Health

Causes of chills before menstruation - why the problem occurs and how to solve it

On the eve of the onset of menstruation, many of the weaker sex notice that they are beginning to freeze. There are several explanations why a woman is shivering before menstruation. Various factors can provoke an increase or decrease in body temperature indicators, resulting in discomfort in the form of a feeling of cold. Basically, the reasons for which it freezes on the eve of menstruation, pass independently in the first days of the new cycle and do not require treatment.

Physiological causes

In the last days of the menstrual cycle, body temperature fluctuates, which is why it starts to freeze.

Increasing or decreasing the temperature index depends on ovulation: on the eve of this process and after it, the measurement results are lower, and in time - higher. As a result of such drops before the beginning of menstruation, a woman has a feeling of chilliness, cold.

Another physiological condition that affects the feeling of coldness during menstruation is an increase in progesterone levels. This hormone affects the processes of thermoregulation in the body, increasing the temperature index in the last days of the menstrual cycle.

These physiological factors cause temperature drops before menstruation, as a result of which the skin turns pale and shivers appear in the muscles. In some cases, with a strong effect on the processes of thermoregulation in a girl, her lips may turn blue.

These symptoms disappear on their own when the next phase of the menstrual cycle begins, but provided that the body temperature does not rise above 37.6 degrees, this is a sign of pathology and requires an appeal to a medical professional.

In order to know exactly what is happening with the woman’s body at each phase of the menstrual cycle, we recommend reading additional information on this topic.

Atypical form of PMS

Chills are caused by the atypical form of premenstrual syndrome (PMS). There are 3 types of this phenomenon, but it can freeze a girl only with one of them: hyperthermic. It is characterized by an increase in body temperature before menstruation to 38 degrees. With the beginning of the monthly this figure falls.

This phenomenon is associated with an increase in the level of progesterone on the eve of critical days and its decrease in the event of bleeding. In this case, the woman is shivering before menstruation due to an increase in temperature.

Inflammatory diseases

The appearance of chills during menstruation can be triggered by inflammation in the genital area. Under such conditions, body temperature rises strongly: it exceeds the rate of 37.6 degrees. Among the main reasons for the appearance of heat on the eve of the onset of menstruation are:

  1. Inflammation and endometritis in the uterus - with an infectious lesion of the mucous membrane of the organ. The inflammatory process at the end of the cycle appears on the background of a weakened immunity, which is why pathogenic microorganisms begin to multiply more actively. Symptoms of pathology: constipation, pain in the lower abdomen and during urination, the appearance of purulent or yellowish vaginal discharge. A gynecological examination indicates an increase in the uterus.
  2. Adnexitis is an inflammatory process in the appendages. With this pathology, the temperature indicator can rise to 40 degrees. At the same time nausea, vomiting, increased sweating, weakness can be observed. Also, the woman begins to freeze. The pain that appeared in the lower abdomen, gives to the legs.

If a girl has problems related to gynecology, chills before menstruation, she should immediately consult a doctor to diagnose the causes of pathological symptoms. If you do not undergo the necessary treatment in a timely manner, the reproductive function may be impaired.

Anemia can trigger a condition where a woman's muscles are trembling during menstruation. In the presence of such a pathology, weakness and chills occur systematically - regardless of the cycle. The situation can worsen on the eve of menstrual bleeding, with the appearance of PMS. In this case, not only freezes, but also shakes.

Low hemoglobin levels provoke fatigue, the appearance of weakness. Because of this, under the influence of an increase in the amount of progesterone, the process of thermoregulation of the body is disturbed, the woman is very freezing.

Other factors

A woman is feverish, not only for the specified reasons, but also under the influence of such factors as:

  • emotional surges
  • hormonal disorders,
  • high blood pressure
  • the period preceding menopause.

If the body temperature rises to non-critical indicators and decreases with the onset of menstruation, chills are the physiological response of the body and do not require treatment. If a woman freezes, while there are strong temperature changes, symptoms of any pathology appear, you should consult a doctor.

Why does chills appear

We all are accustomed to, that the temperature change occurs with colds and viral diseases, in the presence of inflammation in the body. Therefore, women usually do not measure the temperature before menstruation. However, during menstruation, it is not always normal. Indicators can reach up to thirty-seven degrees, but this is not a sign of disease. Values ​​above thirty seven and a half degrees are considered abnormal.

If a woman is shivering before menstruation, her skin becomes pale, goosebumps, and a tremor is noted in the muscles. In severe cases, it is possible blue lips. As a rule, girls do not pay attention to these manifestations and associate them with premenstrual syndrome or hormonal changes that occur in the body. But sometimes these symptoms may indicate the presence of a dangerous pathology.

There are several factors that may cause unpleasant chills:

  1. Increase in basal temperature and its subsequent decrease. Indicators change before and after ovulation, as well as before menstruation. Temperature measurement is carried out in the rectum, in the mouth or vagina. The best method is rectal. The procedure is performed in bed immediately after the morning waking up.
  2. Increasing the amount of progesterone - a hormone that affects the processes of thermoregulation. Its synthesis is directly related to the specific days of the cycle. Progesterone levels rise one week before the start of critical days, and after they start, it decreases.
  3. Premenstrual syndrome is a complex of certain symptoms that manifest themselves depending on the psychological and physiological state of the woman. Among the most frequent manifestations are fever, muscle tremors, changes in normal temperature.
  4. Ovulation - if a woman knows on what days it occurs, you can easily explain the deterioration of well-being.

These are the most common causes of chills that occur before menstruation. Normally, it passes with the onset of bleeding.

  • Discomfort without temperature

If a girl is shivering, and the temperature indicators remain normal, we are talking about a physiological response, which is associated with the need to maintain thermal equilibrium. The problem may occur for the following reasons:

  1. Emotional upheaval, stress or fright. Elevated mental exertion can cause fever before menstruation. In such a situation, it is recommended to visit a neurologist and, if necessary, take sedatives.
  2. Hormonal disruptions - can cause chills. To solve the problem, it is necessary to consult with an endocrinologist, to pass tests for the amount of thyroid hormones.
  3. Blood pressure spikes - often accompanied by chills, hands and feet also become cold. All these manifestations speak of developing hypertension. It is impossible to ignore this state, otherwise a hypertensive crisis or stroke is possible.
  4. Climacteric syndrome - all women tolerate it in different ways, while physiological and genetic factors are important. Many girls feel a fever, hot flashes and pressure fluctuations before menstruation. Relieve the condition will help specialized drugs, but should appoint them only a gynecologist.
  5. Raynaud's syndrome - chills, which is complemented by flattening hands. In this case, there are vascular spasms that are almost harmless. But not everyone is able to do the usual things in such a state. To solve the problem, you can use the heating pad - it will help keep the hands warm. Another option is Botox injection.
  6. Malaria - if a chill has appeared after traveling to southern countries, most likely it is a manifestation of malaria. In addition, severe headaches, malaise, sleep disturbances may occur. In such a situation, you must immediately go to the doctor.

Chills are not always associated only with the menstrual cycle. Often it occurs with severe hypothermia, a common cold, food poisoning and other ailments.

  • Chills during exacerbation of diseases

One of the causes of an unpleasant chill that occurs before the start of critical days is the exacerbation of various diseases. The most frequent pathologies are listed in the table:

Chill without fever

Chills, as noted, are a subjective physiological process. The reason for this is due to the need to maintain heat balance. Shivering is not necessarily caused by a jump in body temperature. Causes of chills without fever:

  • stress,
  • emotional stress
  • hormonal disbalance,
  • high blood pressure
  • menopause.

The female body is extremely susceptible to stress. Constant loads, stress can cause shivering before menstruation. Strong emotional stress, fear, anxiety alter the state of a woman. Doctors advise normalizing the status of the nervous system with sedatives. Pills, herbal tinctures (valerian extract) have a soothing effect.

Repeated occurrence of chills is sometimes caused by hormonal disruption. The best solution is to consult an endocrinologist with subsequent analysis for hormones in order to exclude possible diseases of the thyroid gland.

Chills with increased blood pressure - a sign of the development of hypertension. Ignoring the described state can cause hypertensive crisis, stroke. Women who are shaken with increased blood pressure are recommended to visit a doctor. The doctor will determine the diagnosis, prescribe the appropriate medication.

Climacteric syndrome women suffer in different ways. This is influenced by physiological and genetic factors. Many women entering menopause are shaken, they feel hot flashes, pressure surges. The gynecologist may advise the patient of drugs that soften the discomfort, of plant or synthetic origin.

However, we should not forget that the chills can appear out of touch with menstruation against the background of hypothermia, poisoning, colds and more serious diseases (malaria, Raynaud's disease).

If women cease to shiver after the onset of menstruation, this is probably caused by the normalization of progesterone concentration. Otherwise, the reasons are not related to gynecology.

Chills before menstruation during exacerbation of diseases

Often called the cause of chills before menstruation - the worsening of diseases. The following pathologies that cause chills are most common:

Otherwise, adnexitis is called inflammation of the appendages. Its symptoms are: aching pain in the area of ​​the ovaries, lower abdomen, urination becomes painful, the patient shakes, sometimes nauseous, there is general weakness. The peculiarity of the state is that the temperature of the body increases greatly two to three days before the menstruation.

Endometritis is the process of inflammation of the uterus. In this disease, aching pain in the lower abdomen, painful periods, abundant discharge. Purulent, blood-sucking vaginal secretions are characteristic. Thermometer indicators increase to 38C and more, pulse increases, leukocyte count increases. There is similarity with adnexitis. The presence of these symptoms is a significant reason for seeking medical attention.

Premenstrual syndrome manifests itself unequally. There are more than 150 of its symptoms. The most common changes in the body: fever (less than 38 C), chills, weakness, irritability, chest pain.

The difference between PMS and pregnancy is that when a child is born, the chest pain is constant, you want to eat salty, taste preferences change. There may be mild, short-lived pain in the abdomen, frequent urination, and toxicosis appears at 4-5 weeks. To verify the presence or absence of pregnancy, you should do a test or pass a blood test for hCG.

Body reaction

The physiological norm is considered the temperature from 37.0 to 37.4 ° C, which lasts for about a week before the onset of the next menstruation.

It is associated with an increase in the level of progesterone hormone production, which is necessary during the ovulation period to create in the uterus a favorable environment for fixing the fertilized egg. But at the same time, the hormone has a significant effect on the thermoregulatory center of the brain, which leads to an increase in temperature. But this also contributes to the influx of large amounts of blood to the ovaries.

There is no cause for concern if such a process is repeated with each cycle, and with the onset of menstruation, the thermometer readings return to normal.

Sometimes the above processes, combined with lack of appetite and weakness, indicate overwork. In this case, a small adjustment in nutrition and lifestyle is enough to normalize the condition.

Endometritis

Infection causes an inflammatory process of the mucous membranes of the uterus with a similar ailment. In addition to high temperature signs of endometritis are:

  • chills,
  • lower abdominal pain
  • diarrhea,
  • increased heart rate
  • purulent discharge.

In rare cases, pain may be added when urinating.

Inflammation of the appendages is characterized by a rise in temperature before menstruation up to 40 ° C in a short period of time in combination with additional symptoms:

  • pain in the abdomen
  • fever
  • nausea
  • weakness
  • vomit
  • sweating
  • cutting sensations when urinating.

A characteristic symptom of adnexitis is quite severe pain, which from the lower abdomen gives to the legs.

Premenstrual syndrome

PMS is a condition caused by hormonal changes that is not a disease. Symptoms are very diverse and can vary. Here are the most common ones:

  • headache,
  • weakness,
  • mood swings
  • skin rashes,
  • aches in the bones,
  • insomnia,
  • joint pain
  • increased appetite
  • swelling of the mammary glands,
  • memory loss
  • dizziness,
  • low-grade fever (from 37.1 to 38 ° C),
  • abdominal distension and pain.

Note that premenstrual syndrome begins to bother women closer to the age of thirty. This is due to the hormonal changes in the body and the lack of certain substances (zinc, calcium and magnesium).

Onset of pregnancy

In pregnancy, temperatures around 37 ° C are also considered normal, but they are by no means a guarantee of conceiving a child.

To diagnose this condition, it is necessary to measure the basal temperature throughout the entire menstrual cycle.

Do it in the morning immediately after sleep (must be at least six hours). Measurements should be made with a normal thermometer, placing it in your mouth, vagina or anus for three minutes. The results are recorded in a special schedule and analyzed.

An increase in the reading of the thermometer to 37 ° C indicates possible fertilization. combined with delayed menstruation. Some women have a spotting or brownish discharge when a fertilized egg is inserted into the uterus wall. Unlike menstruation, they last no more than two days and do not constitute full-fledged vaginal bleeding.

There may be additional symptoms of the first trimester of pregnancy: nausea, feeling of weakness, mood swings and so on. Accurately establish the causes of this condition will help test for hCG and gynecologist consultation.

If the basal temperature before menstruation drops, most likely, conception did not occur.

How to ease the condition

Heat and other unpleasant symptoms before menstruation are most often inevitable. But to improve the general condition in such a period is quite realistic. To do this, a few days before menstruation, it is desirable to adjust the diet. Exclude from the diet:

  • alcohol,
  • caffeine,
  • spices and spices
  • salting
  • fatty and spicy foods.

Minimize meat and milk intake. It is better to increase the number of light vegetable dishes and greens, as well as eat foods rich in potassium (for example, dried apricots).


To avoid puffiness, the amount of fluid should be reduced to one and a half liters per day. It is worth to drink a multivitamin complex. Soothe the nerves will help decoctions of herbs (mint, motherwort, etc.) or medicines based on them.

Pay attention to the lifestyle:

  1. Get enough sleep. Go to bed until 11 pm, because it is at this time that the most active production of the necessary hormones occurs.
  2. Put in the habit of walking in the fresh air and give up on time-consuming physical exertion and training during PMS.
  3. Take a contrast shower or chamomile bath (you can not go to the sauna). They will help to normalize the nervous system.
  4. ANDavoid stress and bad habits, namely smoking.

These rules will help maintain vigor and good mood during and before menstruation.

If PMS is very difficult, consult a doctor who will select drugs that alleviate the general condition. Depending on the symptoms, these can be:

  • antispasmodicsthat are prescribed for severe pains in the abdomen or chest (Papaverine, Drotaverin, Halidor),
  • nonsteroidal anti-inflammatory drugs (Paracetamol, Ibuprofen, Bonifen and others),
  • painkillers (Analgin, Baralgin, etc.),
  • Afobazole or Glycine (with acute anxiety),
  • hormonal contraceptives.

The choice of drugs depends on which symptoms are most troubling.

A slight increase in temperature before menstruation is a normal reaction of the female body to hormonal changes. No need to panic, because all states are completely individual. It is important to remember that a doctor should be consulted if there are any uncharacteristic sudden changes during the menstrual cycle, for example, it throws sharply into a fever and the temperature rises to critical points.

The content of the article

  • Temperature before menstruation - alarm or normal
  • Signs before menstruation
  • What is the basal temperature during menstruation and in front of them

The menstrual cycle is a complex process in a woman’s body that can quite naturally cause discomfort of various kinds. In the body of the ladies, serious hormonal work is constantly going on. During the entire cycle, hormone levels fluctuate, and significantly.

When temperature is normal

Against the background of the production of the hormone progesterone, the temperature may rise, because This affects the thermoregulation center located in the brain. After ovulation, the effect increases, as a result of which many women can observe a rise in temperature of up to 37.4 degrees. This usually happens a week before menstruation. After the onset of bleeding, the temperature usually returns to normal.

This reaction of the body to ovulation suggests that your body is too sensitive to hormonal surges. However, it is the temperature used in some attempts to get pregnant. Ladies know that if the basal temperature is about 37.2 degrees after the morning awakening, at this time you can try to conceive a child - the chances are quite high. After all, this temperature indicates the past ovulation.

With premenstrual syndrome, women may also notice a rise in temperature to 37.6 degrees, but not above these figures. In addition, it is normal if such an increase is accompanied by irritability, general weakness and engorgement of the mammary glands.

When to visit a doctor

It is worth guarding when the temperature lasts longer than a few days and when it reaches higher levels. Doctors say that in this case it is worth checking for the development of any urinary infections. And this should be done as quickly as possible, because such conditions require emergency treatment.

These problems most often include inflammation of the appendages and endometritis. In the first case, the temperature can increase to 40 degrees. In addition, there are strong painful sensations in the lower abdomen, weakness and weakness are noted, vomiting, nausea can occur. Going to the toilet can also cause pain. The second disease causes similar symptoms and additionally chills, tachycardia, problems with urination and stool.

To seek treatment for such problems is necessary to a professional gynecologist, who will prescribe you blood tests, urine and ultrasound, on the basis of which he will decide on a treatment plan.

Also, there may be a temperature during menstruation. True, this happens less frequently than before. And if it also reaches high numbers, this indicates serious failures, which must be determined and treated by specialists.

Causes of illness

There are several reasons. Chills can occur because the basal temperature rises. Sometimes a condition is observed due to an increase in progesterone in the blood. It is required to know that chills may appear with ovulation and PMS. It often occurs against the background of an increase in basal temperature, but later on it decreases. Its decrease occurs before ovulation and after it. It is important to correctly determine the basal temperature. In this case, you need to follow simple rules.

Basal temperature is measured in the mouth, vagina and rectum. The duration of the procedure is at least 3 minutes. It is best to determine the temperature in the morning, so you can achieve the most reliable results. In fact, it is often possible to predict how the basal temperature will change. To do this, record daily indicators. Not the last influence on women's health has progesterone: its amount depends on the day of the cycle. Excess hormone in the blood is observed a few days before menstruation, its concentration decreases after the onset of critical days. Progesterone is responsible for thermoregulation in the body, along with it affects the hypothalamus.

Premenstrual syndrome includes a symptom complex associated with the physical and mental state of a woman. Chills with PMS may occur due to endocrine disorders: in this case, there is the appearance of muscle tremors, malaise. As already noted, the syndrome can occur against the background of ovulation. When it starts, the basal temperature rises to the level of 37.5 ° C. If you record the thermometer, you can find out the days of the onset of ovulation. Chills, accompanied by temperature, due to the fact that the body needs to maintain optimal heat balance.

When do I need to see a doctor urgently?

Do not forget that chills before the onset of menstruation may indicate an exacerbation of ailments. These include adnexitis and endometritis. The first is characterized by inflammation of the appendages. The disease is manifested by aching pain in the lower abdomen, the discomfort is also localized in the ovaries. There is discomfort when urinating. The main symptoms of the disease - chills, nausea, weakness, malaise. With adnexitis, the temperature rises 3 days before the start of menstruation.

Endometritis - inflammation of the uterus. In the presence of this disease, there is severe pain in the lower abdomen, menstruation is painful. Purulent discharge is another sign of endometritis. In the presence of this disease, the woman's temperature rises to 38 ° C. The pulse becomes speeded up, the level of leukocytes fluctuates. If a woman is worried about the above symptoms, an urgent need to consult a doctor. With PMS, body temperature does not rise to critical levels. This condition may be accompanied by weakness, chills and an increase in temperature.

Pregnancy

Sometimes a signal of possible pregnancy is also a temperature, which is called subfebrile. It is characterized by indicators from 37 to 38 degrees. Most often we are talking about the basal temperature, measured in the rectum or vagina in the morning before the start of activity. It is the basal temperature that is considered the most accurate. It should be remembered that stress, alcohol, hormonal and sedative drugs affect the thermometer's performance.

If the temperature dropped by itself shortly before the start of the discharge, then pregnancy is excluded. Women need to know what changes occur in the body in different phases of the menstrual cycle. And then if at PMS the body temperature rises, then either this is due to high progesterone, or conception occurred and a delay should be expected, and then a test at home.

By measuring the basal temperature, you can also determine which day is best suited for conception. With ovulation, body temperature rises to 37.2 degrees. And if in the morning you saw this result, then today may be significant for you and in the near future you will become a mother.

Recommendations

There is a pathological condition, as we have said, due to an imbalance between progesterone and estrogen. In addition, malfunction of the thyroid gland also has a negative effect. With a shortage of vitamin B6 and such important trace elements as magnesium, zinc, calcium, premenstrual syndrome increases.

Some women planning conception may take PMS as symptoms of pregnancy, because they are very similar. And only the appearance of discharge dispel doubts. Or a pregnancy test. It is important to know that the temperature increase at PMS does not exceed the mark of 37.6 degrees. Very rarely, it can be equal to 38-39 degrees.

Sometimes the symptoms of PMS can endlessly bother a woman, even during bleeding. In such cases, consultation with a gynecologist-endocrinologist is obligatory. The patient is prescribed a full examination with the identification of hormone levels in all phases of the cycle.

It is best to keep diaries and record your complaints there every day. And then it will be easy to track the connection PMS and temperature.

If a woman does not tolerate fever, then you should consult with your doctor how to get rid of this symptom. To bring down the temperature is not recommended, it will rise again and again.

Quite often, in such cases, homeopathic medicines, herbal treatments, diet and vitamin complexes are prescribed. It is important to lead a healthy lifestyle, excluding bad habits - nicotine, alcohol. It will benefit from moderate physical activity and a full sleep.

Regular sex with the same partner is an aid to the proper functioning of the reproductive system. If possible, avoid nervous tension.

Low temperature in the ICP does not require any measures. If the thermometer rises significantly above 37 degrees, then the doctor should be examined for latent inflammation. Consider the main ones.

When at PMS the body temperature is not higher than 37.3 degrees, you can alleviate your condition using the recommendations below.

  • Physical activity. From exercise, as it is not paradoxical, fatigue passes and mood improves, which will be very useful in such a capricious period.
  • Shower therapy Helping to fight weakness helps the shower. Water should be a little cool, but not cold. Thanks to this, you will be able to reclaim your strength and take up your business again.
  • Full nutrition. It is necessary to refuse fatty and heavy food, to exclude alcoholic drinks, and also sharp seasonings. The more plant foods, vegetables and fruits, the better.
  • Taking care of yourself. If the PMS temperature is elevated, then you should take care of yourself. It is necessary to get enough sleep, more rest and engage in your favorite hobby. Until the condition improves, excessive exercise and sauna are not recommended.
  • Caffeine. In order not to overload the body with active substances, for the time of premenstrual syndrome, you need to abandon coffee.
  • Medicinal plants. Herbs will help to cheer up and feel better - Chinese Schizandra and Eleutherococcus. The dosage can be found on the packaging of drugs or check with your doctor.

Let's sum up. You have already understood whether the temperature can increase with PMS. A woman should monitor her condition so as not to miss a serious pathology. Recall that the temperature rise to 37.4-37.6 degrees without any other alarming symptoms is the norm.

You should never panic, as the body temperature changes throughout the day. By evening, it usually rises. You need to know your rules, because for someone 36.9-37 are the usual “working” indicators at bedtime.

Quite often and during menstruation the thermometer grows. At the end of the bleeding should consult a doctor to conduct an examination. It is possible that this will be a normal situation for you. Otherwise, the gynecologist will help eliminate the cause that caused the temperature increase during PMS and during menstruation.

Health should be constantly monitored, then the treatment will be simple, low-cost. The most important thing is a regular examination by a doctor, which will help to avoid negative consequences in the foreseeable future.

Natalia Andrushko

Psychologist, Ecophacilitator, Supervisor Mediator. Specialist from the website b17.ru

The doctor takes in the clinic.

I think we are not advisers here. Go to the gynecologist. Health to you.

Have you ever had this happen before? I think the monthly nothing to do with. Perhaps it is a cold or poisoning. And if before there was a temperature, but without a fever and is associated with the cycle. maybe from hormones, and maybe thermoneurosis is banal, especially if the stress is complete.

This is the PMS in you so manifested, the vascular tone is naughty, hence the feeling of chills, tinnitus, etc. pressure can deviate from the usual, not measured? the temperature of 36.9 is not a heightened, normal value, all of which can be connected with hormonal changes, which - alas - is a common thing for women, they have to endure and adapt

you have a real PMS, I also have chills in 10 days and more temperature can rise to 37.5

Girls! I have the strongest feeling of chills, I am lying under two blankets, my stomach is already pulling for 10 days, my period should reach 3 numbers, but I haven’t come yet. I feel sick and dizzy. the temperature is exactly 37. and the state is generally terrible. not controlled. as if everything inside is shaking and the blood is boiling. apparently, these are hormones?! Tell me, who had similar sysmpot?

Related topics

Girls! I have the strongest feeling of chills, I am lying under two blankets, my stomach is already pulling for 10 days, my period should reach 3 numbers, but I haven’t come yet. I feel sick and dizzy. the temperature is exactly 37. and the state is generally terrible. not controlled. as if everything inside is shaking and the blood is boiling. apparently, these are hormones?! Tell me, who had similar sysmpot?

Lina! I have a similar situation, but without fever and nausea) What did the doctor say to you?

I also have similar symptoms, not often, but there are also stomach upsets, and bloating,. The most interesting thing is that there is always a different state.

I'm 42. Sometimes such a madhouse happens to be breathtaking.

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