From the Guidelines
Vomiting during menstruation is a concerning symptom that warrants medical attention if it is severe, persistent, or interferes with daily activities.
Causes and Concerns
Vomiting during menstruation can be associated with various conditions, including premenstrual syndrome (PMS), endometriosis, adenomyosis, or other gynecological disorders. According to 1, some women with acute hepatic porphyrias (AHP) may experience cyclic attacks related to the menstrual cycle, which can manifest as vomiting.
Management and Treatment
For mild symptoms, over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg every 8-12 hours) can help by reducing prostaglandin production 1. Ginger supplements (250mg four times daily) may also alleviate nausea. Staying hydrated, eating small frequent meals, and avoiding trigger foods can provide relief. However, severe vomiting that prevents eating or drinking, vomiting accompanied by severe pain, or symptoms that significantly interfere with daily activities should prompt medical evaluation.
Severe Cases and Specialist Referral
In severe cases, birth control pills or hormonal IUDs might be recommended by healthcare providers to reduce menstrual symptoms including nausea and vomiting by regulating hormones and reducing prostaglandin production. Additionally, medications such as ondansetron, metoclopramide, or promethazine may be required in moderate to severe cases, as suggested by 1. It is essential to seek medical attention if vomiting during menstruation is severe or persistent, as it may indicate an underlying condition that requires specific treatment.
Key Considerations
- Severe vomiting during menstruation can lead to dehydration and electrolyte imbalances, which can worsen the condition.
- Underlying conditions such as endometriosis, adenomyosis, or AHP require prompt diagnosis and treatment to prevent long-term complications.
- A thorough medical evaluation, including laboratory tests and imaging studies, may be necessary to determine the underlying cause of vomiting during menstruation.
From the Research
Vomiting with Menstruation
- Vomiting associated with menstruation can be a symptom of various conditions, including cyclic vomiting syndrome (CVS) 2.
- CVS is characterized by episodes of vomiting lasting from a few hours to several days, alternating with periods of no symptoms, and can be triggered by menstruation, among other factors 2.
- In some cases, vomiting with menstruation can be related to catamenial migraine, and treatment with permenstrual percutaneous oestrogen may be effective 2.
Diagnosis and Treatment
- The diagnosis of CVS requires exclusion of alternative diseases, particularly neurological and gastrointestinal disorders 2.
- Treatment for nausea and vomiting associated with menstruation may involve antiemetic drugs, such as serotonin and neurokinin antagonists, dopamine antagonists, and corticosteroids 3, 4, 5.
- In some cases, alternative therapies such as ginger, vitamin B6, and acupressure may be effective in managing nausea and vomiting associated with menstruation 4, 6.
Specific Conditions
- Hyperemesis gravidarum, a severe form of nausea and vomiting in pregnancy, can have significant adverse physical and psychological sequelae, and treatment may involve corticosteroids, ondansetron, and other medications 4, 6.
- Cyclic vomiting syndrome associated with menstruation can be treated with permenstrual percutaneous oestrogen, as reported in a case study 2.