From Premenstrual Syndrome (PMS) angst to missing tampons, there are plenty of myths surrounding menstruation. Dr Dharshini Gopalakrishnakone of The Obstetrics and Gynaecology Clinic at Mount Elizabeth Novena Specialist Centre explains the common period issues women face.
1. PMS angst is real. Period.
The mood swings, irritability and crankiness that occur before Aunt Flo arrives aren’t a made-up excuse for female irrationality. There’s a biochemical reason behind it, which is due to the sudden drop in certain hormone levels, mainly progesterone, the week before the period starts, said Dr Dharshini Gopalakrishnakone of The Obstetrics and Gynaecology Clinic at Mount Elizabeth Novena Specialist Centre.
In fact, a 2011 study in the Journal of Women’s Health found that about one in five women has PMS severe enough to seek medical attention. Studies done by the late Dr Katharina Dalton, a British gynaecologist who coined the term, suggest that in extreme cases, some women may even be vulnerable to violent behaviour and suicidal attempts during this period.
Consider seeking medical attention if PMS symptoms are severe enough to cause problems at work or with personal relationships. Once a diagnosis is confirmed, your doctor may prescribe treatments ranging from supplements such as Vitamin B6 to continuous oral contraceptive pills or anti-depressives, said Dr Dharshini. Cognitive behavioural therapy that involves talking to a therapist and improving problem-solving skills may also be used.
There is a silver lining to these pre-period woes though. According to a study published last October in Nature’s Scientific Reports, the hippocampus — part of the brain that controls and creates new memories as well as regulate mood and emotions — increases in size when your period starts.
2. You can conceive during your period
Unprotected sexual intercourse during your period is never a good idea if baby-making plans are not on the cards. Some women have very short menstrual cycles and may ovulate on Day 10 of their cycle or even earlier, said Dr Dharshini.
“Sperm can survive five to seven days within the pelvic cavity. Technically, it’s very possible to get pregnant if you have unprotected sex during your period,” she explained.
It is also possible to confuse early-pregnancy bleeding with menstruation. According to American Pregnancy Association, about a third of pregnant women experience bleeding in early pregnancy — that’s when the fertilised egg attaches to the uterus lining and implantation bleeding may occur.
The association recommends waiting three days before taking a pregnancy test, if you’re uncertain whether it is your monthly period or implantation bleeding.
3. Excessive weight loss can halt menstruation
While losing weight is recommended if you are overweight or obese, drastic weight loss can affect your fertility.
“Losing weight at a fast rate within a very short time or excessively (where the Body Mass Index goes below 19) causes the brain to recognise it as stress and modify the release of hormones such that ovulation and subsequently, menstruation ceases. When there is no ovulation, there is no period,” said Dr Dharshini.
The Health Promotion Board advises aiming for a weight loss of not more than 0.5kg to 1kg per week, or 10 per cent of your body weight over six months.
4. Tampons can’t get lost in there
From going missing to toxic shock syndrome, tampons have had some bad publicity in past years. But concerns about losing a tampon while using it is entirely unfounded.
“The tampon is inserted in the vagina, which has no other orifices adjoining it, aside from the tiny cervical canal leading to the uterus. There is no possible way for a tampon to sneak through the cervical canal, so it can never be lost,” said Dr Dharshini.
To avoid toxic shock syndrome, a rare but serious infection caused by the release of poisonous substances from bacterial overgrowth, she advised avoiding super absorbent tampons, washing hands before insertion, and maintaining good hygiene.
Tampons should also be changed regularly — every four to six hourly — or more frequently, if there is a heavy flow.
5. Excessive period pain isn’t normal
Most women experience menstrual cramps, which are often described as a dull, throbbing pain in the lower abdomen. But if the cramps are preventing you from getting out of bed or carrying out your daily activities, you should see a doctor, said Dr Dharshini.
Pain during menstruation could be a sign of endometriosis — a condition where cells from the lining of the womb grow in other parts of the body, according to The American College of Obstetricians and Gynaecologists. Severe cases of endometriosis can lead to infertility.
Make a doctor’s appointment too if your menstrual flow is heavy enough for you to change a pad every hour or so, or causes symptoms of anaemia such as general fatigue, weakness, pale skin and dizziness.
To reduce period pain and PMS symptoms like water retention, a low-fat vegetarian diet might help, according to a study published in Obstetrics and Gynecology in 2000.
Both aerobic and stretching exercises were also found to be effective in reducing the severity of menstruation pain, according to a study published in the Journal of Family and Reproductive Health in 2015.
