How menstrual cycle effect mood

Mood and the menstrual cycle

Gynecological experiences are closely linked with a woman’s mood1. Disturbances of her reproductive function can upset her sense of well-being, her feelings about her sexuality, her femininity, and her self-esteem. Symptoms may affect her intimate relationships and bring greater distress than symptoms in other systems. Women presenting with gynecological problems often appear tense and anxious just because of the nature of the intimate questions and examination which they anticipate with some apprehension. Some come distressed and tearful. They may feel shame and disgust about their symptoms or because of the reaction of others. Many find the whole consultation an ordeal. The examination can remind a woman of previous threatening situations such as rape or childhood sexual abuse, or past experience of painful or demeaning examinations by previous clinicians.

Cycle effect mood

Certain conditions have overtones of moral judgment such as termination of pregnancy or sexually transmitted disease. In these cases anxiety and apprehension may be considerable. Some women are suffering with problems that disturb their mood but are not primarily gynecological rather psychological or social. Gynecological complaints are presented instead because there is stigma associated with mental health problems, and social and relationship problems may seem less appropriate to present to the doctor. This chapter considers the relationship between mood and menstrual cycle problems and models of care that enable effective management whatever the cause of the distress.

MOOD AND MENSTRUAL PROBLEMS IN THE CONSULTATION

There are several patterns of presentation of mood disturbances and menstrual complaint:

(1) Distress secondary to a menstrual disorder (e.g. menorrhagia);

(2) Mood disorder presenting under the guise of menstrual complaint (e.g. depressive illness presenting as premenstrual syndrome);

(3) Mood disorder and gynecological disorder (which may or may not have a common etiology) (e.g.oligomenorrhea and anxiety disorder);

(4) Intolerance of certain gynecological events in the setting of particular social and relationship stressors (e.g. complaint of menorrhagia after stopping the oral contraceptive pill following marital breakdown.

Women with problems look for an explanation of their difficulties that may yield some solution or at least exemption from excessive demands. They recognize that the doctor is willing and able to listen to them and to help by diagnosing medical disorders, clarifying the role of nonmedical factors where possible and reassuring them if there is no serious pathology. Gynecological problems are mysterious and abnormalities difficult to judge by women themselves. Menstrual disturbances are particularly ambiguous. Every woman has a slightly different pattern of experience, some have no pattern. Pain, mood changes, heaviness of flow are all difficult to evaluate, and pathology is hidden, requiring invasive examination. Therefore women present when their normal pattern has changed, when there is new or more intense pain or when they are worried about themselves or the impact of their symptoms on others. They may also appear following media or internet disclosure of some new way to manage a problem that they recognize in themselves. The overlap between menstrual cycle problems and psychological problems is considerable. Women need the assistance of the informed clinician to help them differentiate between the various factors that produce the symptoms and plan effective strategies.

Mood disorders and gender differences

Mood disorders in psychiatry are usually referred to under the general title of ‘affective disorder’ to denote a range of disturbances that are related to mood but which include anxiety disorders and depressive illness. Symptoms that range from worry to agitation, sleep problems to delusions.

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