We report menstrual and mid-cycle patterns of self-reported “fluid retention” in 765 menstrual cycles in 62 healthy women. Self-reported “fluid retention,” commonly described as bloating, is one element of the clinical assessment and diagnosis of premenstrual symptoms. These daily diary data were collected as part of an observational prospective one-year study of bone changes in healthy women of differing exercise characteristics. Ovulation was documented by quantitative basal temperature analysis, and serum estradiol and progesterone levels were available from initial and final cycles. Fluid retention scores (on a 0–4 scale) peaked on the first day of menstrual flow (mean ± SE : ), were lowest during the mid-follicular period, and gradually increased from to over the 11 days surrounding ovulation. Mid-cycle, but not premenstrual, fluid scores tended to be lower in anovulatory cycles (ANOVA ), and scores were higher around menstruation than at midcycle ( ). Neither estradiol nor progesterone levels were significantly associated with fluid retention scores. The peak day of average fluid retention was the first day of flow. There were no significant differences in women's self-perceived fluid retention between ovulatory and anovulatory cycles. 1. Introduction Many women perceive changes in fluid retention or “bloating” over the course of their menstrual cycle. As early as 1934, Sweeney [1] reported a pattern of “menstrual edema,” premenstrual weight gain peaking at the onset of flow, in a subgroup of student nurses. Several prospective daily rating studies reported peak fluid retention at the onset of menstrual flow [2, 3], but the hormonal factors underlying these changes remain poorly understood. In particular, it is not clear whether ovulation is necessary, or whether similar changes also occur in anovulatory cycles of normal length. Although oligomenorrheic menstrual cycles are usually anovulatory, anovulation can also occur in clinically unremarkable menstrual cycles of normal length [4, 5]. In a normally ovulatory menstrual cycle, estradiol has two peaks, the higher mid-cycle peak before ovulation and the luteal peak after ovulation. Progesterone, by contrast, is low during the entire follicular phase but rises following ovulation and remains high during the luteal phase. Both estradiol and progesterone levels are low during the first few days of menstrual flow. During anovulatory cycles, estradiol levels may be variable or tonically high with anovulatory androgen excess (also called polycystic ovary syndrome) or variable but normal [6].
References
[1]
J. S. Sweeney, “Menstrual edema: preliminary report,” Journal of the American Medical Association, vol. 103, no. 4, pp. 234–236, 1934.
[2]
J. W. Taylor, “The timing of menstruation-related symptoms assessed by a daily symptom rating scale,” Acta Psychiatrica Scandinavica, vol. 60, no. 1, pp. 87–105, 1979.
[3]
P. M. Meaden, S. A. Hartlage, and J. Cook-Karr, “Timing and severity of symptoms associated with the menstrual cycle in a community-based sample in the Midwestern United States,” Psychiatry Research, vol. 134, no. 1, pp. 27–36, 2005.
[4]
J. C. Prior, Y. M. Vigna, M. T. Schechter, and A. E. Burgess, “Spinal bone loss and ovulatory disturbances,” New England Journal of Medicine, vol. 323, no. 18, pp. 1221–1227, 1990.
[5]
R. F. Vollman, The Menstrual Cycle, W.B.Saunders Company, Philadelphia, Pa, USA, 1977.
[6]
J. C. Prior, “Ovulatory disturbances: they do matter,” The Canadian Journal of Diagnosis, pp. 64–80, 1997.
[7]
I. Nagata, K. Kato, K. Seki, and K. Furuya, “Ovulatory disturbances: causative factors among Japanese student nurses in a dormitory,” Journal of Adolescent Health Care, vol. 7, no. 1, pp. 1–5, 1986.
[8]
S. I. Barr, J. C. Prior, and Y. M. Vigna, “Restrained eating and ovulatory disturbances: possible implications for bone health,” American Journal of Clinical Nutrition, vol. 59, no. 1, pp. 92–97, 1994.
[9]
S. I. Barr, K. C. Janelle, and J. C. Prior, “Vegetarian vs nonvegetarian diets, dietary restraint, and subclinical ovulatory disturbances: prospective 6-mo study,” American Journal of Clinical Nutrition, vol. 60, no. 6, pp. 887–894, 1994.
[10]
B. A. Bullen, G. S. Skrinar, and I. Z. Beitins, “Induction of menstrual disorders by strenuous exercise in untrained women,” New England Journal of Medicine, vol. 312, no. 21, pp. 1349–1353, 1985.
[11]
J. C. Prior, Y. Vigna, and D. Sciarretta, “Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial,” Fertility and Sterility, vol. 47, no. 3, pp. 402–408, 1987.
[12]
J. Jordan, K. Craig, D. K. Clifton, and M. R. Soules, “Luteal phase defect: the sensitivity and specificity of diagnostic methods in common clinical use,” Fertility and Sterility, vol. 62, no. 1, pp. 54–62, 1994.
[13]
J. C. Prior, Y. M. Vigna, M. Schulzer, J. E. Hall, and A. Bonen, “Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak,” Clinical and Investigative Medicine, vol. 13, no. 3, pp. 123–131, 1990.
[14]
J. L. Bedford, J. C. Prior, C. L. Hitchcock, and S. I. Barr, “Detecting evidence of luteal activity by least-squares quantitative basal temperature analysis against urinary progesterone metabolites and the effect of wake-time variability,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 146, no. 1, pp. 76–80, 2009.
[15]
J. C. Prior, “Exercise-associated menstrual disturbances,” in Reproductive Endocrinology, Surgery and Technology, E. Y. Adashi, J. A. Rock, and Z. Rosenwaks, Eds., pp. 1077–1091, Raven Press, New York, NY, USA, 1996.
[16]
J. C. Prior, “Structured daily diary self-report instrument to record daily experiences during the menstrual cycle,” in Menstrual Cycle Diary, Centre for Menstrual Cycle and Ovulation Research, British Columbia, Canada, 1990.
[17]
J. C. Prior, Y. Vigna, and N. Alojada, “Conditioning exercise decreases premenstrual symptoms. A prospective controlled three month trial,” European Journal of Applied Physiology and Occupational Physiology, vol. 55, no. 4, pp. 349–355, 1986.
[18]
J. C. Prior, Y. M. Vigna, and D. W. McKay, “Reproduction for the athletic woman. New understandings of physiology and management,” Sports Medicine, vol. 14, no. 3, pp. 190–199, 1992.
[19]
P. Bouissou, F. Peronnet, and G. Brisson, “Fluid-electrolyte shift and renin-aldosterone responses to exercise under hypoxia,” Hormone and Metabolic Research, vol. 19, no. 7, pp. 331–334, 1987.
[20]
R. L. Landau and L. K. Lugibih, “Inhibition of the sodium-retaining influence of aldosterone by progesterone,” The Journal of Clinical Endocrinology and Metabolism, vol. 18, p. 1237, 1958.
[21]
M. Wang, L. Seippel, R. H. Purdy, and T. Backstrom, “Relationship between symptom severity and steroid variation in women with premenstrual syndrome: study on serum pregnenolone, pregnenolone sulfate, 5 alpha-pregnane-3,20-dione and 3 alpha-hydroxy-5 alpha-pregnan-20-one,” The Journal of Clinical Endocrinology and Metabolism, vol. 81, no. 3, pp. 1076–1082, 1996.
[22]
A. T. Harvey, C. L. Hitchcock, and J. C. Prior, “Ovulation disturbances and mood across the menstrual cycles of healthy women,” Journal of Psychosomatic Obstetrics and Gynecology, vol. 30, no. 4, pp. 207–214, 2009.
