Menstruation, also popularly referred to as periods, chums or ‘Aunt-flow’ is a natural process, which occurs post-puberty every month until menopause. Menstruation provides women with the biological ability to procreate. However, while this process is directly linked with a female’s reproductive abilities, pre and post menstruation can be physiologically and mentally taxing. Prior to one’s period, there are biological and hormonal changes in the body that trigger mood fluctuations, and symptoms of depression and anxiety. Many women also experience abdominal discomfort, water retention and skin sensitivity among other symptoms. The few days leading up to menstruation when women may experience uncomfortable changes in their body is known as premenstrual syndrome (PMS).
Premenstrual syndrome occurs in some form to 20% of women (Yonkers et.al. 2011) and can be categorized as moderate to severe, clinically. There are currently two biological theories with regards to women’s experiences of PMS. The first suggests that premenstrual complaints are elicited by the decrease in progesterone concentrations in the late luteal phase of the reproductive cycle. These changes are then linked to alterations in central nervous system neurotransmitters such as γ-aminobutyric acid (GABA). Alternately another theory indicates that the pre-ovulatory peak of oestradiol (oestrogen produced in the ovaries), or by the postovulatory increase in progesterone, resulting in the experience of symptoms of PMS (Yonker et.al. 2011). Regardless of the biological origin of these symptoms, every month millions of women around the world experience PMS and many suffer in silence.
PMS and mental health have an almost symbiotic relationship. The change in hormone levels, which vary in their modulation every month often trigger symptoms of depression, anxiety, irritability and sometimes even thoughts of suicide. When PMS symptoms are severe, the clinical term for it is Premenstrual dysphoric disorder (PMDD). PMDD impacts your quality of life and due to its cyclical occurrence and frequency can lead women to develop suicidal thoughts.
Imagine every month you start feeling like yourself and then, without warning, you suddenly feel nothing like yourself. It is bound to be frustrating and exhausting.
“Sometimes my mood would deteriorate over a few hours. I couldn’t stand my colleagues, I snapped at my client and I felt I couldn’t think. I got into trouble with my supervisor and was put on probation after this occurred for the second time… I just couldn’t for the life of me understand what was happening. This shift would happen a full ten to fifteen days before my period was due! It took my gynecologist three months to finally diagnose me with PMDD. I thought I was going mad…” (Rochelle, age 35).
The truth is there is a strong biological basis for mental health concerns and it is not surprising that when women experience PMS they experience temporary symptoms of anxiety or depression. For some, the symptoms are minor and fleeting but for some, like Rochelle, they are overwhelming and stretch across almost an entire menstrual cycle. I do think PMS takes in some ways more of a toll on women’s mental health, not only because of the hormonal changes that the body is forced to adapt to but the physiological toll that the body experiences. While the ovaries shed the body is working constantly and is losing blood, which contains nutrients and this puts the body under stress. It is like driving a car, which is leaking oil – while you have control, you also know something is slowing you down and that very understanding that you are not being able to drive/function at your optimum capacity takes a toll on you emotionally.
What has further led to women experiencing mental health concerns during PMS is because of increasing expectations placed on women by society. Particularly within the Indian culture, there is a narrative which implies that menstruation makes women unclean/impure, therefore a large section of society doesn’t openly talk about menstruation and concerns like PMS, and hence, diagnoses like PMDD can never be identified. Today, a large number of women work to support their families, but companies do not take PMS or PMDD seriously enough to have separate leave for them. Schools with strict attendance policies do not make exceptions when female students are uncomfortable during or before their periods. Policies and ideas like these subliminally inform women that not only periods and PMS are normal, but that pain and discomfort is okay, even expected. We send the message that one must be productive, even when uncomfortable and if that doesn’t impact one’s mental health, I don’t know what will.
In order to manage these uncontrollable changes, it is imperative for women to take extra care of themselves pre, during and post menstruation. The first step in taking care of oneself is accepting that menstruation is a biological process and there is no shame attached to it. It is ironic that women are praised and celebrated for giving birth to children yet the very natural cycle that allows them to do so is shamed and considered “disgusting”. Listening to your body and paying attention to what you feel is imperative, especially if you feel that these changes are related to menstruation. For example, if you are experiencing abdominal pain and are finding yourself short-tempered, remove an item from your to-do list and shift a deadline to give you more breathing room. Many women feel rest and slowing down will reflect poorly on their competence professionally, however, the truth is that slowing down or resting when required will help you maintain a balance and will eventually allow you to work consistently for a longer duration.
Finally, do not be afraid to seek professional help or guidance, as women we have somewhere internalized the narrative that discomfort is a part of your existence, it is time we start rewriting this story. If we respect ourselves enough to pause and give PMS and PMDD the time and awareness it needs, eventually we will change the cultural narrative, and society as a whole will move towards understanding these conditions better.