‘That time of the month’ often comes with more than chocolate cravings and extreme moods. It is accompanied by pain that some describe as ‘unbearable’ and ‘excruciating’ and even fatigue. While not being bubbly and lively during your period is often associated with the cramps getting you down and your hormones being all over the place, period fatigue is an actual symptom that causes a hindrance in daily activities and extreme tiredness. We speak to Dr Oshin Behl to understand why this occurs and what can be done to prevent it or lessen the intensity.

What is period fatigue?

Menstrual cycles are regulated by the change in hormones that takes place over the span of the cycle. During the period phase, or the bleeding phase wherein the uterine lining is shed, the estrogen levels fall and this is often said to be the reason for the accompanying PMS symptoms.

“Period fatigue is a very real phenomenon,” says Dr Oshin Behl, Founder of Dr Behl Clinic. “It is also known as period tiredness or menstrual fatigue. Most of the time, this is because of excessive bleeding. However, sometimes it is part of the symptomology of disease and in these times it becomes important to communicate this to your OB-GYN. Women shouldn’t hide this from their doctor, as it is only when they are open about it that something can be done to determine if this is the regular effects of the bleeding, or something more severe.”

How can period fatigue disorder be diagnosed?

Dr Oshin says that menstrual fatigue by itself does not have a separate scale by which it can be measured. However, there are scales that can be used to measure fatigue in general terms, if the period was not taken into account. “The problem with determining the measure of fatigue that a person is experiencing is that similar to pain, the measure is very subjective. It differs from person to person.”

Drawing comparisons between two people’s levels of fatigue could be misleading. “There is a scale called the Karolinska scale that is used to measure fatigue and visual analog scales, however, these are not very reliable unless the data of multiple people is measured and then correlated.”

She says in clinical terms if someone visits their OB-GYN and complains of period fatigue, it is unlikely that they will be asked to measure it on a scale. “They would instead ask you to describe it in terms of how severe is the fatigue on the days of your period while contrasting it with normal days.”

Can menstrual fatigue be prevented?

Women the world over would heave a sigh of relief if this were possible, however, owing to the subjectivity of each woman’s body type, lifestyle, interacting factors etc. it would be tough to have a one size fits all solution to the problem.

Dr Oshin highlights that in order to know how to prevent the issue, the causal factors must be known. “The most common reason is menorrhagia or heavy bleeding. A period that lasts longer than 7 days or if one needs to use both a tampon and a sanitary pad and still observes leaking. In this case, menstrual fatigue can be explained by the loss of blood. Another factor, in this case, could be less iron due to blood loss, and this would lead to anaemia leading to regular fatigue along with period fatigue. If one’s haemoglobin levels fall in the low category, they could go in for iron or B12 related therapy.”

She goes on to explain the other causes, such as disorders or imbalances in thyroid levels. “Hypo or hyperthyroidism can both be factors that lead to period fatigue. In this case, irregular periods can be seen, either too frequently or rarely. If this is the causal factor, weight gain is often seen along with period fatigue and your doctor may recommend you tests to assess the TSH levels.”

What is the difference between PMS and period fatigue?

Pre Menstrual Syndrome, or the bunch of effects that are seen right before one has their bleeding phase or period, is well known. However, Dr Oshin says that what is lesser known is that sometimes PMS can be the cause of this period fatigue. “At this time, the hormones estrogen and serotonin are low. These energy hormones are responsible for one’s activity levels and thus, their levels being low cause fatigue. In this case, it is important to correct the underlying cause. For cramps, antispasmodic help. For sleep-related issues, melatonin supplements may help. However, this should be taken under the supervision of your doctor.”

You may have often been advised by your doctor and by articles that having plenty of water during the period days helps. Dr Oshin agrees. “Hydration is key. Maintaining electrolyte levels of zinc and magnesium are important for the regulation of fatigue levels. They also help in the regulation of hormones.”

She advises that while period fatigue may seem normal and you might find ways to deal with it, you should visit your doctor and let them know. There is always a solution or help available at hand.