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Pots And Your Menstrual Cycle


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Hypertension. 2010 May 17. [Epub ahead of print]

Menstrual Cycle Affects Renal-Adrenal and Hemodynamic Responses During Prolonged Standing in the Postural Orthostatic Tachycardia Syndrome.

Fu Q, Vangundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD.

Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Tex; University of Texas Southwestern Medical Center at Dallas, Dallas, Tex; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Abstract

Approximately 500 000 American premenopausal women have the postural orthostatic tachycardia syndrome (POTS). We tested the hypothesis that in POTS women during orthostasis, activation of the renin-angiotensin-aldosterone system is greater, leading to better compensated hemodynamics in the midluteal phase (MLP) than in the early follicular phase of the menstrual cycle. Ten POTS women and 11 healthy women (controls) consumed a constant diet 3 days before testing. Hemodynamics and renal-adrenal hormones were measured while supine and during 2-hour standing. We found that blood pressure was similar, heart rate and total peripheral resistance were greater, and cardiac output and stroke volume were lower in POTS subjects than in controls during 2-hour standing. In controls, hemodynamic parameters were indistinguishable between menstrual phases. In POTS subjects, cardiac output and stroke volume were lower and total peripheral resistance was greater in the early follicular phase than MLP after 30 minutes of standing; however, blood pressure and heart rate were similar between phases. Plasma renin activity (9+/-6 [sD] versus 13+/-9 ng/mL per hour; P=0.04) and aldosterone (43+/-22 versus 55+/-25 ng/dL; P=0.02) were lower in the early follicular phase than MLP in POTS subjects after 2 hours of standing. Catecholamine responses were similar between phases. The percentage rate of subjects having presyncope was greater in the early follicular phase than MLP for both groups (chi(2) P<0.01). These results suggest that the menstrual cycle modulates the renin-angiotensin-aldosterone system and affects hemodynamics during orthostasis in POTS. The high estrogen and progesterone in the MLP are associated with greater increases in renal-adrenal hormones and presumably more volume retention, which improve late-standing tolerance in these patients.

PMID: 20479333

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Hypertension. 2010 May 17. [Epub ahead of print]

Menstrual Cycle Affects Renal-Adrenal and Hemodynamic Responses During Prolonged Standing in the Postural Orthostatic Tachycardia Syndrome.

Fu Q, Vangundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD.

Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Tex; University of Texas Southwestern Medical Center at Dallas, Dallas, Tex; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Abstract

Approximately 500 000 American premenopausal women have the postural orthostatic tachycardia syndrome (POTS). We tested the hypothesis that in POTS women during orthostasis, activation of the renin-angiotensin-aldosterone system is greater, leading to better compensated hemodynamics in the midluteal phase (MLP) than in the early follicular phase of the menstrual cycle. Ten POTS women and 11 healthy women (controls) consumed a constant diet 3 days before testing. Hemodynamics and renal-adrenal hormones were measured while supine and during 2-hour standing. We found that blood pressure was similar, heart rate and total peripheral resistance were greater, and cardiac output and stroke volume were lower in POTS subjects than in controls during 2-hour standing. In controls, hemodynamic parameters were indistinguishable between menstrual phases. In POTS subjects, cardiac output and stroke volume were lower and total peripheral resistance was greater in the early follicular phase than MLP after 30 minutes of standing; however, blood pressure and heart rate were similar between phases. Plasma renin activity (9+/-6 [sD] versus 13+/-9 ng/mL per hour; P=0.04) and aldosterone (43+/-22 versus 55+/-25 ng/dL; P=0.02) were lower in the early follicular phase than MLP in POTS subjects after 2 hours of standing. Catecholamine responses were similar between phases. The percentage rate of subjects having presyncope was greater in the early follicular phase than MLP for both groups (chi(2) P<0.01). These results suggest that the menstrual cycle modulates the renin-angiotensin-aldosterone system and affects hemodynamics during orthostasis in POTS. The high estrogen and progesterone in the MLP are associated with greater increases in renal-adrenal hormones and presumably more volume retention, which improve late-standing tolerance in these patients.

PMID: 20479333

Interesting. Thanks for posting. I know I tend to have fewer symptoms mid cycle. I think that is what this article is suggesting.

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I think ive also posted before that Angiotensin II is increased and has more effect during a woman's period - which provides another reason why female POTS patients may experience a worsening of symptoms during that time.

Vandy also have some work pending publishing on this issue.

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  • 2 weeks later...

Can someone help me understand this article? I have definitely made the menstrual cycle connection with the POTS, dizziness especially. I tend (though not always), but tend to feel better right before my period and then things get BAD. I thought maybe it was the total drop in hormones and then the climb back up making things bad and then feeling better when hormones are more stable?

Is this article saying things will be worse from the time you get your period until mid cycle?

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I too am worst symptom-wise about 4 days before my period until about day 2-3. I usually have the fewest symptoms right after ovulation until the 4th day before my cycle starts. I have been learning about NFP (Natural Family Planning, basically fertility charting), mainly the sympto method (I've been checking cervical mucus, although one could check temperatures and cervical placement for more accuracy as far as avoiding pregnancy, but since I'm single and have no chance of becoming pregnant, I don't need that much accuracy), and it's been a very fascinating process learning about what my body does depending on the point I am in my cycle.

I guess my own symptoms are in line with this study. The early follicular phase is the time period leading up to ovulation and the mid-luteal phase is after up until menstruation. Perhaps part of why I might be feeling so awful right before menstruation is partially the hormones that are released at that time. I also have a period of feeling bad (although not as terrible as when my visitor is here) right around the time I ovulate, usually for about 4 days (2 days before and 2 days afterwards).

The human body is a very complicated and complex machine and when just one part goes down, the rest of it gets taken for a ride as well. Until I developed POTS, I hardly had any issues with PMS or other cycle related maladies, but that just another thing I can check off the list.

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I also feel really bad two or three days before and a few days into my period, and then I slowly start feeling better.

Although I was always like this, even before I got sick, and my sister is the same and she doesnt have POTS.

Ditto this. My POTS doc said this is a very common complaint.

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I hate that I can't use quotes like I wanted to so some of the quoted material is just in bold print ..

Thanks for the info.

I've been looking at this too because I was feeling great up until 2 months ago when I started ovulating AGAIN. I've been post menopausal for over a year and hadn't had to deal with any of this. :rolleyes: I can't say that I've noticed any difference in my OI during this time but I've been feeling like poo most of the time for 2 months now ... I still HAVE to lay down every few hours in order to think straight.

Some of this may help explain what's going on. These are references to CFS but most of us know that POTS and CFS appear to be the same or at least related. I have CFS/ME/FM with OI and excercise intolerance.

Originally Posted by richvank (GD-MCB researcher)

"That's what I suggest goes on. I don't doubt that the increase in blood volume during pregnancy also helps. And not having to break down and get rid of estrogen every month would also be a big help, because, as I suggested in a 2007 IACFS poster paper, I think this is what causes CFS to be more prevalent in women than in men. Those who inherit certain polymorphisms experience redox cycling when their bodies are disposing of estrogen, and this biases them toward oxidative stress and glutathione depletion, which I've suggested is what leads to the onset of CFS in people who are genetically predisposed."

Dr. Myhill (UK - CFS doc) says ...

http://balancedmedicine.co.uk/docs/l...myhill-cfs.pdf

This is a PDF so I had to type this in myself so there may be errors ... just in case the part about female hormones is on page 6 and says ...

"Female hormones have marked immunodysruptive effects and malign effects on nutritional status. The extensive use of the oral contraceptive pill in young women probably accounts for the fact that 75% of CFS sufferers are women with the mean age onset of 29 - 35. These women are most likely to have been subject to many years of OCP (37). "

This idea is what I find most interesting. I have tons of allergies and antibodies so this wouldn't surprise me.

http://www.sciencedaily.com/releases/2006/...60330182210.htm

Evidence Of Estrogen And Progesterone Hormone Allergy Discovered

ScienceDaily (Mar. 30, 2006) ? AUSTIN, Texas--Some women with menstrual cycle disorders like asthma and migraine headaches may be experiencing allergies to their own estrogen and progesterone hormones, Texas researchers have discovered.

Russell Roby, M.D., director of the Roby Institute, Dr. **** Richardson, professor at The University of Texas at Austin, and Dr. Aristo Vojdani, of Immunosciences Lab, Inc. in California, found that female patients who experienced health changes during their menstrual cycle had higher levels of IgE antibodies against progesterone and estrogen than control subjects. An increase in IgE antibodies is typically associated with allergic response.

The researchers published their findings in the March 27 issue of the American Journal of Reproductive Immunology.

"This is going to explain a lot of unexplained illnesses," says Roby, alumnus of The University of Texas at Austin. "The primary disorders are premenstrual asthma, menstrual migraines, interstitial cystitis and fibromyalgia. We have no idea what causes these things, but they are definitely linked to hormonal cycles."

The researchers studied blood samples from healthy women and women who experienced symptoms associated with their menstrual cycles, like asthma, migraines and joint pain. A significant number of patients in the latter group showed high levels of IgG, IgM and IgE antibodies against estrogen and progesterone.

Antibodies play a critical role in immune response and are produced by the body in response to antigens, molecules the body recognizes as foreign.

Hormones haven't been implicated in allergic response in the past, because it was thought that hormone molecules were too small to create an allergic response. The researchers found that estrogen and progesterone combine with other proteins and that the hormone part of the molecular complex is recognized as the antigen.

"We have shown that IgE antibodies, Type 1-immediate allergy antibodies, are produced against estrogen and progesterone," says Roby. "This opens a whole new area of treatment possibilities."

Roby says that in the process of the clinical study, it was found that symptoms could be diminished by very low concentrations of progesterone, which served both as a diagnostic feature and for symptomatic relief when needed.

And then there's this on how candida can flare during our menses ...

http://www.faqs.org/abstracts/Health/Candi...ul...cycle.html

Candida albicans: cellular immune system interactions during different stages of the menstrual cycle

Article Abstract:

Candida albicans is a yeast-like fungus, normally present in the vaginal tract, which causes vaginal infections when it grows beyond controlled levels. For many women candida infections are not eliminated by conventional treatments.

Recurrent infections occur more often in pregnant women, women using birth control pills, and right before the onset of menstruation. Therefore, it is suggested that high estrogen and progesterone hormone levels increase susceptibility to vaginal candida infection.

The ability for the candida organism to adhere to the cells of the vagina and optimal conditions for growth determine whether candida will flourish. To determine the factors which influence growth, the immune response of healthy women with a history of candida infections was studied during the menstrual cycle.

Blood samples obtained during different phases of the menstrual cycle were used to grow candida in the laboratory. Candida albicans grew best in blood serum taking during the luteal phase of the menstrual cycle, the period just before menstruation.

Cellular immune responses were diminished, affecting the ability of cells to fight infecting organisms, and the ability to prevent continued growth of organisms.

Fluctuations in hormone levels produced by oral contraceptives explained changes in the immune response to candida in this population.

Candida vaginal infections which appear before menstruation are the result of altered immune function.

author: Witkin, Steven S., Kalo-Klein, Aliza

Publisher: Elsevier B.V.

Publication Name: American Journal of Obstetrics and Gynecology

Subject: Health

ISSN: 0002-9378

Year: 1989

Infection, Causes of, Candidiasis, Menstrual cycle, Vagina, Candida albicans

Read more: http://www.faqs.org/abstracts/Health/Candi...ul...z0pLaAFWQ7

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"ScienceDaily (Mar. 30, 2006) ? AUSTIN, Texas--Some women with menstrual cycle disorders like asthma and migraine headaches may be experiencing allergies to their own estrogen and progesterone hormones, Texas researchers have discovered."

I agree with this statement. So essentially we are allergic to ourselves? I came to a similar conclusion when all hormone testing came back normal over and over -- it's not too much or too little of anything, everything comes back "in range," but it's a sensitivity to those "normal" hormones. Oh and I was an absolute mess during pregnancy -- ten times worse when things should have been better (if we go by the POTS/blood volume theory). It was those darn hormones... if only it were possible to isolate which ones are causing the problem and some way to counteract the sensitivity.

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From the Sciencedaily article ..

Roby says that in the process of the clinical study, it was found that symptoms could be diminished by very low concentrations of progesterone, which served both as a diagnostic feature and for symptomatic relief when needed.

I haven't tried progesterone yet because this is just the second time I've ovulated after a year. But, I have a younger CFS friend who's still ovulating every month who is using this and says it's really helped her.

My reaction to my own hormones back in April, one year after not ovulating, was excessive vaginal swelling and pain ... Honestly, it felt like battery acid. TMI ... This last time (one month later) I didn't swell much at all and the pain was minimal. HOWEVER, I saw my GP because I simply couldn't get my digestive tract to calm down despite using the same treatments that had helped me every time before. I had gastroparesis again ... and gastritis. My digestive symptoms have calmed down significantly since I started spotting.

And here all this time I thought that all of my digestive problems had been resolved by changing my diet. DUH !!! :blink: Of course, not eating at TACO BELL, KFC, etc and avoiding gluten, dairy, etc has helped just not as much as I'd thought.

We women are being screwed by the medical profession ... This article came out in 2006 and how many here ever heard this ? :blink:

BTW. I have celiac disease and thyroid antibodies so I certainly wouldn't be surprised if I had this too ..

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