I have extreme fatigue about a week before my menstrual cycle. Is this due to my lupus or the hormone changes during menses? Do you have any other suggestions to help alleviate the pre-menstrual fatigue? Madison, WI
Hormonal changes, especially shifts in estrogen and progesterone around the time of menses, are a common trigger of fatigue in women both with and without lupus. Be sure you get checked for other causes such as thyroid disease and anemia if you have not already. Keeping a monthly symptom diary may help you predict the timing and severity of your premenstrual symptoms. There is some evidence that certain anti-depressant medications may help with premenstrual symptoms such as fatigue. Hormonal birth control, such as birth control pills, are often prescribed to treat premenstrual syndrome, including fatigue, however estrogen-containing formulations should be avoided in patients at risk for blood clots, so the decision should be discussed with your lupus doctor before starting.