painful. Difficulties with sleepiness or sleeplessness may also pose problems. Within a few days of starting to menstruate, these difficulties diminish or disappear.
Women for whom these sorts of changes occur at a predictable time in most menstrual cycles may be suffering from premenstrual syndrome. Hormonal changes during the menstrual cycle are sometimes blamed for the condition but it seems there is also a strong psychological component. Distress from other sources, such as marriage, parenthood or occupation, may interact with hormonal changes resulting in intermittent negative moods and behaviours.
Patricia, a 35-year-old mother, sought help for severe irritability, uncontrolled anger, confusion, insomnia, fatigue and low libido, which typically appeared two weeks before her period and disappeared about a week after bleeding stopped. With a thirty day menstrual cycle, this meant she experienced only about eight days when she felt well and ‘in control’ of her situation. Doctors occasionally suggest a hysterectomy in such circumstances in a bid to relieve symptoms that are disrupting relationships and generally making life a misery. There is, however, little evidence to support the value of this approach as symptoms often persist after hysterectomy.
Patricia found a coping skills program incorporating anxiety-reduction techniques and responsible assertiveness training to be extremely helpful. Within twelve weeks she was increasingly positive about her relationships in all directions and regarded her premenstrual phase as a time when she felt ‘out of sorts’ but from which she would recover her competence within a day or two.
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