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Mental Health and the Menstrual Cycle

Association of Healthcare Funders of Zimbabwe (AHFoZ) article written by: Dr. Chido Rwafa- Madzvamutse, Consultant Psychiatrist for publication in The Herald on 31 October 2022

As discussed in previous articles, mental health is defined as a state of well-being in which an individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to their community. The menstrual cycle is a normal part of every healthy woman’s life, however many women face emotional challenges at the start of menses in puberty, during the monthly menstrual cycles and at the end of the fertile life of a woman, at menopause. Many times, these emotional and psychological challenges associated with menstruation have been misunderstood and mishandled, in addition the shame and stigma women face concerning menstruation and menopause can also affect women’s mental wellbeing and affect their ability to thrive in life.

How the menstrual cycle can affect mental health and wellbeing

The menstrual cycle works on a series of hormonal shifts and changes each month and over the course of a woman’s life. These hormonal changes can however have an impact on mental wellbeing in some women.

• Puberty and the first period: The first period often occurs around 12 years of age and is often seen as a right of passage in the development into womanhood. However, without adequate preparation, the changes that come with menstruation can result in anxiety, confusion, embarrassment and shame. The emotions that accompany the menstrual cycle maybe overwhelming initially and young women need support and guidance to help them navigate this transition and to better understand the transformation their bodies and minds will be experiencing so that they can cope and thrive.
• Premenstrual symptoms: Many women, even those long past the first period can struggle with premenstrual symptoms or Premenstrual Syndrome (PMS). These symptoms can affect up to 3 of every 4 women and occur during the week before the menstrual bleed and are both physical and psychological in nature. Physical symptoms include: abdominal bloating, appetite changes, breast tenderness, constipation or diarrhoea, difficulty sleeping, fatigue, skin eruptions or acne, muscle and joint pain. Psychological symptoms include: anxiety (feeling tense or on edge), sadness, tearfulness, irritability, social withdrawal and difficulty concentrating. The cyclical, monthly nature of these symptoms can be frustrating and overwhelming. For some women these symptoms can be severe and about 8% of women develop Premenstrual Dysphoric Disorder. These women in addition to the symptoms of Premenstrual Syndrome, may also experience depression, profound hopelessness, anger outbursts and difficulty or inability to function at home, at school or work. The symptoms may start up to 2 weeks before the menstrual bleed and can thus cause monthly distress and disruption in a woman’s life if not managed.
• Menopause: As women get older, a natural process of menopause occurs as the fertile period of a woman’s life comes to an end. This occurs on average around 50 years of age as reproductive hormones (mainly progesterone and oestrogen) fluctuate and eventually decrease leading to a range of physical and emotional symptoms. Physically during menopause women may experience erratic menstrual bleeding which eventually stops completely. Women often experience hot flushes which are sudden bursts of heat and skin flushing; night sweats, difficulty sleeping, fatigue, headaches and vaginal dryness and pain. Mentally, women may struggle with low mood; irritability or a short temper; difficulty concentrating or brain fog; forgetfulness, decreased libido and worsening of existing mental health problems such as depression or anxiety.

 

Shame and stigma associated with menstruation and menopause

Menstruation is a natural part of women’s lives yet many women and girls often feel ashamed and embarrassed about it. Families and society may also be part of the challenge, generating and reinforcing these feelings of shame. Menstruation still remains a taboo topic, it is often hidden and thought of as an unclean or dirty aspect of a woman’s life. The emotional impact of menstruation through premenstrual emotional and physical symptoms is also stigmatized even sometimes ridiculed worsening the sense of shame associated with menstruation. Menopause is also often associated with stigma and shame. Some very visible symptoms of menopause such as hot flushes, can expose women to ridicule and even discrimination. It is also a taboo topic and women often feel they have to endure the symptoms of menopause privately and quietly even if they are struggling and need additional support. All this can affect a woman’s self-esteem and confidence across their lifespan. It is critical that women, families and societies normalise conversations about menstruation and menopause so that women can get adequate support and are not ashamed or embarrassed concerning these normal experiences of a woman’s life.

 

How can I cope better with Premenstrual Symptoms and Menopause?

• Eat healthy: a healthy diet can help with hormonal fluctuations and mood swings.
• Moderate exercise: exercise helps the body release endorphins which are natural feel good
• Get adequate rest and sleep: sleep deprivation worsens physical and emotional symptoms associated with both PMS and Menopause
• Medication: Consult with your health care provider for adequate pain management for PMS and any pain associated with menstruation. Medication may also be prescribed to manage severe physical and emotional symptoms of PMS and menopause.
• Emotional support: It is critical for women to be able to acknowledge distressing emotions that may occur during the menstrual cycle and in menopause and find ways to express these emotions in a healthy way. Build an emotional support system around yourself with people who can give adequate emotional and practical support to help yourself cope with the challenges that may arise due to PMS and in menopause.

 

As we strive to be more aware of our mental health and wellbeing, it is important to support women and normalise the conversation around menstruation and menopause so that women can better cope and continue to contribute meaningfully and effectively to our families and communities and to thrive. If you think that you or someone you know may be struggling with a mental health problem linked to menstruation or menopause, please contact your nearest health care provider and get help.

 

(Dr. Chido Rwafa- Madzvamutse +263714987729)(www.ahfoz.org ; ahfoz@ahfoz.co.zw)