Menstrual cycle

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The menstrual cycle plays a role in the variation of symptoms and symptom severity in many immunological, neurological, and female predominant diseases.

Cycles and phases[edit | edit source]

Follicular Phase[edit | edit source]

At the beginning of a woman's cycle, the hypothalamus begins to secrete Gonadotropin Releasing Hormone (GnRH), stimulating the pituitary 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.

Ovulation[edit | edit source]

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.

Luteal Phase[edit | edit source]

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.[1]

Immune changes[edit | edit source]

Populations of Tregs 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[edit | edit source]

Women with chronic fatigue syndrome report higher rates of polycystic ovarian syndrome (PCOS) and anovulatory cycles, higher rates of dysmenorrhea and higher rates of endometriosis.[2]

Women who develop CFS report at higher rates a history of irregular cycles, amenorrhea, anovolutory cycles and sporadic bleeding between periods.[3]

Numerous outbreaks of epidemic myalgic encephalomyelitis noted menstrual irregularities and a tendency toward relapse before or during menstruation.[4][5][6]

Health effects in other conditions[edit | edit source]

The menstrual cycle can have effects on the timing and severity of symptoms of women suffering from many different conditions, including epilepsy, migraines, asthma, rheumatoid arthritis and irritable bowel syndrome.[7]

Many women with epilepsy have patterns of seizure activity linked to their menstrual cycles, called catamenial epilepsy.[8][9][10][11] Seizure activity increases just before ovulation and just before menstruation.[12]

Abrupt estrogen withdrawal, such as what occurs just prior to menstruation, can trigger migraines.[13][7] Women with rheumatoid arthritis experienced reduced symptoms after ovulation, owing potentially to the anti-inflammatory effects of progesterone and estrogen.[14]

In a retrospective study, 72% of women with fibromyalgia reported a worsening of symptoms just before their periods.[15]

Women with these diseases may experiencing a worsening of symptoms at specific points in their menstrual cycle, particularly just before or around their periods.[16]

Managing premenstrual symptoms[edit | edit source]

Nonsteroidal anti-inflammatory agents are occasionally effective in women with menstrual migraine, as are beta blockers, calcium channel blockers, ergotamine, antidepressants, estrogen and estradiol.[7]

Pathophysiology of menstrual symptoms[edit | edit source]

Estrogen may directly affect blood vessels 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.[17]

Notable studies[edit | edit source]

  • 2011, Gynecological History in Chronic Fatigue Syndrome: A Population-Based Case-Control Study[18]

See also[edit | edit source]

References[edit | edit source]

  1. Reed, Beverly G.; Carr, Bruce R. (2000). Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George; Dungan, Kathleen; Grossman, Ashley; Hershman, Jerome M.; Kaltsas, Gregory; Koch, Christian, eds. "The Normal Menstrual Cycle and the Control of Ovulation". South Dartmouth (MA):, Inc. PMID 25905282. 
  2. Allen, Peggy Rosati (Jul 2008). "Chronic fatigue syndrome: implications for women and their health care providers during the childbearing years". Journal of Midwifery & Women's Health. 53 (4): 289–301; quiz 399. doi:10.1016/j.jmwh.2007.12.001. ISSN 1542-2011. PMID 18586181. 
  3. Komaroff, AnthonyL; Dailey, Christine; Hall, JanetE; Signorello, LisaB; Harlow, BernardL (Sep 28, 1998). "Reproductive correlates of chronic fatigue syndrome". The American Journal of Medicine. 105 (3): 94S–99S. doi:10.1016/S0002-9343(98)00173-9. ISSN 0002-9343. 
  4. Shelokov, Alexis; Habel, Karl; Verder, Elizabeth; Welsh, William (August 1957), "Epidemic Neuromyasthenia — An Outbreak of Poliomyelitis-like Illness in Student Nurses", New England Journal of Medicine, 1957 (257): 345-355, doi:10.1056/NEJM195708222570801 
  5. Albrecht, Robert (Mar 21, 1964). "Epidemic Neuromyasthenia Outbreak in a Convent in New York State". Journal of the American Medical Association. 187: 904–907. 
  6. Poskanzer, David C.; Henderson, Donald A.; Kunkle, E. Charles; Kalter, Seymour S.; Clement, Walter B.; Bond, James O. (1957), "Epidemic Neuromyasthenia — An Outbreak in Punta Gorda, Florida", New England Journal of Medicine, 1957 (257): 356-364, doi:10.1056/NEJM195708222570802, PMID 13464939 
  7. Reid, Robert L.; Case, Allison M. (Jul 13, 1998). "Effects of the Menstrual Cycle on Medical Disorders". Archives of Internal Medicine. 158 (13): 1405–1412. doi:10.1001/archinte.158.13.1405. ISSN 0003-9926. 
  8. Herzog, Andrew G. (Mar 1, 2008). "Catamenial epilepsy: Definition, prevalence pathophysiology and treatment". Seizure - European Journal of Epilepsy. 17 (2): 151–159. doi:10.1016/j.seizure.2007.11.014. ISSN 1059-1311. PMID 18164632. 
  9. Herzog, Andrew G.; Harden, Cynthia L.; Liporace, Joyce; Pennell, Page; Schomer, Donald L.; Sperling, Michael; Fowler, Kristen; Nikolov, Blagovast; Shuman, Sevie (2004). "Frequency of catamenial seizure exacerbation in women with localization-related epilepsy". Annals of Neurology. 56 (3): 431–434. doi:10.1002/ana.20214. ISSN 1531-8249. 
  10. Herzog, Andrew G.; Klein, Pavel; Rand, Bernard J. (1997). "Three Patterns of Catamenial Epilepsy". Epilepsia. 38 (10): 1082–1088. doi:10.1111/j.1528-1157.1997.tb01197.x. ISSN 1528-1167. 
  12. Reid, Robert L.; Case, Allison M. (Jul 13, 1998). "Effects of the Menstrual Cycle on Medical Disorders". Archives of Internal Medicine. 158 (13): 1405–1412. doi:10.1001/archinte.158.13.1405. ISSN 0003-9926. 
  13. Brandes, Jan Lewis (Apr 19, 2006). "The Influence of Estrogen on Migraine: A Systematic Review". JAMA. 295 (15): 1824–1830. doi:10.1001/jama.295.15.1824. ISSN 0098-7484. 
  14. Latman, Neal S. (Jun 1, 1983). "Relation of menstrual cycle phase to symptoms of rheumatoid arthritis". The American Journal of Medicine. 74 (6): 957–960. doi:10.1016/0002-9343(83)90789-1. ISSN 0002-9343. 
  15. Østensen, Monika; Rugelsjoen, Anne; Wigers, Sigrid Horven (Jan 1, 1997). "The Effect of Reproductive Events and Alterations of Sex Hormone Levels on the Symptoms of Fibromyalgia". Scandinavian Journal of Rheumatology. 26 (5): 355–360. doi:10.3109/03009749709065698. ISSN 0300-9742. PMID 9385346. 
  16. Zierau, Oliver (2012). "Role of female sex hormones, estradiol and progesterone, in mast cell behavior". Front Immunol. 
  17. Brandes, Jan Lewis (Apr 19, 2006). "The Influence of Estrogen on Migraine: A Systematic Review". JAMA. 295 (15): 1824–1830. doi:10.1001/jama.295.15.1824. ISSN 0098-7484. 
  18. Boneva, Roumiana S.; Maloney, Elizabeth M.; Lin, Jin-Mann; Jones, James F.; Wieser, Friedrich; Nater, Urs M.; Heim, Christine M.; Reeves, William C. (Jan 2011). "Gynecological history in chronic fatigue syndrome: a population-based case-control study". Journal of Women's Health (2002). 20 (1): 21–28. doi:10.1089/jwh.2009.1900. ISSN 1931-843X. PMC 3017420Freely accessible. PMID 21091051. 

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.