Drug Treatment of Syndromes Exacerbated or Triggered by the Menstrual Cycle

Medical conditions that are exacerbated by or occur in phase with the menstrual cycle vary from the common [premenstrual exacerbation of asthma and menstrual migraine (MM)] to the exceptionally rare (catamenial pneumothorax, autoimmune progesterone dermatitis, and cyclical thrombocytopenia). All cyclical syndromes require prospective symptom and menstrual charting to confirm their relationship with menstruation and to avoid recall bias. The triggers for the various syndromes are different; they are generally hormonal (late luteal estrogen fall in MM; high estrogen, low progesterone in catamenial epilepsy), but may also be physical (vicarious menstruation, possibly related to endometriosis) and in some conditions remain unknown. An understanding of the underlying pathophysiology of the relationship between symptoms and the menstrual cycle can aid in successful treatment of these cyclical conditions.