For years before my official diagnosis I would get really ill for about 4 days before each period.  My symptoms included extreme fatigue, intense muscle pain, fevers, sore throat and flu-like symptoms.  This still happens now but I can handle it better because I know what is going on.  I can prepare and take better care of myself in the week before my period.     I wanted to look into whether there was any research into premenstrual flares.  A study (1) published last year found that many patients with lupus had higher pain, fatigue and disease activity during their period.  The authors of the study note that pre-menstual syndrome and flares may be confused but that there does seem to be menstrual cycle flares in lupus.     In an article written by Professor Graham Hughes (2) called  Is it Lupus? – The St. Thomas’ Hospital “Alternative Criteria”  premenstrual exacerbations are mentioned:  “All rheumatic diseases are clinically influenced by the menstrual cycle, and none more so than lupus. Some patients are almost immobilised during the 2 to 3 days preceding menstruation. It is my practice in some cases, to alter the dose of medication during this time. Although difficult to quantify, I believe that significant pre-menstrual disease flare is sufficiently prominent in lupus to be included in this “alternative criteria” list”.     I think that it is helpful to understand that lupus might be impacted by the menstrual cycle.  I find this empowering because I can take better….