Can Menstruation Cause Vomiting?
Yes, menstruation can trigger vomiting, particularly in individuals with cyclic vomiting syndrome (CVS), where hormonal fluctuations linked with phases of the menstrual cycle are recognized triggers for vomiting episodes. 1
Menstruation as a Trigger for Cyclic Vomiting Syndrome
- Hormonal fluctuations during the menstrual cycle are established triggers for CVS episodes, occurring alongside other triggers like stress, sleep deprivation, and infections. 1
- CVS affects approximately 2% of the U.S. population and is more common in women, which aligns with the hormonal trigger mechanism. 1
- In documented cases, some patients experience stereotypical vomiting attacks occurring specifically during every menstruation period, with successful treatment using gonadotropin-releasing hormone analogues to suppress menstrual cycling. 2
Hormonal Mechanisms and Susceptibility
- Fluctuating estrogen levels over the menstrual cycle influence susceptibility to nausea and vomiting, with the luteal phase (days 20-24) showing the highest incidence of nausea and vomiting—up to 77% in surgical patients compared to 18-32% in other phases. 3
- Women not using oral contraceptives experience more severe nausea during the peri-menstrual phase compared to the peri-ovulatory phase, while oral contraceptive users show no phase-related differences, suggesting hormonal fluctuation as the key mechanism. 4
Clinical Recognition and Management
- If vomiting occurs stereotypically with menstrual periods, consider CVS as a diagnosis, particularly if episodes are recurrent (at least 3 discrete episodes per year with 2 in the prior 6 months), separated by symptom-free intervals. 1
- CVS episodes are characterized by acute-onset vomiting lasting less than 7 days, often with prodromal symptoms including nausea, abdominal pain, and autonomic symptoms. 1
- For menstrually-triggered CVS, hormonal suppression therapy with GnRH analogues plus oral estrogen has demonstrated effectiveness in preventing recurrent episodes, with documented symptom-free periods extending up to 5 years. 2
Important Caveats
- Not all menstruation-related vomiting is CVS—normal nausea and vomiting of pregnancy (NVP) occurs in 30-90% of pregnant women and typically peaks at 8-12 weeks gestation. 1, 5
- Distinguish CVS from other causes: CVS requires stereotypical episodes separated by wellness periods, whereas continuous symptoms suggest alternative diagnoses. 1
- The luteal phase represents the highest-risk period for postoperative nausea and vomiting in menstruating women, requiring more aggressive prophylactic antiemetic therapy. 3