How Your Period Can Change Chronic Illness Symptoms—and What to Do About It

We all know getting your period can be a major pain – cramps, nausea, bloating and a general feeling of blah. But if you're one of the 46 per cent of Australian women aged 18 to 44 who live with at least one chronic health condition, you may get the double whammy of period pain plus symptoms that worsen at a particular time of the month.

“Hormonal fluctuations during the menstrual cycle can impact multiple parts of our bodies, including the immune system, skin, metabolism, brain and other organs,” explains Dr Natasha Bhuyan, a GP.

The immune system behaves sort of like a seesaw during your cycle, adds Dr Shelly Chvotzkin, an obstetrician and gynaecologist. After you ovulate in the middle of your cycle, certain infection-fighting white blood cells increase in your bloodstream, while immunity in your reproductive tract dials down. “This is probably so the body doesn't reject a fertilised egg,” she explains.

But then once you get your period, the immune defences in your vaginal and cervical area tend to ramp back up. “There's a monthly recalibration of your immune defences, pain sensitivity, stress response, mood and skin,” Dr Chvotzkin says. “How strongly you feel these shifts depends a lot on your individual biology.”

And while, yes, it totally sucks that your period can wreak havoc on health conditions that don't even involve the reproductive system, there's a bright side to this: By paying attention to when your symptoms get worse or better during the month, you can build a timeline of when and how best to treat them.

In addition to reproductive health conditions such as fibroids, endometriosis and polyendocrine metabolic ovarian syndrome (PMOS, until recently known as PCOS), here are five other conditions your cycle can affect.

Migraine

Up to 60 per cent of women who get migraines – extreme, throbbing headaches often accompanied by nausea and sensitivity to light and sound – may notice they can time their period to when their headaches hit, and vice versa.

“The drop in oestrogen right before your period is a well-known migraine trigger,” says Dr Chvotzkin, who points out that these so-called ‘menstrual migraines' tend to be longer, more painful and harder to treat than migraines that occur at other times of the month.

The (somewhat) good news about this is you can work with your doctor to schedule headache meds – both preventive ones taken before a migraine hits and ones to dial down the pain once it does – based on your cycle. One review found that using frovatriptan twice daily for prevention, starting two days before menstruation, and then sumatriptan during the headache had the best chance of reducing pain in women with menstrual migraine.

And though it may not provide much comfort now, there's a light at the end of the migraine tunnel: “When women enter menopause and have fewer fluctuations in their oestrogen, their migraines tend to go away or improve,” points out Dr Christina P. Le-Short, a pain-management specialist.

Epilepsy

About 40 per cent of women who have epilepsy and menstruate may notice that the timing of their seizures coincides with their monthly cycle, a condition known as catamenial epilepsy.

“Oestrogen tends to make brain cells more excitable, which can lower the threshold for having a seizure, while progesterone does the opposite,” says Dr Chvotzkin. “It boosts a calming brain chemical called GABA and generally has a protective, anti-seizure effect.”

If you notice this timing, discuss it with your doctor, who may adjust your medications depending on the time of month when you're most at risk of seizures.

Depression

Premenstrual syndrome (PMS) is widely known for the irritability, moodiness, sore breasts and exhaustion many women get a week or two before their period. And for up to five per cent of women who menstruate, the hormonal changes can cause premenstrual dysphoric disorder (PMDD), a much more severe version of PMS that can cause depression, suicidal thoughts and panic attacks, among other symptoms.

Plus, the estimated 10 per cent of women who live with clinical depression all month long may find their symptoms get worse at certain points in their cycle.

“The impact of hormones on the brain is well established,” says Dr Bhuyan. “The decline in oestrogen impacts serotonin, a brain chemical that supports our mood. The interesting thing about brain health is that women who have depression versus women who don't have depression actually have the same level of hormones. So it's likely the hormonal fluctuations that are the key difference, not the total level of hormones themselves.”

Asthma

You might not think that your period can have anything to do with asthma (the chronic condition in which airflow through the lungs is restricted by certain triggers, making it harder to breathe), but up to 40 per cent of women with asthma have perimenstrual asthma. This group may experience more wheezing, coughing and shortness of breath in the days leading up to their period.

“Scientists don't know exactly why this happens, but they suspect the drop in hormones causes inflammation in the airways,” says Dr Bhuyan.

IBS

Irritable bowel syndrome (IBS) is twice as common in women as in men, and experts suspect hormonal fluctuations play a part, says Dr Chvotzkin, who points out that many women with IBS report looser stools, more bloating and worse abdominal pain right before and during their period. “Oestrogen and progesterone both influence how the gut moves, how sensitive it is to pain and how permeable the intestinal lining is,” she explains.

How Tracking Your Symptoms Can Help Keep Them Under Control

If you have to deal with chronic health issues that get worse during your cycle, the most useful thing you can do is take advantage of the data your body provides to come up with the best treatment plan for your symptoms.

The simplest and most effective way to do this is to keep a symptom diary, noting both where you are in your menstrual cycle and the severity of your symptoms on a scale of 1 (none) to 6 (extreme).

It can also be helpful to note other triggers, such as lack of sleep, diet, alcohol, travel and stress. Keep this up for at least two to three cycles, suggests Dr Chvotzkin, who points out that recognising patterns can help with timing treatments, adjusting medications and understanding why symptoms aren't always the same from week to week.

Several apps can also help you with this, such as Ourself and Bearable (always check privacy settings). You can also go old school and jot the info down in a notebook or on a calendar.

Once you have at least three months of data, bring your notes to your doctor so you can look for patterns and discuss the best ways to treat your condition based on your cycle.

“Certain types of contraception might be helpful in some cases, but might actually be detrimental in other instances,” says Dr Bhuyan.