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Model Zara Peerzada recently touched upon a topic not many people talk about in Pakistan, especially in public. She spoke about her difficulties going to work and being socially interactive while battling the "mentally taxing" symptoms of her menstrual cycle.

The model took to Instagram Stories to start a conversation on menstruation and the toll it takes on women mentally and physically, especially when they step out to work, study or engage in social activities. "We talk about going to work with [menstrual] cramps and headaches but where are my sisters with severe hormonal imbalances, PMDD, poor mental health and PMS? How do you cope if you have socially interactive job or work environment?" Peerzada asked her followers.

Many women routinely face physical, mental or emotional challenges during their periods. Hormonal imbalances, as mentioned by Peerzada, can manifest via medical problems such as Polycystic Ovary Syndrome (PCOS). Premenstrual syndrome (PMS) is a mix of symptoms that many women get before their period. These include bloating, headaches, cramps and moodiness. Premenstrual dysphoric disorder (PMDD) is more severe than PMS. It causes severe irritability, depression, or anxiety in the week or two before a period starts. While symptoms usually fade away once the period starts, women may need medicine or other treatment to help with their symptoms.

The symptoms of hormonal imbalances, PMS and PMDD can be severe enough to make it difficult to do everyday activities like go to work or school, or engage in various socially interactive activities that require a better frame of mind and health from the individual.

"As I've gotten older, my menstrual cycle has become extremely mentally taxing," Peerzada wrote. "Extreme anxiety, extreme anger, irritability and despondency. I feel like when it started happening I was caught off guard because so much of the conversation is based around the physical struggles of menstruation, and not the mental or hormonal changes [that occur] as your body grows older and your menstrual cycle evolves."

According to the US Department of Health and Human Services, PMS symptoms may get worse as women reach their late 30s or 40s and approach menopause.

"Younger audience, you will have mania to look forward to as you continue to menstruate," Peerzada said. "No one told me so I'm telling you. You're going to feel awful and out of control and cis men do not understand. Initially it will be hard to distinguish PMS or PMDD from your usual mental health struggles but soon you will be able to tell the difference, even though no one else will."

The model highlighted her personal struggles as well. "My partner and family have suffered the worst of it because I have a terrible temper that I have learned now to control, at least a little, when I'm ovulating or menstruating. But most days it cannot be helped. I try articulating that I am feeling angry or frustrated when I can instead of just exhibiting it. I give a fair warning to my partner when doomsday is near so they can be understanding when I am being unreasonable.

"The helplessness cannot be helped at all, neither the despondency. It can only be endured. An emotional support animal is my only respite in the days [my symptoms] are especially bad," she shared.

Peerzada stressed with her female followers the importance of learning more about PMS and PMDD in order to "learn about your body and its processes". "It brings a lot of peace in knowing the facts of how you may possible be functioning," she said. "Cis men with menstruating partners might also want to acquaint themselves (with PMS or PMDD) to make our lives just a little easier."

Peerzada apparently triggered an avalanche of supportive messages about her posts on menstruation. However, there were also messages from followers who couldn't understand why she didn't just stay home on days when her symptoms were especially difficult, as opposed to continuing going to work. "I know [these messages are] supposed to be well meaning but what? First of all, what days [should we choose to stay at home]?" she asked.

"PMS can start as early as day 14 of your cycle, around the time you ovulate, and last for several days after it's done," she explained. "That is two weeks out of a month. This is again feeding feeding into the narrative of periods bringing only physical discomfort for a couple of days. [Discomfort that can be] reduced with painkillers, sugar and heating pads. That is all really nice but that is really not all there is to it. At least not as you get older, and especially not if you are dealing with pre-existing mental health issues."

Peerzada also wondered whether there truly is a job out there that allows women to take leave whenever they want. "Not everyone can do that, or afford that," she stressed. "Please don't tell women that's all they can do. Again, it is not a matter of a couple of days for everyone. It does eventually become part of a lifestyle we have to continuously and secretly manage while being outwardly erratic."

We appreciate the model for starting a conversation that really needs to be had. Not only do people need to be educated about periods and the ill effects women suffer from during their menstrual cycle, other women also need to learn that they're not alone.