Tamara is a 22 year old young lady who lives in Passagefort, Portmore. Her menstrual symptoms are so bad each month that she often has to miss a week from work. The pain is really severe and she also experiences headaches, nausea, vomiting, tiredness and feels bloated during the entire menses. Although her employers are decent she is worried that she might lose her job as she is not yet confirmed as a permanent worker. Tamara has seen a physician more than once and has been prescribed with pain killers. Some of them help the pain but she still does not feel well enough to go to work. She asks Lifeline for help as she does not want to loose her job.

The hormones produced by the female ovaries and pituitary gland which influence the menstrual cycle, also affect tissues elsewhere in the body. These hormones have action not only on the uterus, cervix and vagina but also on the breasts, central nervous system and gastro intestinal tract. Common symptoms associated with menstruation are:

Dysmenarrhea (painful menses);

menarrhagia (heavy blood flow);

mastalgia (breast tenderness); and

pre-menstrual syndrome.

These symptoms all result from the effects of oestrogen and progesterone (female hormones) and so disappears during pregnancy and after and cease permanently after the menopause (change of life).

The Pre-menstrual syndrome can be associated with:

Loss of control of emotions including aggression anxiety, irritability and depression;

inability to perform normal tasks or to concentrate;

abnormal bloating;

Swelling of the breasts and breast tenderness;

acne; and

headaches (including migraine).

There is actually no hormonal imbalance to account for these symptoms. What has been found is that in these cases, the females' tissues exhibit increase responsiveness to the normal hormonal changes occurring. An association with decreased blood levels of serotonin, a brain hormone, has been found, which is why treatment with serotonin re uptake inhibition (SSRI'S) eg paxil, prozac and zoloft which are often used to treat depression and anxiety, might also help to settle the symptoms of the pre-menstrual syndrome.

The bloated feeling experienced by some ladies is thought to be due to gaseous distension as studies have shown that there is no actual increase in body weight or body water at this time. Because of this water pills (diuretics) will not work in this condition.

Use of an SSRI drug, e.g. paxil or zoloft, in association with non-steroidal anti-inflammatory drugs (NSAIDS) e.g. cataflam, feldene, ponstan, may help to subdue the symptoms associated with the pre-menstrual syndrome. Baralgin, an anti-spasmodic, may also assist with pain relief. Gravol or stemetil can also be used when nausea and vomiting occur. When the disorder is severe the expensive hormone, Danazol, can be used, short term, to suppress the ovarian cycle and bring relief from symptoms. Gonadotraphin releasing hormone analogue is also used to induce a type of menopause and stop the symptoms of the pre-menstrual syndrome.

Breast pain and dysmenorrhea are also reduced with the use of NSAIDS which can be combined with other medications such as panadine or tramacet, if necessary. Cyclical use of the oral contraceptive pill relieves dysmenorrhea (pain) in some women. Tamara should see a gynaecologist for review of her symptoms. There are other disorders, e.g. endometriosis, which can cause many of the symptoms experienced and associated with a bad, painful menstruation.

Write to:

Lifeline,

P.O. Box 1731

Kgn 8