RESEARCH - Effects of the menstrual cycle on medical disorders

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Effects of the Menstrual Cycle on Medical Disorders

M. Case, MD; L. Reid, MD

Arch Intern Med. 1998;158:1405-1412.

Excerpt:

RHEUMATOID ARTHRITIS

Symptoms of rheumatoid arthritis often improve in the luteal phase when

gonadal steroid production is maximal. Similarly, improvement is seen during

pregnancy, with exacerbation postpartum.76-78 A subjective increase in

morning stiffness and arthritic pain during menstruation and the early

follicular phase has been shown.79 Rudge et al80 objectively documented

menstrual cycle-related variations in rheumatoid arthritis by demonstrating

a significant decline in mean grip strength at the start of menstruation.

Similarly, the size of finger joints peaked within 6 days of the start of

menstruation, corresponding in many cases with increased body weight.80

The abrupt decline of ovarian steroidogenesis resulting from involution of

the corpus luteum is thought to be responsible for " menstrual arthritis, " a

rare condition in which arthritis occurs exclusively at the time of

menses.81 Cyclic alterations in rheumatoid arthritis may be attributable to

menstrual cyclicity in the immune response. Cyclic changes in local antibody

release82-83 and in white blood cell subpopulations84 have been described.

Both estrogen and progesterone have anti-inflammatory properties that may

ameliorate arthritic symptoms.85-86 Premenstrual exacerbation of symptoms

has also been attributed to altered pain perception associated with

premenstrual alterations in mood.80

Estrogen, either alone87 or in the combination oral contraceptive pill,88

has proved beneficial for some women with rheumatoid arthritis. Oral

contraceptives may delay onset of disease, but do not prevent its

occurrence.89-91 Although not as thoroughly studied, estrogen replacement

therapy in postmenopausal women appears not to protect against the

occurrence of rheumatoid arthritis.92-93

http://archinte.ama-assn.org/cgi/content/full/158/13/1405

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