Coping with Eve's Curse

By Anastasia Toufexis

Doctors are finally treating menstrual miseries

It has many names: period, monthly, that time, my friend. But for many women the most apt description is the curse. For about half of all women of child-bearing age, menstruation is a monthly misery that causes intense physical and mental discomfort. In the U.S. alone, menstrual problems result in the loss of 140 million hours of work a year. Menstrual pain, says Pathologist Laurence Demers of the Milton S. Hershey Medical Center in Hershey, Pa., "probably is the most common cause for absence of women from the work force."

Yet despite its impact, menstrual distress rarely has stirred medical interest. Some attribute the neglect to sexist bias by a male-dominated medical Establishment. Says Family Practitioner Penny Budoff of the State University of New York at Stony Brook: "Many physicians act as if pain is women's due and getting rid of it is almost sacrilegious." A more basic reason may be that doctors have been unable to explain the link between a bewildering array of physical and psychological problems and a normal physiological event. As a result, women have been urged to cope as best they can with bed rest and aspirin, or they have been labeled neurotics and offered tranquilizers. Says Psychiatrist-Endocrinologist Ronald Norris of Boston's Tufts University School of Medicine: "When there's no obvious injury, physicians tend not to be sympathetic." Neither is the public. According to a poll conducted for Tampax, 22% believe that menstrual pain is psychosomatic.

There are signs, however, of a shift in attitude. It stems in part from studies showing that the gripping pelvic cramps as well as the headaches, backache, nausea and diarrhea suffered by many women during their monthly flow may be caused by prostaglandins. These potent chemicals, produced by the body, help regulate functions such as blood pressure, blood clotting and reproduction. Says Demers: "Some prostaglandins made by the uterus precipitate the contractions that are necessary for menses and labor. But when they're produced in excess, the uterine muscle cramps." Carried through the bloodstream to other parts of the body, the prostaglandins trigger additional discomfort.

Some drugs inhibit prostaglandin production. Oral contraceptives, for example, are effective but inefficient. Says Budoff: "You have to take 21 days' worth of pills for 24 hours' worth of relief. And then there are the dangerous side effects" (increased blood pressure, a greater risk of stroke and cardiovascular disease). Aspirin is helpful against mild pain. Most favored today are three drugs used against arthritis: ibuprofen, naproxen sodium and mefenamic acid.

Less understood than menstrual cramps is the premenstrual syndrome. Days or even two weeks before menstrual bleeding begins, many women experience tenderness and swelling of the breasts, migraine headaches, abdominal bloating and acne. They become lethargic, irritable and depressed. Researchers contend that severely distressed women are apt to have accidents, abuse their children or commit suicide or violent crime.

Dr. Katharina Dalton of London's Premenstrual Syndrome Clinic has been investigating the problem for more than a quarter-century. She recently studied three female convicts who repeatedly broke the law and found that their infractions occurred only in the days just before their period. One woman with 26 convictions was well behaved most of the time, recalls Dalton, "but would suddenly burst out with some attention-seeking episode like arson, assault, or even trying to strangle herself." These incidents occurred at intervals of about 29 days. Eventually, the convict's charge was reduced from murder to manslaughter on the ground that she had committed a fatal stabbing when she was experiencing premenstrual syndrome.

Dalton believes the syndrome is tied to a drop in the level of the hormone progesterone before menstruation. Her recommendation: supplements of natural progesterone. Her ideas are controversial, but she has some supporters in the U.S. Among them is Tuft's Norris, who opened the nation's first premenstrual clinic last April in Reading, a Boston suburb. In addition to progesterone, the clinic offers other unconventional remedies such as vitamin B6, biofeedback and hypnosis. Also available are traditional counseling, diuretics, tranquilizers, antidepressants and advice to cut down on salt, caffeine, sweets and alcohol.

The most helpful treatment for many women may lie in a simple acceptance of their complaints. Says Virginia Cassara, who last year co-founded Premenstrual Syndrome Action in Madison, Wis., to provide information to physicians and the public: "You'd be amazed at how much just knowing you're not crazy helps." But clearly the educational effort is just be ginning. According to the Tampax survey, two-thirds of the public find menstruation an unfit topic for the office or social conversation and one-quarter deem it unacceptable for discussion by the family.

-- Anastasia Toufexis. Reported by Janice C. Simpson/New York and Sue Wymelenberg/Boston

With reporting by JANICE C. SIMPSON, Sue Wymelenberg

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