ASK THE DOC
Dr Rayne answers your questions about adrenal fatigue, heavy periods and bruises before a menstrual cycle.
Q: I am really stressed. A friend said I could have adrenal fatigue. What should I do?
A: The adrenals, a pair of glands that sit on top of the kidneys, produce many of the hormones that humans need to survive. Their main product, cortisol, regulates our growth and wellbeing. They also produce some male and female hormones (especially in women after the menopause) and they produce adrenaline, which gives us the fear response of palpitations and extra alertness.
Adrenal fatigue is a name that has been given to a theory that chronic stress could cause an ‘overuse’ of the adrenal glands and therefore cause them to fail. Many pills and regimens to combat ‘adrenal fatigue’ are being promoted, but a recent scientific review found no medical studies or literature to support this theory. However, it feels like an attractive theory when there is very little to explain why we may feel tired or lethargic without any other seeming cause.
How we respond to stressful circumstances is variable, and a home, work or relationship issue that might stress one person might not affect another. So studies looking at stress and how it affects the body are quite difficult to do.
What is true is that when people feel that they suffer from burnout, it is important to break the cycle of stress and feelings of ill health. Studies into work stress have found that a lack of control over circumstances is an important factor and can hamper resilience. A combination of a thorough physical work-up by a good doctor to pick up underlying medical conditions, some psychological input and changing of circumstances (if at all possible) may help.
Q: I’m a couple of years short of the average age of the menopause. My period is heavier than ever (and it has always been heavy). Is this normal?
A: The menopause is the term for a time where a woman’s ovaries stop producing oestrogen and her monthly periods cease. It normally happens between 48 and 55 years. Most women go through the menopausal transition, during which the hormones can fluctuate. Often, your periods will change in their character and become heavier for longer; at the same time they may become more irregular. These erratic hormones can make your breasts feel more tender and affect your mood. Hot flushes are common, and you might notice a change in your sex drive.
Regarding your periods, you should see a doctor if they go on for more than eight days or happen more frequently than every three weeks. For more information, there are great resources at www.menopause.co.za.
Q: I bruise very easily, especially as I get closer to my menstrual cycle. I can have up to 20 bruises on my legs then. Should I be worried?
A: Bruising is caused by a breakage in the capillaries under the skin. When they break, blood leaks out and takes up space, causing pressure – which is why a bruise is sore. It takes a while for the blood to be broken down by the body and reabsorbed. It does this by breaking the blood into different parts, some of which have green or blue colours, which is why bruises go through that fantastic range of colour changes.
Women have finer capillaries than men, so we bruise more easily. Bruising is also well described as part of the spectrum of premenstrual symptoms, so it is common to get more bruises in the second half of your cycle. If you take antiinflammatories to help with premenstrual symptoms, they can also affect your clotting and lead to more bruising. So I wouldn’t be worried by that.
If your bruises are lumpy, however, or you also have problems such as nosebleeds and gum-bleeding, it’s worth talking to your doctor about it. There is a little-known clotting condition called Von Willebrand Disease that affects a woman’s ability to clot well, and the most common signs are heavy periods and prolonged bleeding after small injuries. It is not lifethreatening, but sometimes needs careful management, particularly around pregnancy and birth.