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, including increasing weight gain and swollen belly, legs, or ankles. Water retention is felt by some women of all backgrounds before their menstruation onset, and is listed as one of the most common premenstrual symptoms, in addition to cramping and back pain. Age is potentially linked to the intensity of symptoms, with the maximum symptom intensity experienced around age 35. Water retention is an element in assessing premenstrual syndrome (PMS), a set of disruptive symptoms experienced by women before menstruation. Water retention itself can cause other symptoms of PMS, such as body aches, headaches, and nausea. The duration of symptoms can vary from a few days to two weeks. Premenstrual water retention 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, so these people should take extra caution when experiencing this symptom. The cause of water retention remains unclear. 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, but a study found no correlation between water retention severity and serum levels of progesterone or estradiol. It is also suggested that dietary factors may play a role, such as salt and magnesium consumption, and fluid intake. There are methods to relieve or manage water retention and related symptoms. These include both medication (such as water pills) and non-medication management (such as diet control).
Symptoms People of all ages who have periods 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. The Penn Daily Symptom Rating Form was used in multiple studies that demonstrated these symptoms as core symptoms of the premenstrual cycle.
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. Synthetic progestin lacks the ability to antagonize mineralocorticoid receptors, leading to more sodium and water retention and subsequently, temporary weight gain. 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.
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. Non-pharmacological considerations to reduce the effects of the condition is focused on an individual's diet and activity levels such as exercise
Pharmacological
Hormonal treatments Hormonal treatments such as oral contraceptives or intrauterine devices (IUDS) alters the menstrual cycle and lessen the amount of fluid retention. 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. 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.
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. The therapy consists of drugs that pharmacologically adjusts the renal fluid regulation in favor of excreting water and electrolytes. This class of drugs works to achieve the objective of fluid removal through the increase in production and volume of urine.
Midol A popular pharmacologic over-the-counter treatment on the market to alleviate symptoms associated with menstrual cycles in the USA is Midol. More specifically, many Midol products contain a mild diuretic in their active ingredients to help with bloating. 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. 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. 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.
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.
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.
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.
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