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The question

As I age, my period has become absolutely exhausting the day before it hits. It's embarrassing to miss work for "hormonal" reasons. Help!

The answer

Prior to menstruation, women commonly experience some unpleasant symptoms such as bloating, cramping, irritability, mood changes and fatigue. For many, these symptoms are mild and a mere inconvenience, but for others they can significantly disrupt quality of life and interfere with day to day activities. Of all the physical and emotional premenstrual symptoms, fatigue is one of the most common and most challenging to deal with.

As in your situation, many women have to miss school or work and lose a day or two each month due to extreme exhaustion. The reassuring news is that there are many things within your control that may help to improve your energy. Before getting to these tips however, let's first understand why you may be experiencing this symptom.

Fatigue is thought to be secondary to an interplay of several factors with the most common being due to hormonal changes that occur prior to menstruation. Specifically, levels of the hormone estrogen rise and fall rapidly prior to menstruation which can lead to both physical and emotional fatigue. These hormonal changes can also trigger cravings for salt and sugar which in the short run may seem to satisfy, but can actually worsen symptoms.

First, if you haven't already done so, try making some healthy lifestyle changes the week before your expected period such as getting regular exercise, drinking plenty of fluids and eating a balanced diet. Try to eat several meals throughout the day to maintain your energy levels.

While it may be tempting to have some caffeine to perk up your energy or alcohol to relax, these can actually decrease your sleep quality and lead to lower energy.

If these changes do not seem to help and you're still finding yourself exhausted and needing to miss work, a visit to your doctor may be helpful to ensure that your symptoms are not due to an underlying medical condition such as low thyroid function, depression or iron deficiency.

Your doctor will be able to assess other potential symptoms that may accompany the fatigue, review your mood and may suggest medications such as the birth control pill which can balance the hormonal fluctuations and may help to decrease your fatigue.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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