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Menstrual cycle
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The [[menstrual cycle]] plays a role in the variation of symptoms and symptom severity in many [[immune system|immunological]], [[neurological]], and [[female predominant diseases]]. == Cycles and phases == === Follicular Phase === At the beginning of a woman's cycle, the [[hypothalamus]] begins to secrete Gonadotropin Releasing Hormone (GnRH), stimulating the [[pituitary gland]] to create Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which travel to the ovaries. FSH causes follicles in the ovaries to begin to mature. Several follicles, each of which stores an egg, begin to grow as they mature, and in the process release estrogen. This estrogen produces a negative feedback during the first 10 days of the cycle that tells to the pituitary to inhibit the release of LH. It is important to note that ''low'' levels of estrogen will inhibit the release of LH from the pituitary, while ''high'' levels will stimulate it.{{Citation needed | date = Mar 2021}} === Ovulation === As estrogen continues to rise due to the maturing follicles, it also causes FSH levels to fall steadily (''low'' estrogen levels trigger the release of FSH). Around day 10 of the cycle, estrogen levels reach a threshold which stops the negative feedback of LH and begins a positive one resulting in the secretion of LH by the pituitary. The resulting spike in LH triggers the most mature follicle to release an egg (or oocyte); this is called ovulation.{{Citation needed | date = Mar 2021}} === Luteal Phase === After ovulation, the empty follicle will begin to die. This dying follicle is called a corpus luteum. As the corpus luteum degrades, it secretes three hormones: estrogen, inhibin, and progesterone. Inhibin provides a negative feedback to the pituitary to suppress the production of FSH. Progesterone provides a similar feedback to prohibit the release of GnRH, which in turn decreases the levels of LH and FSH. It also stimulates endometrial growth (the interior lining of the uterus). As the corpus luteum degenerates, it will secrete fewer and fewer hormones, and progesterone, estrogen, and inhibin will steadily decrease. In the absence of fertilization, the decreasing levels of progesterone can no longer maintain the lining of the uterine wall, so the wall dies and sheds out of the body, resulting in menstruation. This decrease in progesterone also allows for the secretion of GnRH to begin again, and the cycle repeats.<ref>{{Cite book | last = Reed | first = Beverly G. | last2 = Carr | first2 = Bruce R. | date = 2000 | editor-last = Feingold|editor-first = Kenneth R.|editor2-last=Anawalt|editor2-first = Bradley|editor3-last=Boyce|editor3-first = Alison|editor4-last=Chrousos|editor4-first = George|editor5-last=Dungan|editor5-first = Kathleen|editor6-last=Grossman|editor6-first = Ashley|editor7-last=Hershman|editor7-first = Jerome M.|editor8-last=Kaltsas|editor8-first = Gregory|editor9-last=Koch|editor9-first = Christian | title = The Normal Menstrual Cycle and the Control of Ovulation | url =http://www.ncbi.nlm.nih.gov/books/NBK279054/|location=South Dartmouth (MA)|publisher=MDText.com, Inc.|pmid=25905282}}</ref> == Immune changes == Populations of [[Treg]]s increase peak just before ovulation and bottom out during the [[luteal phase]], just before [[menstruation]].{{Citation needed}} [[Progesterone]] and [[estrogen]] have [[anti-inflammatory]] effects.{{Citation needed}} ==Health effects in ME/CFS == Women with [[chronic fatigue syndrome]] report higher rates of [[polycystic ovarian syndrome]] (PCOS) and anovulatory cycles, and higher rates of [[endometriosis]].<ref name=":0">{{Cite journal | last = Allen | first = Peggy Rosati | date = Jul 2008 | title = Chronic fatigue syndrome: implications for women and their health care providers during the childbearing years|url=https://www.ncbi.nlm.nih.gov/pubmed/18586181|journal=Journal of Midwifery & Women's Health|volume=53|issue=4|pages=289–301; quiz 399|doi=10.1016/j.jmwh.2007.12.001|issn=1542-2011|pmid=18586181}}</ref> Women who develop [[ME/CFS]] have higher rates a history of [[irregular menstrual cycles]], [[amenorrhea]], [[dysmenorrhea]], [[anovolutory]] cycles and sporadic bleeding between periods.<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 =Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 =Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref><ref>{{Cite journal | last = Komaroff|first = AnthonyL | last2 = Dailey | first2 = Christine | last3 = Hall | first3 = JanetE | last4 = Signorello | first4 = LisaB | last5 = Harlow | first5 = BernardL | date = 1998-09-28 | title = Reproductive correlates of chronic fatigue syndrome|url=https://www.amjmed.com/article/S0002-9343(98)00173-9/abstract|journal=The American Journal of Medicine|language=English|volume=105|issue=3 | pages = 94S–99S|doi=10.1016/S0002-9343(98)00173-9|issn=0002-9343}}</ref> Numerous outbreaks of [[epidemic myalgic encephalomyelitis]] noted [[Menstrual problems in ME/CFS|menstrual irregularities]] and a tendency toward relapse before or during menstruation.<ref name="Shelokov, 1957">{{Citation | last = Shelokov | first1 = Alexis | authorlink1 = | last2 = Habel | first2 = Karl | authorlink2 = | last3 = Verder | first3 = Elizabeth | authorlink3 = | last4 =Welsh | first4 = William | author-link4 = | title = Epidemic Neuromyasthenia — An Outbreak of Poliomyelitis-like Illness in Student Nurses | journal = New England Journal of Medicine | volume = | issue = 257 | page = 345-355 | date = August 1957 | doi = 10.1056/NEJM195708222570801 }}</ref><ref name=":1">{{Cite journal | last = Albrecht | first = Robert | date = March 21, 1964 | title = Epidemic Neuromyasthenia Outbreak in a Convent in New York State|url=https://www.ncbi.nlm.nih.gov/pubmed/14100144|journal=Journal of the American Medical Association|volume=187 | pages = 904-907|via=}}</ref><ref name="Poskanzer, 19572">{{Citation | last = Poskanzer | first1 = David C. | authorlink1 = | last2 = Henderson | first2 = Donald A. | authorlink2 = | last3 = Kunkle | first3 = E. Charles | authorlink3 = | last4 = Kalter | first4 = Seymour S. | authorlink4 = | last5 =Clement | first5 = Walter B. | authorlink5 = | last6 = Bond | first6 = James O. | authorlink6 = | title = Epidemic Neuromyasthenia — An Outbreak in Punta Gorda, Florida | journal = New England Journal of Medicine | volume = | issue = 257 | page = 356-364 | date = 1957 | pmid = 13464939 | doi = 10.1056/NEJM195708222570802 | url = http://www.nejm.org/doi/full/10.1056/NEJM195708222570802 }}</ref> {{See also|Menstrual problems in ME/CFS}} ==Illnesses worsened by the menstrual cycle== Mental illnesses or disorders worsened by the menstrual cycle include: <div style="column-count:2"> *[[Anxiety]] *[[Bipolar disorder]] *[[Anorexia and eating disorders|Eating disorders]] *[[menopause|perimenopausal]] [[depression]] *[[Premenstrual dysphoric disorder]] (PMDD)<ref name="Case2001" /></div> Physical diseases and illnesses worsened by the menstrual cycle include: <div style="column-count:2"> *Acne *Acute appendicitis *Acute intermittent [[porphyria]] *Aphthous ulcers *[[Asthma]] *[[Diabetes]] *Endocrine [[allergy]] and [[anaphylaxis]] *[[Epilepsy]] *Erythema multiforme *Glaucoma *Hereditary angioedema *[[Irritable bowel syndrome]] *[[Migraine]]s *[[Multiple sclerosis]] *Paroxysmal supraventricular tachycardia *[[Rheumatoid arthritis]] *[[Urticaria]] (hives)<ref name="Case2001">{{Cite journal | title = Menstrual cycle effects on common medical conditions| date = 2001 |url=https://pubmed.ncbi.nlm.nih.gov/11280858/|journal=Comprehensive Therapy|volume=27|issue=1 | pages = 65–71 | last = Case | first = A.M. | last2 = Reid | first2 = R.L. | doi=10.1007/s12019-001-0010-8|pmid=11280858|issn=0098-8243}}</ref></div> == Health effects in other conditions == The menstrual cycle can have effects on the timing and severity of symptoms of women suffering from many different conditions, including [[epilepsy]], [[migraine]]s, [[asthma]], [[rheumatoid arthritis]] and [[irritable bowel syndrome]].<ref name=":2">{{Cite journal | last = Reid | first = Robert L. | last2 = Case | first2 = Allison M. | date = 1998-07-13 | title = Effects of the Menstrual Cycle on Medical Disorders|url=https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/208109|journal=Archives of Internal Medicine|language=en|volume=158|issue=13|pages=1405–1412|doi=10.1001/archinte.158.13.1405|issn=0003-9926}}</ref> Many women with [[epilepsy]] have patterns of seizure activity linked to their menstrual cycles, called [[catamenial epilepsy]].<ref>{{Cite journal | last = Herzog|first = Andrew G. | date = 2008-03-01 | title = Catamenial epilepsy: Definition, prevalence pathophysiology and treatment|url=https://www.seizure-journal.com/article/S1059-1311(07)00233-6/abstract|journal=Seizure - European Journal of Epilepsy|language=English|volume=17|issue=2|pages=151–159|doi=10.1016/j.seizure.2007.11.014|issn=1059-1311|pmid=18164632}}</ref><ref>{{Cite journal | last = Herzog|first = Andrew G. | last2 = Harden | first2 = Cynthia L. | last3 = Liporace | first3 = Joyce | last4 = Pennell | first4 = Page | last5 = Schomer | first5 = Donald L. | last6 = Sperling | first6 = Michael | last7 = Fowler | first7 = Kristen | last8 = Nikolov | first8 = Blagovast | last9 = Shuman | first9 = Sevie | date = 2004 | title = Frequency of catamenial seizure exacerbation in women with localization-related epilepsy|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.20214|journal=Annals of Neurology|language=en|volume=56|issue=3 | pages = 431–434|doi=10.1002/ana.20214|issn=1531-8249}}</ref><ref>{{Cite journal | last = Herzog|first = Andrew G. | last2 = Klein | first2 = Pavel | last3 = Rand | first3 = Bernard J. | date = 1997 | title=Three Patterns of Catamenial Epilepsy|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1528-1157.1997.tb01197.x|journal=Epilepsia|language=en|volume=38|issue=10|pages=1082–1088|doi=10.1111/j.1528-1157.1997.tb01197.x|issn=1528-1167}}</ref><ref>{{Cite journal | title = The Influence of Gonadal Hormones on Neuronal Excitability, Seizures, and Epilepsy in the Female | date = 2006 | url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1528-1167.2006.00672.x|journal=Epilepsia|volume=47|issue=9|pages=1423–1440 | last = Scharfman | first = Helen E. | last2 = MacLusky | first2 = Neil J.|language=en|doi=10.1111/j.1528-1167.2006.00672.x|issn=1528-1167}}</ref> [[Seizure]] activity increases just before ovulation and just before menstruation.<ref>{{Cite journal | last = Reid | first = Robert L. | last2 = Case | first2 = Allison M. | date = 1998-07-13 | title = Effects of the Menstrual Cycle on Medical Disorders|url=https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/208109|journal=Archives of Internal Medicine|language=en|volume=158|issue=13|pages=1405–1412|doi=10.1001/archinte.158.13.1405|issn=0003-9926}}</ref> Abrupt estrogen withdrawal, such as what occurs just prior to menstruation, can trigger [[migraine]]s.<ref>{{Cite journal | last = Brandes | first = Jan Lewis | date = 2006-04-19 | title = The Influence of Estrogen on Migraine: A Systematic Review | url =https://jamanetwork.com/journals/jama/fullarticle/202685|journal=JAMA|language=en|volume=295|issue=15|pages=1824–1830|doi=10.1001/jama.295.15.1824|issn=0098-7484}}</ref><ref name=":2" /> Women with [[rheumatoid arthritis]] experienced reduced symptoms after ovulation, owing potentially to the anti-inflammatory effects of [[progesterone]] and [[estrogen]].<ref>{{Cite journal | last = Latman | first = Neal S. | date = 1983-06-01 | title = Relation of menstrual cycle phase to symptoms of rheumatoid arthritis|url=https://www.amjmed.com/article/0002-9343(83)90789-1/abstract|journal=The American Journal of Medicine|language=English|volume=74|issue=6 | pages = 957–960|doi=10.1016/0002-9343(83)90789-1|issn=0002-9343}}</ref> In a retrospective study, 72% of women with [[fibromyalgia]] reported a worsening of symptoms just before their periods.<ref>{{Cite journal | last = Østensen | first = Monika | last2 = Rugelsjoen | first2 = Anne | last3 = Wigers | first3 = Sigrid Horven | date = 1997-01-01 | title = The Effect of Reproductive Events and Alterations of Sex Hormone Levels on the Symptoms of Fibromyalgia|url=https://doi.org/10.3109/03009749709065698|journal=Scandinavian Journal of Rheumatology|volume=26|issue=5 | pages = 355–360|doi=10.3109/03009749709065698|issn=0300-9742|pmid=9385346}}</ref> Women with these diseases may experiencing a worsening of symptoms at specific points in their menstrual cycle, particularly just before or around their periods.<ref>{{Cite journal | last = Zierau|first = Oliver| date = 2012 | title = Role of female sex hormones, estradiol and progesterone, in mast cell behavior |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377947/|journal=Front Immunol|volume=|pages=|via=}}</ref> == Managing premenstrual symptoms == [[Nonsteroidal anti-inflammatory drug]]s are occasionally effective in women with menstrual [[migraine]], as are [[:Category:Beta-blockers|beta-blockers]] (e.g. [[propranolol]]), [[:Category:Calcium channel blockers|calcium channel blockers]], [[ergotamine]], [[Antidepressant|antidepressant]]s, [[estrogen]] and [[estradiol]].<ref name=":2" /> {{See also|Premenstrual syndrome|Premenstrual syndrome|Premenstrual dysphoric disorder|Premenstrual dysphoric disorder}} == Pathophysiology of menstrual symptoms == [[Estrogen]] may directly affect [[blood vessel]]s by stimulating [[nitric oxide]] release. Women with a history of menstrual migraine had a heightened activation of the [[nitro oxide]] and [[L-arginine]] pathways, especially during the luteal phase.<ref>{{Cite journal | last = Brandes | first = Jan Lewis | date = 2006-04-19 | title = The Influence of Estrogen on Migraine: A Systematic Review | url =https://jamanetwork.com/journals/jama/fullarticle/202685|journal=JAMA|language=en|volume=295|issue=15|pages=1824–1830|doi=10.1001/jama.295.15.1824|issn=0098-7484}}</ref> == Notable studies == * 2011, Gynecological History in Chronic Fatigue Syndrome: A Population-Based Case-Control Study<ref>{{Cite journal | last = Boneva | first = Roumiana S. | last2 = Maloney | first2 = Elizabeth M. | last3 = Lin | first3 = Jin-Mann | last4 = Jones | first4 = James F. | last5 = Wieser | first5 = Friedrich | last6 = Nater | first6 = Urs M. | last7 = Heim | first7 = Christine M. | last8 = Reeves | first8 = William C. | date = Jan 2011 | title = Gynecological history in chronic fatigue syndrome: a population-based case-control study|url=https://www.ncbi.nlm.nih.gov/pubmed/21091051|journal=Journal of Women's Health (2002)|volume=20|issue=1|pages=21–28|doi=10.1089/jwh.2009.1900|issn=1931-843X|pmc=3017420|pmid=21091051|quote= | authorlink3 = Jin-Mann Sally Lin | authorlink4 = | authorlink5 = |via= | authorlink8 = William Reeves}}</ref> == See also == *[[Pregnancy]] *[[Premenstrual syndrome]] *[[Premenstrual dysphoric disorder]] (PMDD) == References == {{Reflist}} [[Category:Triggers and risk factors]]
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