Menstruating While Pursuing Combination Therapy | Hepatitis Central

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Menstruating While Pursuing Combination Therapy

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Menstruating women have to deal with a period every month, even when on interferon-ribavirin therapy for Hepatitis C. Although menstrual discomfort can be magnified by combination therapy’s side effects, the usual drugs to relieve menstruation symptoms likely won’t mix with antiviral therapy. Thankfully, there are some natural ways to help ease this additional challenge to completing treatment.

Whether you are a woman facing combination therapy for Hepatitis C, or you are interested in offering support to one, this sex has an extra challenge to endure. Known as the standard therapy for treating Hepatitis C, pegylated interferon with ribavirin harbors many side effects and has an approximate success rate of only 50 percent. However, this is the best option physicians currently have for treating Hepatitis C. Women of childbearing age with this virus choosing standard therapy are bound to menstruate while taking their prescription. Unfortunately, interferon and ribavirin can exacerbate some common menstruation woes.


Each month, a woman’s menstrual cycle prepares her for a possible pregnancy. The average menstrual cycle is 28 days from the first day of menstruation to the start of the next one, but it can last between 21 to 35 days. The menstrual cycle commences with menstruation.

Commonly referred to as a period, menstruation is the part of a woman’s menstrual cycle in which blood and tissue are discharged from the vagina. Most menstrual periods last from three to five days. Aside from the characteristic vaginal bleeding, many women have undesirable symptoms around the time of menstruation including:

  • Cramping, bloating and sore breasts
  • Fatigue
  • Mood swings, depression and irritability
  • Headaches

If these symptoms are severe and occur one to two weeks prior to menstruation, premenstrual syndrome (PMS) is usually the culprit. Whether experienced before or during a period, the challenges accompanying this time of the month are even more of a struggle when compounded by the harsh side effects of Hepatitis C treatment.

Side Effects Most Prevalent for Women

According to liver specialist Melissa Palmer, M.D., women on pegylated interferon plus ribavirin experience side effects more often than men. The most frequently encountered issues women suffer from while on combination therapy encounter include:

  • Fatigue
  • Headaches and body aches
  • Depression
  • Anxiety
  • Irritability
  • Insomnia
  • Menstrual irregularities

Especially when compounded with cirrhosis, the three menstrual irregularities most reported by those taking interferon and ribavirin include:

  1. Premature or delayed menses
  2. Clotting and spotting during menstruation
  3. Increased premenstrual syndrome symptoms

Double Whammy

An estimated nine out of ten women live with menstrual cycle discomfort on a monthly basis. For the majority of people with Hepatitis C on interferon-based treatment, the drugs are prescribed for a minimum of six months. Therefore, women of childbearing age who are taking interferon-ribavirin therapy have a good chance of dealing with their period’s discomfort half a dozen times during the course of their medication. Since some of the symptoms occurring around menstruation and interferon-ribavirin side effects are similar, the effect is often compounded for the affected women. Some examples of this double whammy are:

  • Menstrual cramps coupled with the body aches characteristic of interferon medication
  • The fatigue that typically saps women during their period added to the fatigue inflicted by combination therapy
  • Premenstrual mood swings can intensify the level of depression associated with interferon therapy
  • Thanks to ribavirin-induced anemia, a woman who normally encounters delayed and scanty menstruation may find herself experiencing extreme exhaustion after her period

Safe and Natural Solutions

While a good percentage of menstruating women turn to over-the-counter drugs for their monthly discomfort, these beacons of relief are likely to be banned during interferon treatment. When this is the case, turning to four old, natural standbys for easing menstruation woes can lessen the impact of this double whammy:

  1. Apply Heat – A recent study found that applying heat to the lower abdomen relieves menstrual cramps as well as ibuprofen. The Lumbar Pac is an ideal sized hot pack that can be warmed in the microwave to deliver a nurturing heat to the low abdomen for up to an hour.
  2. Move Your Body – Even gentle, non-aerobic movement like yoga can lift the mood by releasing endorphins, which are natural antidepressants. In addition to the mood lift, movement can increase blood circulation, which reduces painful menstrual cramps.
  3. Eat Cold Water Fish – When eaten regularly, salmon, tuna or other deep-sea fish can relieve cramps and enhance mood thanks to their high levels of omega-3 fatty acids.
  4. Limit Caffeine – Studies have shown that women who reduce their caffeine intake two weeks before menstruation suffer less premenstrual breast tenderness.

There is no simple way to prevent menstrual or premenstrual symptoms while persevering through interferon-ribavirin therapy. However, acknowledging this inevitability can remove any surprises of intensified malaise. In addition, remembering that your period only lasts a few days can help keep your spirit from sagging. Lastly, leaning on the four complication-free suggestions to minimize menstruation woes can help you persist through a course of combination therapy – an effort that has the potential to suppress the Hepatitis C virus.

References:, What are the Side Effects of Treatment?, Hoffman-La Roche Inc., 2007., Women’s Issues with Hepatitis C – Side Effect Management, Melissa Palmer, M.D., 2007., Menstruation and the Menstrual Cycle, National Institutes of Health, 2007., Home: Curb Menstrual Woes,, 2007., Depression Symptoms Worsen Before Menstruation, Miranda Hitti, WebMD Inc., 2007.

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