Fluid retention - Premenstrual syndrome - Ideopathic edema

Fluid retention syndrome

Very many women know these complaints: Especially in the second half of the cycle, they wake up in the morning with puffy eyes, almost as if they had looked too deeply into the glass in the evening. The rings stick to their fingers, their breasts tighten and the scales show a considerable increase in weight, although they have not eaten more than usual. It is true that the swellings on the face and hand get better in the course of the day. But by the evening, the legs are tense. And they also feel tired, dull and irritable.

Complaints

Many names - one disease?

Increased water retention in otherwise healthy women has many names. Since it occurs mainly in the second half of the cycle, i.e. after ovulation, it is often called cyclic idiopathic edema. The word "cyclic" is self-explanatory, since the symptomatology occurs completely regularly. Some women suffer only in the days immediately preceding their period, while others can distinguish two good weeks from two bad weeks. In medicine, "idiopathic" refers to clinical pictures whose cause is unknown.

More familiar is the term "premenstrual syndrome", i.e. a pattern of symptoms that occurs primarily before (pre = before) menstruation, the period bleeding.

However, the same water retention can also occur largely independently of the period and, for example, only be more prevalent during warm, humid weather. In summary and more neutrally, these symptoms can therefore be referred to as fluid retention syndrome (retention = restraint).

Exclusively women

The symptomatology affects practically exclusively women. The symptoms usually begin with puberty, in early adulthood or with pregnancy. After menopause, the edema usually subsides. These are very common complaints. Although the severity varies greatly, up to 40% of all women are said to suffer from at least mild symptoms, especially before menstruation.

Symptoms

As mentioned, the condition usually begins after ovulation in the second half of the cycle. It consists of fatigue, tiredness and excruciating headaches or migraines. Abdominal discomfort often presents itself, such as bloating, increased bowel sounds, flatulence or constipation. The lower part of the abdomen is not infrequently bulging.

Blood pressure may drop, dizziness, lightheadedness are common. Although sufferers drink a lot, they excrete little. This explains why the edema increases slowly. Especially the tissues around the eyes, cheeks, fingers, chest and in the evening the lower legs are swollen. The water retention is sometimes only 1-2 kg, but in individual cases it can be 10 kg and more!

In many cases, vegetative dysregulation also occurs. Blood pressure fluctuations, increased freezing or sweating, diarrhea or constipation, sleep disturbances, food cravings or nausea, the whole body seems to be in turmoil.

While some women simply feel unwell, others are significantly affected, feeling irritable or depressed. Everything becomes too much for them, even the smallest tasks seem like a mountain. Partners or family have to get through these days or weeks, when a wrong word can trigger violent reactions.

After the period, the whole spook is usually over and everyone involved breathes a sigh of relief. Water excretion begins to increase, and with it the edema disappears. The feeling of well-being is restored.

Sometimes also different

Some women suffer from virtually the same complaints, but they are not so clearly linked to the menstrual cycle or even occur completely independently of it. Even after menopause, the complaints can occur. Phases with and without edema come and go without a clear assignment of cause.

These are subtypes of the fluid retention syndrome, which do not differ in principle from the cyclic idiopathic syndrome.

Diagnosis

Water load

The diagnosis is usually based on the typical symptoms and the exclusion of other diseases. In unclear cases, a two-day water stress test can confirm the diagnosis.

For this purpose, 1-2 liters of water are drunk on the first day, depending on body weight. The next 4 hours must be spent lying down. After that, the bladder is emptied and the urine volume is determined.

The procedure is repeated the next day. Unlike the day before, now it is 4 hours of standing, which is quite difficult for many patients. Again, the bladder is emptied and the volume is measured. If significantly less water and salt is excreted on the second day, fluid retention is present. Due to standing, edema has formed in the legs.

Causes

Capillary permeability

The central cause of discomfort is again an increased permeability of the capillary walls to protein. There is thus a similarity to lipedema. The leakage of protein and fluid into the connective tissue causes a lack of fluid in the vascular system.

The body reacts promptly to this. It produces a whole series of hormones (renin, angiotensin, aldosterone, ADH), all of which have the same effect: they retain body water and common salt, thus reducing excretion. At the same time, you feel thirsty and drink more.

In this way, the loss of fluid in the bloodstream is compensated for. However, there is protein-rich edema in the tissues that cannot be adequately removed by the lymphatic system.

It is obvious that the female sex hormones play a role. But which ones? The estrogens or the ratio of estrogens to progestins (corpus luteum hormone e.g. progesterone) are decisive.

Estrogens also affect the water balance in many respects. They increase the amount of water circulating, weaken the pumping function of lymphatic vessels, and increase blood levels of some hormones that retain water (renin, angiotensin, aldosterone).

Estrogens are thus a major partial cause of the symptomatology. However, they are not the sole culprits. How the increased permeability of the capillaries comes about is ultimately not clear.

Therapy

Those who suffer severely from the symptoms may not take comfort in the fact that they will probably (not always) get better after menopause. As a rule, affected women first turn to their gynecologist to have a possible hormone disorder treated. Of course, serious hormonal disorders must be ruled out, but the results of hormone therapy are almost always disappointing. Therefore, the general principles described in detail in the therapeutic section apply to the therapy. Example

Here is another tip: Taking calcium tablets should also improve the symptoms. Since the side effects of calcium are negligible, it is definitely worth trying.

Otherwise, there is probably no drug therapy at present. Diuretics are only suitable in exceptional cases.

For the therapy of lipedema

Fluid retention - Premenstrual syndrome - Ideopathic edema

Fluid retention syndrome

Complaints

Many names - one disease?

Exclusively women

Symptoms

Sometimes also different

Diagnosis

Water load

Causes

Capillary permeability

Therapy

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