How PMS Can Promote Relapse

By Shannon Kelley 05/14/11
Women are used to Aunt Flo showing up every month. But few know how susceptible it leaves them.
Relapse: Worse than monthly cramps Thinkstock

It’s easy to make light of PMS—especially if you’ve never experienced it—but the hormonal fluctuations of a woman’s cycle can be all too unfunny when you’re experiencing them firsthand. And, as it turns out, the time leading up to Game Day for Crimson Tide can actually be a trigger for relapse. Sue Constantine, a residential nurse practitioner at Florida’s Hanley Center, says, “Time and again, we see girls go out, and then they’ll come back and say, ‘It was right before my period when I picked up again.’”

It’s a familiar story to 60 year-old Nancy, who logged 15 stints in detox between the ages of 24 and 30. And, she says, almost every time it played out the same way. “I’d have some time sober, then I’d get angry, irritable, impatient, depressed, and I’d say screw it and drink.” Every time, the morning after, Nancy would get her period. “It probably wasn’t until the tenth time it happened,” she says, “that I made the connection.”

Just think about the typical PMS symptoms—irritability, fatigue, emotionality, insomnia, bloating, cramping, backache, increased appetite, and cravings—and it makes you begin to wonder why all women don’t relapse then. And when you consider the physiology behind some of these symptoms, it becomes even clearer just what women are up against. For instance, those cravings for all things carbalicious come about because hormonal changes cause a drop in blood sugar, which makes women primed to seek out high-sugar stuff that’ll give that blood sugar a nice, quick spike. And what does that in spades? Alcohol.

“Time and again, we see girls go out, and then they’ll come back and say, ‘It was right before my period when I picked up again.’”

There are other ways PMS can wreak havoc on a woman’s sobriety. Jenny, a 31-year old New Yorker who’s nearly two years sober, says she notices a distinct “shakiness in my sobriety when I’m PMSing.” The emotional roller coaster knocks her self-confidence, and exacerbates those feelings of  “terminal uniqueness”—which leads to behaviors that are “antithetical to what you’re supposed to be doing as a sober woman.” When she should normally be engaging with people and going to meetings, instead “I want to stay inside and isolate—which can very easily and very quickly lead to relapse.”

Additionally, PMS is a notorious relationship-stressor (Nancy recalls kicking her boyfriend out for that one week every month) and relationship drama is another trigger for relapse. And for a woman who’s been using or drinking for many years, the first sober go-round with a nasty bout of PMS can be intense. “Around my period I would always drink a ton,” Jenny recalls, and says that being sober during PMS is “like putting a magnifying glass on my issues, because they’re not cushioned by wine. It was like I was experiencing them for the first time.”

Dr. Alisa Ruby Bash, an MFT in Beverly Hills who has worked with women in recovery for several years, says, “Learning to tolerate discomfort while sober is one of the most important cornerstones of recovery. Most people are very fragile in recovery, especially in the beginning, and can easily relapse when faced with unexpected challenges and stress. You can see how PMS would create the perfect storm for relapse.”

All of which is why paying close attention to your cycle is so important, says Constantine. At Hanley, women track their cycles and moods each day using a simple graph. “Then we can determine when the hormones are shifting,” Constantine explains, adding that this is when cravings are the strongest. Being armed with this information allows a woman to plan—as 33-year-old Haley does. “If I know I’m going to have a rough time for a few days a month,” she says, “I’ll be accountable to my sponsor those days and go to a women’s meeting—maybe even two on the same day."

But it’s not just PMS. Hormonal swings at all stages of a woman’s life are inevitable—and inevitably troublesome. Constantine notes that, several years ago, when doctors began pulling women off of hormone replacement therapy (which was used to alleviate menopause symptoms) after a study exposed a link between HRT and breast cancer, she began seeing women with decades of sobriety relapse. “We’d ask, ‘What happened? Is there anything you can think of?’ And they’d say ‘Yeah, I stopped taking my HRT.’”

Menopause is actually what snuck up on Nancy after 20 years of sobriety.  “I went through menopause, and relapsed,” she admits. “And I’ve been relapsing for ten years.” At the time of our interview, she had 72 days of sobriety. 

“I didn’t know that when I hit menopause that this would happen,” she says. “I went down into the black hole and didn’t have enough of a program to buoy me up before I relapsed.” This time, she says, she’s doing everything she did when she was 30 and eventually stayed sober for two decades: “going to meetings, getting active, doing the steps and talking my sponsor.”

Since there’s no escaping the hormonal highs and lows of womanhood, the message for sober women is clear: pay attention to your body and reach out for support. Because you just know your monthly “gift” isn’t going to give it to you. 

Shannon Kelley is the author of the book Undecided and a columnist at the Santa Barbara Independent. Her work has appeared in Woman's Day, The Christian Science Monitor and Santa Barbara Magazine.

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