Nausea During Menstruation

The rhythm of life for girls and women of childbearing age is primarily influenced by the intricate interplay of hormones within the female cycle. This approximately 28-day cycle is orchestrated by various female sex hormones that govern not only the reproductive system but also exert their influence on the entire body. Consequently, individuals may experience cycle-related discomfort from fluctuating hormone levels. For many women, menstrual bleeding is accompanied by distressing symptoms such as abdominal pain, diarrhea, and migraines [2]. Additionally, nausea during menstruation is another potential symptom worth exploring. In this article, you will discover:

  • How the female cycle functions.
  • Whether nausea could indicate endometriosis.
  • Other possible causes behind cycle-related nausea.

Understanding the Female Menstrual Cycle

The menstrual cycle is characterized by the relatively regular occurrence of menstrual bleeding, during which endometrial cells and blood are discharged through the vagina. From the onset of the first menstruation, typically around the age of 12 during puberty, until the last menstruation in menopause, healthy, non-pregnant women typically experience menstrual bleeding approximately once a month. This marks the commencement of a new menstrual cycle.

The menstrual cycle duration typically ranges from 25 to 36 days for most healthy women. By definition, it begins with the first day of menstrual bleeding. The menstrual cycle is intricately regulated by multiple hormones in the hypothalamus (located in the diencephalon), the anterior pituitary (pituitary gland), and the ovaries. This cycle unfolds in three distinct phases:

  1. The follicular phase (from the initiation of menstruation until ovulation).
  2. The ovulation phase (ovulation itself).
  3. The luteal phase (extending from ovulation until the onset of menstrual bleeding).

The first day of the follicular phase coincides with the commencement of menstrual bleeding, marking the period when the menstrual symptoms discussed here typically begin. As the follicular phase begins, there is a decline in the levels of the hormones estrogen and progesterone. This decrease in hormone levels triggers the breakdown and shedding of the upper layers of the uterine lining, known as the thickened endometrium, which is expelled during menstruation. Simultaneously, follicle-stimulating hormone (FHS) rises, initiating a new menstrual cycle. This rise prompts the maturation of several follicles, each containing an egg.  However, typically, only one follicle completes its maturation, and it is within this follicle that estrogen is produced.

During the ovulation phase, luteinizing hormone (LH) levels increase, initiating the process of ovulation. Within this phase, progesterone levels also begin to rise. Subsequently, the luteal phase follows, during which the egg travels toward the uterus and, if fertilized, implants into the endometrium. While the levels of luteinizing hormone and follicle-stimulating hormones decrease, progesterone, produced by the corpus luteum (a follicle without an egg), continues to rise. The elevated levels of progesterone and estrogen contribute to the thickening of the endometrial lining. However, if fertilization does not occur, the corpus luteum regresses, causing a decline in progesterone levels.

Concurrently, estrogen levels also decrease, leading to the breakdown of the upper layers of the uterine lining and the initiation of menstrual bleeding once again.

Overview: Understanding Menstrual Symptoms

Menstruation brings a range of symptoms that affect many women, with some potentially indicating more underlying severe conditions [3]. Unfortunately, specific symptoms are often dismissed as “women’s issues” or “psychosomatic,” reflecting the ongoing societal taboo surrounding the female menstrual cycle [4]. Consequently, there is a lack of comprehensive information in the medical literature about various symptoms or discomforts that can still be distressing while not stemming from serious causes. Studies on this topic are often conducted by pharmaceutical companies or commissioned by women’s magazines.

Among the most prevalent complaints during menstruation are [1, 5]:

  • Abdominal pain
  • Mood swings
  • Blemished skin
  • Back pain
  • Diarrhea
  • Flatulence
  • Swollen breasts
  • Nausea

What are the Potential Triggers of Nausea During Menstrual Bleeding?

Nausea during menstruation can stem from various factors, some directly linked to the menstrual cycle, while others having more indirect or unrelated origins. Please note that this list is not exhaustive, and if you experience severe or recurrent nausea during your menstrual period, you should seek specialized medical advice.

  • Hormonal Causes [6]: The menstrual cycle involves fluctuations in the levels of various female sex hormones. These hormonal shifts can affect the reproductive organs and other bodily systems, potentially contributing to nausea during menstruation. For instance, the hormone progesterone, typically elevated in the latter part of the cycle and reduced during menstrual bleeding, can impact smooth muscles in various organ systems, including the gastrointestinal tract.
  • Medications: Nausea may result from medications taken during menstruation, particularly those used to alleviate abdominal pain [7]. Even in cases where medications are taken continuously, a connection between menstrual bleeding (i.e., its timing within the cycle) and medication use might exist. This is because many medicines have been studied less extensively in women than in men [8].
  • Gastrointestinal Conditions: While it is possible for gastrointestinal diseases to coincide with the onset of menstruation, this does not necessarily indicate a direct causal link between nausea and menstruation. Such instances are statistically unlikely to occur three or more times in succession.
  • Stress [9]: Stress can influence physical processes and potentially lead to discomfort during menstrual bleeding. Stressors may be unrelated to menstruation or associated with it. In the latter scenario, menstrual bleeding could be perceived as highly unpleasant or represent an unfulfilled desire for pregnancy, contributing to stress.
  • Endometriosis: Nausea is among the symptoms grouped under the term “dysmenorrhea” in cases of endometriosis [10]. However, both nausea and other symptoms classified under dysmenorrhea are non-specific and can occur for various reasons. Therefore, the presence of nausea alone does not necessarily indicate endometriosis. However, seeking medical consultation is advisable if it accompanies other more typical endometriosis symptoms.

Summary:

Nausea, including cases with vomiting, can have a wide range of causes. While some instances are related to the menstrual cycle, others originate from different factors. While nausea is among the symptoms of endometriosis, not all occurrences indicate this condition.

It is crucial to emphasize that if nausea happens repeatedly during menstruation or is exceptionally severe, seeking guidance from a specialist is advisable.

Maintaining a symptom diary can be immensely helpful to monitor and better understand your symptoms. You can access a symptom diary through the Endo-App. Consider downloading the Endo-App to give it a try.

References

  1. https://de.statista.com/statistik/daten/studie/1268407/umfrage/umfrage-unter-frauen-zu-den-haeufigsten-menstruationsbeschwerden/
  2. https://link.springer.com/article/10.1007/s00940-019-0977-9
  3. https://www.aerzteblatt.de/nachrichten/117060/Studie-Zyklusstoerungen-koennten-bei-Frauen-das-Leben-verkuerzen
  4. https://books.google.de/books?id=wxclBgAAQBAJ&pg=PA81&lpg=PA81&dq=beschwerden+w%C3%A4hrend+der+Menstruationsblutung+medizingeschichte&source=bl&ots=Jr6SRIU2GA&sig=ACfU3U2tJ3b2x-QqxJj3nhV0aEDhBOVsvQ&hl=de&sa=X&ved=2ahUKEwitl4Pm9uf0AhUERuUKHd5oD2IQ6AF6BAgWEAM#v=onepage&q=beschwerden%20w%C3%A4hrend%20der%20Menstruationsblutung%20medizingeschichte&f=false
    Patient Frau: Psychosomatik im weiblichen Lebenszyklus
    herausgegeben von Marianne Springer-Kremser, Marianne Ringler, Anselm Eder, Springer Verlag
  5. https://www.toppharm.ch/krankheitsbild/menstruationsbeschwerden
  6. https://www.aerzteblatt.de/nachrichten/72278/Biologische-Ursache-der-praemenstruellen-dysphorischen-Stoerung-gefunden
  7. https://www.gelbe-liste.de/wirkstoffe/Ibuprofen_289#Nebenwirkungen
    (exemplarisch für Ibuprofen; gilt aber für nahezu alle Schmerzmittel)
  8. https://www.aerzteblatt.de/nachrichten/66613/In-klinischen-Studien-sind-Frauen-oft-unterrepraesentiert
  9. Hassan S, Muere A, Einstein G. Ovarian hormones and chronic pain: A comprehensive review. Pain [Internet]. 2014 [cited 2021 May 20];155(12):2448–60. Available from: https://journals.lww.com/00006396-201412000-00005
    https://link.springer.com/chapter/10.1007/978-3-662-49322-9_5; Gerber M., Schilling R. (2018) Stress als Risikofaktor für körperliche und psychische Gesundheitsbeeinträchtigungen. In: Fuchs R., Gerber M. (eds) Handbuch Stressregulation und Sport. Springer Reference Psychologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49322-9_5
  10. Andreas D. Ebert; Endometriose, Ein Wegweiser für die Praxis; De Gruyter

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