Most women suffer discomfort to a greater or lesser degree during their monthly periods but how many feel frustrated, depressed, stressed and unable to focus for days, perhaps a week, before the first signs of bleeding even start?
Premenstrual syndrome (PMS) - sometimes called premenstrual tension (PMT) - is common to women all over the world - indeed, it's the subject of surveys, research and treatment in many countries. Here in Thailand, though, knowledge about the symptoms is limited.
Last year, the College of Public Health Sciences, Chulalongkorn University, decided to do something about this extraordinary gap by conducting its own PMS research based on the American College of Obstetricians and Gynaecologists international measurement standard. They found 58 per cent of Thai women suffer from PMS, most of them reporting its more common emotional symptoms.
"We used internationally accepted measures in conducting the research," says college dean, Dr Surasak Taneepanichkul, adding that PMS was diagnosed by combining at least one physical and emotional symptom. These symptoms must appear five days prior to menstruation and disappear four days after and reappear at least three months in succession.
The survey asked respondents to fill out a Women's Health Assessment Questionnaire that serves to measure the seriousness of the symptoms ranked from 0 to 4.
Physical symptoms include breast tenderness, oedema (visible swelling of hands, feet and legs), migraine, bloating and weight gain, insomnia and cravings.
Emotional symptoms include anxiety, frustration, depression, mood swings, confusion, stress, inability to focus and an unusual need to be alone.
The research shows that emotional symptoms such as mood swings tended to be higher than the other symptoms at 4.5 on the scale, while impaired concentration came in at 3.7 and water retention at 2.9.
While PMS symptoms have yet to become part of any public health campaign directed at Thai women, the ladies - and their menfolk - do share the physical and emotional manifestations as well as experiences in online chatrooms. Today, many Thais regard Internet communities as more instructive than the doctor's office.
The research, as well as online sharing, indicates that the main PMS symptoms suffered by Thai women are mood swings, the urge to cry and feeling down. Husbands and close friends bear the brunt of these emotions, though it seems working relationships suffer too.
"In worst-case scenarios, it can affect marriages. I've met women in the middle of a divorce who didn't know that the main cause of their unhappiness stemmed from PMS until they came to see me," says Asst Prof Manopchai Thamkhantho of the Department of Obstetrics and Gynaecology at Siriraj Hospital's Medical Faculty.
When emotional symptoms degenerate even further, women are described as suffering from Premenstrual Dysphoric Disorder or PMDD, a condition that can trigger the desire to commit suicide. About 8 to 12 per cent of American women are considered as PMDD sensitive.
"Thai women seem more tolerant of the symptom. I would say fewer than 3 per cent of Thai women have the desire to commit suicide when they are diagnosed with PMDD," says Dr Manopchai.
The cause of the symptoms is as yet unknown but is probably related to the hormonal changes caused by the menstrual cycle.
Dr Surasak hopes that the results of the survey will help women learn more about the symptoms and reduce misunderstandings in other parts of their lives.
"In fact, the symptoms are not that severe but if you don't recognise them for what they are, they can affect the quality of life. The research is just the beginning. We need to do more," says Surasak.
Tension and depression can be eased through exercise, getting enough sleep and finding an outlet for emotions. Medical treatment is an option. Manopchai says contraceptive pills of the "24/4" formula help to ease the symptom as well. The 24/4 regimen, he explains, is a unique low dose of the hormone drospirenone (synthesised progestogen), taken for 24 days followed by four days of hormone-free pills.
The regimen is clinically and significantly proven to treat the emotional and physical symptoms of PMDD.
However, women aged 35 and over who smoke should consult a doctor before taking the pills, as there is a risk of blood clots. And, as with other birth control pills, the treatment is not appropriate for those who have breast or uterus cancer, as well as those suffering liver diseases. Women who have dysfunctional uterine bleeding should also not use the pill.
"The side effects are bleeding and headache but less than with the conventional contraceptive pills. That's why it's not recommended for those with certain diseases," says Manopchai.
Another treatment option for severe PSM and PMDD is psychiatric counselling, though Dr Manopchai warns that this could have negative effects in the longer term.
In the end, staying away from medications and just going with a good understanding of nature is still the best option. But if you are considering the 24/4 pills, then do consult a doctor first.