From the Guidelines
Vomiting with menstruation can be effectively managed with a gonadotropin-releasing hormone (GnRH) analogue, which can prevent cyclic attacks related to the menstrual cycle by down-regulating gonadotropin receptors and preventing ovulation and corpus luteum formation 1. To manage vomiting with menstruation, several approaches can be considered.
- For women with acute hepatic porphyrias (AHP), recognizing and removing exacerbating factors, or using prophylactic hemin infusions can help prevent cyclic attacks related to the menstrual cycle 1.
- GnRH treatment can be initiated during the first 1–3 days of a cycle to prevent an initial agonistic effect that induces ovulation, and menopausal symptoms and bone loss can be prevented with a low-dose estradiol skin patch after ~3 months 1.
- Switching to a low-dose hormonal contraceptive or using prophylactic hemin infusions can also be effective in preventing cyclic attacks 1. It is essential to note that oophorectomy and hysterectomy should not be considered unless there is another indication 1. Measuring serum progesterone at the onset of symptoms can help identify luteal phase and potentially progesterone-induced attacks, allowing for targeted treatment 1. Overall, a comprehensive approach to managing vomiting with menstruation should prioritize the individual's specific needs and medical history, and may involve a combination of hormonal therapies, prophylactic infusions, and lifestyle modifications.
From the Research
Vomiting with Menstruation
- Vomiting associated with menstruation can be a symptom of primary dysmenorrhea, which is characterized by menstrual pain in the absence of pelvic disease 2, 3.
- Primary dysmenorrhea is caused by the overproduction of prostaglandins by the endometrium, leading to uterine hypercontractility and pain 2, 3.
- Treatment for primary dysmenorrhea typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives 2, 3.
- However, there is limited research on the specific treatment of vomiting associated with menstruation.
- Studies on nausea and vomiting in other contexts, such as pregnancy and emergency department patients, have investigated the use of antiemetic medications like ondansetron and metoclopramide 4, 5, 6.
- These studies have shown mixed results, with some finding similar efficacy between different antiemetic medications and others finding no significant difference between active treatment and placebo 5, 6.
Antiemetic Medications
- Ondansetron and metoclopramide are commonly used antiemetic medications that have been studied in various contexts, including pregnancy and emergency department patients 4, 5, 6.
- These medications have been shown to be effective in reducing nausea and vomiting in some studies, but the evidence is not consistent across all studies 5, 6.
- The use of antiemetic medications for vomiting associated with menstruation is not well established and would require further research to determine their efficacy and safety in this context.
Gaps in Research
- There is a lack of research specifically addressing vomiting associated with menstruation, making it difficult to provide evidence-based recommendations for treatment.
- Further studies are needed to investigate the efficacy and safety of antiemetic medications and other treatments for vomiting associated with menstruation.