Tuesdays, 9 a.m. - 12 p.m.
Indiana University Health Center
600 N. Jordan, Fourth Floor
Bloomington, Indiana
Ph. 812/855-3878

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).

Clinic Philosophy

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.)

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.

Patient Assessment

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.

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