Srilekha is in college. She dreads getting her periods because it means she'll suffer from an intense headache a day before she gets her menses. Subbulakshmi carries her inhaler in her bag around the time of her periods because she knows her asthma will get aggravated.
Why do periods precipitate problems?
Just before the period starts, the blood levels of estrogen and progesterone drop in the body. This can trigger several reactions which may aggravate a problem that does not seem to be so intense at other times. Migraine, asthma, epilepsy and vaginal yeast infections are some conditions that can be aggravated just before the period. This may also happen in the middle of the cycle, when ovulation occurs and the level of estrogen drops abruptly.
Asthma attacks
It is common for women to experience worsening of asthma symptoms when the menstrual period begins.
Coping with asthma
Most women will be able to cope with their asthma attacks once they see the connection with their periods. They just have to make sure that they use their inhalers more frequently close to their periods and also take any oral medication prescribed to them specifically at this time. It is also smart to lose weight (if overweight) and avoid other trigger factors such as dust and smoke.
Migraine
Migraines are intense headaches that occur periodically and are accompanied by nausea, eye pain, dizziness and sometimes, inability to function normally. They may be one-sided or may feel like a band of pain encircling the head. Migraines affect women much more than men.
Those with migraine know that the headaches are more frequently experienced just days before or during menstruation. In fact, studies have shown that approximately 60 per cent of women who experience migraines tend to have the attacks close to their monthly menstrual periods. Menstrual migraines typically begin between two days before and one day after the start of a woman's period. This association can be used to an advantage because those with migraine can prepare themselves and cut short the duration and severity, if not completely prevent, the attack.
Migraine attacks may also occur mid-way in the menstrual cycle, at the time of ovulation when there is less estrogen in the blood.
Coping with migraine
Some women have triggers such as salty food, chocolates and sweets that can bring on migraine. It is better to avoid these, especially before the period.
Triptans are a class of drugs that work directly to reduce the pain of migraines. They reduce inflammation of certain blood vessels in the brain thought to cause pain and block the release of irritating chemicals in the nerve endings. Women who have menstrual migraines can ask their physician if a triptan can be taken from two days before their period starts to two days after and see if it makes a difference.
Epilepsy
Many women with epilepsy find that their seizures cluster around menstruation, a phenomenon known as catamenial epilepsy. They may also have more seizures around ovulation.
Women with temporal lobe epilepsy seem to be most likely to have catamenial epilepsy. This has been correlated to the fluctuations of estrogen and progesterone at those times.
Coping with catamenial epilepsy
Your neurologist may prescribe extra medication in the week before menstruation in the form of an 'add-on' anti-epileptic. This is the commonest method of treating seizures around the time of menstruation.
Vaginal yeast infection
Vaginal yeast infection or candidiasis, is common and easily treated in most women. The infection is usually caused by an overgrowth of a fungus that is always present in the vagina. Normally it is kept in check by the body's own resistance and causes no symptoms. Occasionally, the yeast can multiply rapidly and cause thick, curdy discharge with intense itching.
Yeast infections may be more common around the time of a menstrual period. Usually, the most severe symptoms occur before the onset of a woman's period. During and after the flow, symptoms usually subside.
Coping with yeast infection
Women are usually prescribed an antifungal medication called fluoconazole, one tablet of which is taken at the onset of the period, usually for three cycles. If the infection continues to recur, further investigations may be required.
( The author is an obstetrician and gynaecologist practising in Chennai and has written the book ‘Passport to a Healthy Pregnancy'.)
