Monday, June 20, 2011

Fighting Our Evil Twin

The PMS - Relapse Connection

For many women, the days prior to the start of their period are marked by an increase in unpleasant symptoms, ranging from the physical to the emotional.  We may become irritable, moody, and listless while our bodies put on weight, cramp, or otherwise put us through physical discomfort.  For some, this monthly roller-coaster becomes overwhelming.  Research has shown a correlation between the luteal phase of the menstrual cycle (days 14-28) and increased alcohol consumption in women.  For those with dependency issues, this is of particular concern as it raises the real issue of relapse during this period of emotional distress.

In early sobriety especially, PMS can be a major trigger in relapse.  It could even be suggested that the difficulties so many women face in obtaining 30 days of continuous sobriety are tied to the hormonal cycle.  For those who suffer more serious symptoms immediately prior to their periods, having these symptoms occur during the initial withdrawal phase of recovery can be devastating.  Those with longer sobriety can similarly find their recovery faltering when their “evil twin” makes an appearance.  This hormonal sabotage even finds its way into menopause, causing some women to relapse after years of sobriety.

Relapse doesn’t have to be the end result of a particularly fierce case of PMS, however.  As with all other aspects of recovery, the more attention we pay to our behavior and thoughts the stronger we become and the less likely we are to resort to addictive methods of handling emotional stress.  We can think of PMR (pre-menstrual relapse) prevention as a focused effort within our overall plan.  There are several aspects for us to consider in constructing this plan, which I will discuss below.

Determining Your Cycle (charting)

The most important aspect of preventing a Pre-Menstrual Relapse is knowing when to heighten our awareness.  Maintaining a cycle chart can help us discover when during our cycles we begin to experience problems.  You may incorporate this charting into your daily journaling activities or choose another method.  You want to list when you are feeling certain symptoms associated with PMS.  These break down into a few areas:

Emotional – Moodiness, irritability, anxiety, sadness, tension, crying spells, difficulty concentrating
Physical – Bloating, breast tenderness &/or swelling, cramps, headaches/migraines, joint pain, backache
Sleep – Fatigue, increased sleep, insomnia
Cravings – Food binging, alcohol cravings

This list is not exhaustive.  You may have other symptoms which you generally recognize as happening just prior to your period, including changes in libido and bowel/bladder function.  Your charting entry for each day should include the date and any symptoms you are experiencing, along with their severity.  You should keep this chart for a couple of months, until you can see where in your cycle you begin to see your symptoms reaching a critical mass.

If you are new to sobriety, don’t assume you will have to suffer through relapses for months until you fill out your chart.  Recognizing the immediate symptoms can help to short-circuit the relapse process even the first month of recovery.

Nutritional Support & Exercise

Good nutrition is important throughout recovery, but even more so during the PMS phase.  B Vitamins, thiamine, niacin, calcium, Vitamin D, riboflavin, folate, magnesium, and zinc are all important as they are excreted at a higher rate when estrogen levels are high.  High levels of estrogen also appear to contribute to sugar/carbohydrate cravings.  Taking a good multi-vitamin is an important part of your daily nutritional regimen.

It is also suggested that women limit their intake of caffeine, salt, and refined sugar during this phase.  Eating smaller meals more frequently may help maintain blood sugar levels and even mood.  Don’t go too long without eating.  Snack suggestions include plain yogurt, unsalted nuts or popcorn, whole wheat bread with peanut butter, oatmeal or bran muffins, apple slices, raisins, dates, fresh vegetables, and fruits.

Exercise remains important during the PMS phase.  Exercise, such as walking or swimming, has been shown to reduce PMS symptoms which can also reduce the risk of a pre-menstrual stress-related relapse. 

You may also wish to consider yoga, meditation, relaxation therapy or massage.   Being gentle with yourself is more important during this time as your thoughts and feelings may seem outrageous or overboard.  

Meetings & Other Support

From the point of view of relapse prevention, this is an extremely important area to consider.  If you do not regularly attend chats or meetings, you should plan to do so during the period of greatest risk in your cycle.  Formal online chats are available through the Women for Sobriety site twice per day most days, and other programs certainly offer online chats as well.  Even if you do not feel like talking during a formal chat, making the effort to be present will help keep your mind focused on the importance of your sobriety.

Friends can be a valuable asset during your “cranky” phase.  Having someone you can talk to helps alleviate the pressure you can feel when you are out of sorts with yourself.  Don’t be afraid of expressing negative thoughts during this time; recognize that they are coming from a part of yourself that is transient and that they do not have any more power than you give them.

Talking to Your Doctor

If you suffer from severe PMS and/or severe cravings for alcohol during the days just prior to your period, you should talk to your doctor about medical options.  Certain anti-depressants and birth control pills have shown success in leveling moods during PMS and reducing symptoms.  There are other medications which may be successful as well.  Psychotherapy has also shown promise in preventing relapse during the PMS phase.  It is important to take your thoughts seriously if they involve harm to yourself or others or if you find you cannot weather the emotional storm without drinking month after month.  Speaking to a doctor or healthcare professional is a sign of strength, not weakness.  Do not feel that you have to “do it alone”.


PMS can be an emotional roller-coaster that makes drinking look like a sane treatment option.   The physical and emotional symptoms may seem unmanageable without losing our sobriety, but by recognizing the biological processes at work and formulating – and following – a plan to counter the monthly blues, we can weather the visit from our “evil twin” with our recovery intact.

#4. Problems bother me only to the degree I permit them to.
I now better understand my problems and do not permit problems to overwhelm me.

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