Q. I am a 33-year-old female who has been living in Mexico City for the past year working as a newspaper correspondent. I have suffered a great deal of stress especially in the first half year. When I started having more time to myself and was able to relax, I started feeling absolutely exhausted and would occasionally wake up with my heart racing. Now, what worries me is that on some days, I feel a kind of pressure in my head. It's not a pain, more like a tight dullness that keeps me from concentrating. I have been suffering from PMS, which I had not had for a while, along with symptoms of depression and breast tenderness. Could it be that I am developing or have developed a hormone disorder or imbalance? Or could this just be a late reaction to the stress and the pollution in Mexico City and/or the altitude?

A. A number of things could be contributing to the symptoms you are experiencing. I would not attribute all to stress factors until you have had a thorough exam. In addition, it would be unusual to be experiencing the effects of altitude after living there for a year, since the body adapts to altitude pretty well after about 6 weeks. Mexico City is at 7000 feet elevation; the highest altitude of permanent habitation is found in some areas of Nepal at 17,000 feet!

Definitely start with a general check-up from your doctor which would include blood tests to assess blood count, liver, kidney, and thyroid function, and cholesterol. This will give a basis for proceeding with other tests as indicated.

HELPFUL WEBSITES:

• http://womenshealth.about.com/health/womenshealth/msub1.htm

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