Why am I so turned off by sex before my period?

Q. I usually enjoy sex, but before my period I am turned off intercourse completely. I get irritable and don't want to be touched. Why?

A. Premenstrual dysphoric disorder (PMDD) is similar to the well-known premenstrual syndrome (PMS). It appears a week or two before menstruation, due to the hormonal changes throughout the menstrual cycle.

PMDD affects up to 5% of women in their reproductive years. The symptoms appear as hormone levels begin to fall after ovulation. Researchers have discussed the role of the brain chemical serotonin and its role in the symptoms of PMDD and the milder PMS.

Serotonin levels naturally change throughout the menstrual cycle and some people may be more sensitive to these changes, resulting in symptoms of depression, irritability and tension. Noticeable differences in libido, desire and preferences in sexual pleasure play can be expected.

Symptoms of PMDD include irritability that may affect other relationships, feelings of sadness or despair, or even thoughts of suicide. In this case, medical care should not be delayed.

Other symptoms include anxiety, panic attacks, lack of interest in daily activities and relationships, poor concentration, fatigue, food cravings or binge eating, insomnia and feeling out of control.

The classic PMS symptoms, such as cramps, bloating, breast tenderness, headaches and joint or muscle pain may also be severe.

Treatment options include antidepressants. Selective serotonin re-uptake inhibitors have been approved to treat PMDD. Birth control pills containing drospirenone and ethinyl estradiol are recommended for use.

Over-the-counter pain medications are used to relieve physical symptoms such as cramps, joint pain, headaches, backaches, and breast tenderness.

PMDD can affect the quality of life - or the symptoms may warrant management by a specialist team of healthcare providers.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za. Mofokeng has been named SA's Commissioner of Gender Equality by President Cyril Ramaphosa.

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