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

Wellness Update - - Fatigue And Lupus -

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.

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