Premenstrual water retention

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Premenstrual water retention (or premenstrual fluid retention) is the buildup of additional water or fluid in the body. This phenomenon can be seen in various forms like increasing weight gain and swollen belly, legs, or ankles. Water retention is a symptom felt by some women of all backgrounds before their menstruation onset and was listed as one of the most common premenstrual symptoms in addition to cramping and back pain. [1] There is a study that mentions the age effect being potentially linked to the intensity of symptoms, where the maximum symptom intensity was seen around age 35. [1] This symptom, among others, have been connected to premenstrual syndrome (PMS), which is experienced by women days before their menstrual cycle begins. [2] [3] However, water retention itself can cause symptoms similar to those of PMS like body aches, headaches, and nausea. The actual duration of how long symptoms can last varies in length, from a few days to two weeks. [3]

Contents

Premenstrual water retention could be passed off as little weight gain before the start of a menstruation cycle, but should be carefully watched if weight is gained quickly within days. Water retention can cause serious consequences in people who have a kidney or cardiovascular disease and should take extra caution when experiencing this symptom. [4] [5]

As of now, the actual cause of water retention remains unclear. It was noted that there is no correlation to serum levels of progesterone or estradiol according to actual data, [6] but it is thought to be caused by hormone changes during the menstrual cycle through high levels of circulating progesterone, estrogen, and prolactin, which stimulate secretory cells in the body. [7] [8] [9] It is also thought that diet may play a role in increased water retention, such as salt and magnesium consumption, and fluid intake. [10]

Although the cause is still unclear, there are ways to relieve or manage water retention and symptoms caused by it. These methods include both medication (like water pills) and non-medication (diet control) management.

Symptoms

Both girls and women have reported water retention symptoms days prior to their menstrual cycle. The symptoms can appear up to two weeks before the menstrual cycle (before the luteal phase) and can present as physical symptoms such as breast tenderness, weight gain, and bloating. [11] [ needs update ] [12] The Penn Daily Symptom Rating Form was used in multiple studies that demonstrated these symptoms as core symptoms of the premenstrual cycle. [13]

Causes

Water retention during the premenstrual cycle can be linked to the use of conventional oral contraceptives. This is due to them containing estrogen and progestin. [14] Synthetic progestin lacks the ability to antagonize mineralocorticoid receptors, leading to more sodium and water retention and subsequently, temporary weight gain. [15] In addition, estrogen is known to interfere with the renin-angiotensin-aldosterone system (RAAS), since high concentrations of estrogen causes the release of more angiotensin II and aldosterone. [15]

Treatment

Overview

There are pharmacological and non-pharmacological treatment options in alleviating symptoms and providing relief during the phase of premenstrual fluid retention. Currently, pharmacological agents that are often used to treat premenstrual water retention in removing or limiting the fluid that is present. [10] Non-pharmacological considerations to reduce the effects of the condition is focused on an individual's diet and activity levels such as exercise [10]

Pharmacological

Hormonal treatments

Hormonal treatments such as oral contraceptives or intrauterine devices (IUDS) alters the menstrual cycle and lessen the amount of fluid retention. [16] Within the four phases of the menstrual cycle, water retention occurs during the Luteal phase due to the production of the hormone progesterone and estrogen. [17] The increase of these hormones results in an increase in water retention. Hormonal treatments are then used to reduce the amount of progesterone and estrogen that are produces and therefore, leading to a reduce amount of fluid.[ citation needed ][ medical citation needed ]

Diuretics

In the setting of increased fluid retention, the use of Diuretics is for the removal of fluid in the body. Diuretics are known as one of the main therapies for volume overload and includes several classes whose mechanisms of actions, and pharmacokinetics are involved in the principles of nephrology. [18] The therapy consists of drugs that pharmacologically adjusts the renal fluid regulation in favor of excreting water and electrolytes. [19] This class of drugs works to achieve the objective of fluid removal through the increase in production and volume of urine. [19]

Midol

A popular pharmacologic over-the-counter treatment on the market to alleviate symptoms associated with menstrual cycles in the USA is Midol [ clarification needed ]. More specifically, many Midol products contain a mild diuretic in their active ingredients to help with bloating. [20] Pamabrom helps relief premenstrual and menstrual symptoms of water retention. It is a xanthine derivative that acts as a mild, short-acting diuretic that eliminates sodium and chloride and sometimes potassium. [20] Although the exact mechanism of how this works is still unclear, it is speculated to be due to increasing the GFR (glomerular filtration rate) and decreasing sodium reabsorption in the proximal tubule. [20] Some Midol products also contain caffeine as a diuretic. Caffeine increases the GFR by inhibiting adenosine receptors, thus preventing vasoconstriction of the afferent arteriole in the renal system. [21]

Inhibition of prostaglandins

Studies shows that minimizing of the use of the medication class non-steroidal anti inflammatory drugs (NSAIDs) such as Naproxen and Ibuprofen will reduce premenstrual fluid retention. NSAIDs mechanism of action consists of the inhibition of cyclooxygenase (COX) which further inhibits the production of prostaglandins and resulting in the reduction of renal water and sodium excretion in the kidneys. [22]

Non-pharmacological

Magnesium supplements

There is ongoing research regarding the efficacy of magnesium supplement in improving premenstrual symptoms and effectively reducing water retention. They may increase fluid output which can reduce premenstrual fluid retention and alleviate symptoms. [23]

Exercise

In several studies, it was shown that people experiencing PMS symptoms had a decrease in water retention and breast tenderness when they exercised regularly compared to those who did not. [24] [25]

Diet

Studies have shown a positive correlation between PMS symptoms and foods that are high in calories, fat, salt, and sugar. [26] Instead, individuals should focus on incorporating more fruits and vegetables that are high in fiber and anti-oxidant properties to reduce PMS symptoms. [27] Consuming smaller meals or limiting the amount of food can help minimize the occurrence of symptoms since more food consumed causes more volume in the body. [28]

Society and culture

Traditional Chinese medicine

In Traditional Chinese Medicine, PMS is seen to be caused by the qi in the liver being blocked which leads to an accumulation of blood flow in the lower half of the body. Additionally, the spleen and the stomach have an impact on water retention due to their role in digestion and nutrient breakdown. To open up the qi, people can be treated with herbs, acupuncture, diet therapy, and deep breathing exercises. [29] PMS symptoms are also tied to changes in yin and yang that happen throughout the menstrual cycle. [30]

Acupuncture has been traditionally used as a Chinese medical treatment for over 2000 years in Asian countries to relieve PMS symptoms. It has been speculated to work by altering blood flow, inflammatory markers, and prostaglandin levels. Especially because inflammatory markers is the main pathway in decreasing premenstrual physical symptoms such as breast tenderness and water retention. [31] The acupoints that are most commonly used to relieve PMS symptoms due to hormone regulating properties and regulation of the nervous system include SP6, LR3, and RN4. [30]

Qigong is another practice that consists of meditation, breathing-exercises, dance-like movements, and relaxation that has been shown to reduce PMS symptoms when compared to placebo results. [32] Practitioners of qigong can redirect or emit their qi to heal themselves or others, helping to improve symptoms of negative feelings, water retention, etc. [32]

Drinking green tea, which is one of the most consumed beverages, is also encouraged to reduce water retention due to its diuretic properties. Green tea contains caffeine and catechins which are anti-oxidants.[ medical citation needed ] [33] [34]

Middle Eastern countries

Many studies regarding the symptoms of PMS were based on populations in the Western or Far Eastern countries. However, the prevalence of PMS is just as dominant in Middle Eastern countries like Saudi Arabia and Palestine. These studies looked into many risk factors that could be correlated with symptom onsets but interestingly have shown that neither smoking or medical history (like chronic illnesses or medications) were related to an increase in symptoms. [35] [36] The frequency these symptoms were mainly associated with people who have family history of PMS symptoms [36] and dietary habits. [35] [36] These studies observed the effects certain types of drinks (caffeinated) may have on the severity and frequency of symptoms but noted that the amount of fluid intake was not taken into account. [35] [36]

See also

Related Research Articles

<span class="mw-page-title-main">Menstruation</span> Shedding of the uterine lining

Menstruation is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hormones. Menstruation is triggered by falling progesterone levels, and is a sign that pregnancy has not occurred.

<span class="mw-page-title-main">Progesterone</span> Sex hormone

Progesterone (P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the major progestogen in the body. Progesterone has a variety of important functions in the body. It is also a crucial metabolic intermediate in the production of other endogenous steroids, including the sex hormones and the corticosteroids, and plays an important role in brain function as a neurosteroid.

<span class="mw-page-title-main">Edema</span> Accumulation of excess fluid in tissue

Edema, also spelled oedema, and also known as fluid retention, dropsy and hydropsy, is the build-up of fluid in the body's tissue, a type of swelling. Most commonly, the legs or arms are affected. Symptoms may include skin that feels tight, the area feeling heavy, and joint stiffness. Other symptoms depend on the underlying cause.

<span class="mw-page-title-main">Menstrual cycle</span> Natural changes in the human female reproductive system

The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive an embryo. These cycles are concurrent and coordinated, normally last between 21 and 35 days, with a median length of 28 days. Menarche usually occurs around the age of 12 years; menstrual cycles continue for about 30–45 years.

Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Symptoms vary, though commonly include one or more physical, emotional, or behavioral symptoms, that resolve with menses. The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability. To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording. PMS-related symptoms are often present for about six days. An individual's pattern of symptoms may change over time. PMS does not produce symptoms during pregnancy or following menopause.

<span class="mw-page-title-main">Progestogen (medication)</span> Medication producing effects similar to progesterone

A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a synthetic progestogen. Progestogens are used most commonly in hormonal birth control and menopausal hormone therapy. They can also be used in the treatment of gynecological conditions, to support fertility and pregnancy, to lower sex hormone levels for various purposes, and for other indications. Progestogens are used alone or in combination with estrogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of progestogens include natural or bioidentical progesterone as well as progestins such as medroxyprogesterone acetate and norethisterone.

<span class="mw-page-title-main">Dysmenorrhea</span> Pain during and sometimes before menstruation

Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea or nausea.

Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase, improve within a few days after the onset of menses, and are minimal or absent in the week after menses. PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment. Within this population of reproductive age, some will meet the criteria for PMDD.

Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. Pain that involves only one part of a breast is more concerning, particularly if a hard mass or nipple discharge is also present.

<span class="mw-page-title-main">Drospirenone</span> Medication drug

Drospirenone is a progestin and antiandrogen medication which is used in birth control pills to prevent pregnancy and in menopausal hormone therapy, among other uses. It is available both alone under the brand name Slynd and in combination with an estrogen under the brand name Yasmin among others. The medication is an analog of the drug spironolactone. Drospirenone is taken by mouth.

Hypoestrogenism, or estrogen deficiency, refers to a lower than normal level of estrogen. It is an umbrella term used to describe estrogen deficiency in various conditions. Estrogen deficiency is also associated with an increased risk of cardiovascular disease, and has been linked to diseases like urinary tract infections and osteoporosis.

<span class="mw-page-title-main">Luteal phase</span> The latter part of the menstrual cycle associated with ovulation and an increase in progesterone

The menstrual cycle is on average 28 days in length. It begins with menses during the follicular phase, followed by ovulation and ending with the luteal phase. while historically, medical experts believed the luteal phase to be relatively fixed at approximately 14 days, recent research suggests that there can be wide variability in luteal phase lengths not just from person to person, but from cycle to cycle within one person. The luteal phase is characterized by changes to hormone levels, such as an increase in progesterone and estrogen levels, decrease in gonadotropins such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), changes to the endometrial lining to promote implantation of the fertilized egg, and development of the corpus luteum. In the absence of fertilization by sperm, the corpus luteum degenerates leading to a decrease in progesterone and estrogen, an increase in FSH and LH, and shedding of the endometrial lining (menses) to begin the menstrual cycle again.

<span class="mw-page-title-main">Menstrual disorder</span> Medical condition affecting menstrual cycle

A menstrual disorder is characterized as any abnormal condition with regards to a woman's menstrual cycle. There are many different types of menstrual disorders that vary with signs and symptoms, including pain during menstruation, heavy bleeding, or absence of menstruation. Normal variations can occur in menstrual patterns but generally menstrual disorders can also include periods that come sooner than 21 days apart, more than 3 months apart, or last more than 10 days in duration. Variations of the menstrual cycle are mainly caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, and early detection and management is required in order to minimize the possibility of complications regarding future reproductive ability.

Estrogen dominance (ED) is a theory about a metabolic state where the level of estrogen outweighs the level of progesterone in the body. This is said to be caused by a decrease in progesterone without a subsequent decrease in estrogen.

<span class="mw-page-title-main">Catamenial epilepsy</span> Epilepsy exacerbated during certain phases of the menstrual cycle

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<span class="mw-page-title-main">Progesterone (medication)</span> Medication and naturally occurring steroid hormone

Progesterone (P4), sold under the brand name Prometrium among others, is a medication and naturally occurring steroid hormone. It is a progestogen and is used in combination with estrogens mainly in hormone therapy for menopausal symptoms and low sex hormone levels in women. It is also used in women to support pregnancy and fertility and to treat gynecological disorders. Progesterone can be taken by mouth, vaginally, and by injection into muscle or fat, among other routes. A progesterone vaginal ring and progesterone intrauterine device used for birth control also exist in some areas of the world.

The pharmacology of progesterone, a progestogen medication and naturally occurring steroid hormone, concerns its pharmacodynamics, pharmacokinetics, and various routes of administration.

Menstrual suppression refers to the practice of using hormonal management to stop or reduce menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation, hormonal methods to manipulate menstruation are reversible.

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Menstruation can have a notable impact on mental health, with some individuals experiencing mood disturbances and psychopathological symptoms during their menstrual cycle. Menstruation involves hormonal fluctuations and physiological changes in the body, which can affect a person's mood and psychological state. Many individuals report experiencing mood swings, irritability, anxiety, and even depression in the days leading up to their menstrual period. This cluster of symptoms is often referred to as premenstrual syndrome (PMS). For some individuals, the psychopathological symptoms associated with menstruation can be severe and debilitating, leading to a condition known as premenstrual dysphoric disorder (PMDD). PMDD is characterized by intense mood disturbances, cognitive, and somatic symptoms, which occur in a cyclical pattern linked to the menstrual cycle. In addition to PMDD, menstruation can exacerbate existing mental health conditions. The complex relationship between menstruation and mental well-being has garnered increased attention in both scientific research and public discourse.

References

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