Horrible Hormones

“Oh! It’s The Hormones,” They Say

When I was a medical student, I once witnessed a disagreement between a male and female classmate. After the female student left, the guy just commented exasperatedly, “She must be PMS-ing!”. That came as a total surprise to me. It was the first time I had heard a guy use PMS (pre-menstrual syndrome) as a derogatory remark for his female counterpart. Is this how men generally perceive strong, vocal women? Is this why women are not taken seriously and not given equal opportunities as men? Because we have “hormones” that affect our physiology and psychology on monthly basis, a phenomenon none of us have control over.

So, what exactly are these “hormones” and how do they affect our mind and body? When a baby is born, it is the external genitalia that tells us whether it is a boy or a girl. Internally, boys have testicles and girls have ovaries that contain millions of follicles aka future eggs, that are ready to be released as soon as the girl hits puberty. And then it happens! The brain releases a set of hormones, FSH and LH, that trigger a cascade of physiologic events leading to puberty and menstruation – commonly known as periods. Ovaries release important hormones such as estrogen and progesterone which make us fertile or “child-bearing potential”.

Progesterone primarily supports a pregnancy. Most of the hormonal birth control methods such as pills, skin patches, injections, and implants contain progesterone which creates a fake state of pregnancy in the body hence preventing ovulation. Whereas estrogen triggers ovulation, and helps in breast development, strengthening bones (preventing osteoporosis), increasing fat stores in the body especially hips, thighs, and waist, preventing vaginal dryness, preventing acne, and also has an effect on mood changes. The exact mechanism of how estrogen affects the mood is unknown but experts believe different women react differently to the fluctuation of estrogen in the body during the menstrual cycle, hence the rollercoaster of mood swings in the more vulnerable kind.

That brings us to conditions like premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and post-partum depression (PPD). As many as 90% of women experience the unpleasant symptoms associated with these conditions before or during periods. These can range from mild to severe abdominal pain, cramping, headaches, bloating, breast tenderness, overly emotional state, anxiety, depression, irritability, and social withdrawal. Not all women have all symptoms, but 40% of women do suffer from some symptoms of PMS at some point in their life.

PMDD is a severe form of PMS and can cause significant personal problems in relationships if not treated in a timely manner. PMDD is mostly diagnosed when negative mood symptoms overshadow physical symptoms.  Low dose antidepressants and anti-anxiety medications can help lower the intensity of severe mood swings.

Around 20% of women suffer from post-partum depression (PPD) which is defined as a major depressive disorder within 6 months of childbirth. A lot of times, mild mood changes are ignored under the pretext of “baby blues” which is considered normal after childbirth. However, if the symptoms worsen, continue to prolong, are unmanageable and disabling, cause a rift in your social life, it is a  sign that you need help. The cause of PPD is the sudden drop of estrogen and progesterone in the body after childbirth.

Many times, doctors prescribe hormonal pills to control the symptoms of PMS, PMDD, and PPD. There is a general perception or fear that lies in the society that birth control pills disrupt the hormonal balance and can lead to infertility. Whereas, the opposite is true. Every women’s menstrual cycle is different and unique to herself. For some, a two-day period is normal, for others a 7 day period is normal. As long as your cycle is regular and maintaining its normality, you do not need to interfere unless it is causing a problem in your life such as excessive bleeding, not able to conceive, other severe PMS symptoms, etc. Birth control pills are basically hormones that regulate your cycle and correct the imbalance of hormones in your body. They are not only prescribed to prevent pregnancy but also for hormonal acne and mood swings. They are also given to post-menopausal women to prevent osteoporosis, and other post-menopausal symptoms such as hot flashes, vaginal dryness, etc. It is imperative to understand that these pills are there to alleviate your symptoms, and not cause them. You must always talk to your health care professional in detail, share your fears and get a complete understanding of your physical and mental health condition before starting any medication, be it pills or anti-depressant medications. Always start with a low dose to prevent dependency and reach out to a mental health expert for cognitive behavioral therapy to prevent prolonged mental health issues.

Do not let your hormones dictate your life.

Boss Women Pakistan is committed to playing a positive role in creating awareness about health issues women face overall. We need to be able to talk about the physical and mental health issues openly.