Multiple Sclerosis
EFFECTS OF THE MENSTRUAL CYCLE ON MEDICAL DISORDERS
It is well recognised that certain medical conditions are
exacerbated at specific phases of the menstrual cycle. Abrupt
changes in the concentrations of circulating ovarian steroids
at ovulation and premenstrually may account for menstrual-cycle
related changes in these chronic conditions. Accurate documentation
of symptoms on a menstrual calendar allows identification
of women with cyclic alterations in disease activity.
The evidence supporting a relationship between oestrogen
withdrawal and migraine headache is compelling. The frequency
of migraine headaches in women increases considerably after
menarche and 60% of women with migraine link attacks to
menstruation. Seventy to ninety percent of women with menstrual
migraine experience improvement during pregnancy but may
experience migraine attacks in the postpartum period.
Menstrual exacerbations occur with all types of seizures.
Catamenial epilepsy is believed to result from cyclic alterations
in both ovarian hormone levels and drug metabolism.
In many women with asthma there is an increased frequency
and severity of attacks premenstrually or at menstruation
and may be related to changing levels of progesterone or
prostaglandins.
Symptoms of rheumatoid arthritis often improve in the luteal
phase when gonadal steroid production is maximal. A subjective
increase in morning stiffness and arthritic pain during
menstruation and the early follicular phase has been shown.
In women with irritable bowel syndrome symptoms tend to
recur and become cyclic, with exacerbation during the postovulatory
and premenstrual phases of the menstrual cycle, suggesting
a hormonal influence.
Menstrual cycle-related alterations in glycemic control
during the luteal and premenstrual phases have been reported
in some women with diabetes.
Other disorders exacerbated by the postovulatory and premenstrual
phases of the menstrual cycle include acne, endocrine allergy
and anaphylaxis, erythema multiforme, urticaria, apthous
ulcers, glaucoma and multiple sclerosis.
Case, A.M. and Reid, R.L.
ARCH.INT.MED. 1998, 158 (13) 1405-12
