Tuesdays, 9 a.m. - 12 p.m.
Indiana University Health Center
600 N. Jordan, Fourth Floor
The Kinsey Institute Menstrual Cycle Clinic is intended to help women
experiencing problems related to their menstrual cycles, in particular
difficult and painful menstruation (dysmenorrhea), heavy bleeding
(menorrhagia), or mood changes and other symptoms that recur
before and during menstruation (often referred to as premenstrual
syndrome or premenstrual dysphoria).
The philosophy of the clinic is to assess each woman's problem carefully
and help her decide on the best course of action. This may involve various
types of self-help, or medication, or both. We recognize three factors
that may possibly be relevant in each woman's case:
1. The timing factor -- the ovarian hormonal cycle and
its effects on brain function and other changes in the body. In the large
majority of cases there is no evidence of any abnormality or imbalance
in the ovarian hormones. Most women are aware of some variation in how
they feel throughout their cycle without it being a problem. For some
women, these cycle-related changes are particularly marked, causing distress
and disruption in their lives and relationships. The reasons for this
are not well understood. There are usually no abnormalities or imbalances
in the hormonal cycle itself. (The cycle depends on the presence of normal
ovaries, but does not depend on the presence of a uterus.)
In many cases, one or two of these factors appear to be important and interact
with each other; not infrequently, all three. There is, for example, a strong
link between period-type pain and premenstrual and menstrual negative mood.
2. The menstruation factor -- The build-up and shedding of the
lining of the womb is associated with biochemical and other changes that
may bring on pain or heavy bleeding, as well as mood changes. (This factor
obviously depends on the presence of a uterus.)
3. The vulnerability factor -- Other elements in the woman's life,
such as stress, relationship problems, or a tendency to get depressed,
while not directly related to the menstrual cycle, may make her more vulnerable
to the effects of the first two factors.
Before attending the first appointment, or when first arriving at the
clinic, each patient is asked to complete a Menstrual Health Questionnaire,
which asks for relevant details about menstrual history, use of contraception,
and symptoms experienced around the most recent menstrual period. This
provides much of the basic information required, and enables the assessment
interview to focus on other issues specific to a particular woman.
The patient is then asked to monitor her next two menstrual cycles by
completing a daily form on which she rates the presence and severity of
a number of emotional and physical changes. She is seen in the clinic
at the end of the first assessment cycle (when we find out more about
her and any background problems), and again at the end of the second assessment
cycle. By then, enough information has usually been gathered to enable
the clinic to advise the patient on management. It is particularly important
to carry out this assessment before prescribing medication. When this
is not done, it is difficult to determine to what extent the medication
is either appropriate or effective.
In advising women, we assess the relative importance of each of the three
factors described above. If, for example, problems in the woman's relationship
or work appear to be the most important factor, with the reactions to
these problems being most marked and noticeable around menstruation, focusing
on those problems may be the best course of action. We will discuss with
the woman how best to do that. Striving to modify a hormonal cycle when
some other problem is the key issue is not likely to be of much benefit.
In some cases, the menstruation factor appears to be the most relevant.
Treatment aimed at modifying menstrual bleeding and/or pain, often by
starting medication well before the onset of bleeding, may well be effective.
Oral contraceptives are sometimes useful in these circumstances. When
the timing factor is important, hormonal regimes may be helpful, not because
they correct any hormonal abnormality, but because they minimize the impact
of the natural hormones by flattening out the hormonal cycle (e.g., by
giving continuous estrogen and intermittent progestagen). Often, when
mood changes are marked, an antidepressant of the Prozac variety (Selective
Serotonin Reuptake Inhibitors) can be very effective.
Treatment and Follow-Up
Having completed assessment, treatment recommendations can either be
sent to the woman's primary care physician or organized through the clinic,
with periodic follow-up, whichever the patient prefers.
For further details about this clinic, please see the article, "Treating
Menstrual Cycle Problems the Interdisciplinary Way" in the September
1997 issue of Research and Creative Activity, an online publication
of Indiana University.
[Sexual Health Clinic]