Hussain, Sarah Yasmeen; (1994) The compartmental distribution of fluid and electrolytes in relation to the symptomatology of the ovarian cycle and premenstrual syndrome. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The aims of this thesis were to study fluid, electrolyte and hormonal changes during the menstrual cycle and to determine their relationship to symptoms in patients suffering from Premenstrual Syndrome (PMS). The fluid and electrolyte changes were assessed in relationship to psychological and somatic symptoms, but particularly bloatedness, which has long been considered to be due to water retention or fluid shifts. The first study demonstrated atrial natriuretic peptide (ANP) to be significantly lower in patients compared to controls throughout the menstrual cycle, with a significant decrease in the luteal phase of the patients. Mid-luteal ANP concentrations showed a strong negative correlation with PMS symptoms. Cycle simulation with hormones resulted in a significant fall in ANP during oestrogen replacement only. Vascular permeability taken as the 0-10 minute albumin change before and after application of venous pressure, demonstrated a significant increase in the patients in the luteal phase, suggesting increased fluid permeability. Total body water, extracellular fluid, and plasma volume demonstrated no significant change in either group from follicular to luteal phases. There was a follicular to luteal phase decrease in total body exchangeable sodium in both patients and controls. This decrease was significantly different when compared between patients and controls. Creatinine and urea significantly increased, whereas the urinary volume significantly decreased in patients compared to controls in the luteal phase. Follicle stimulating hormone and luteinising hormones were both significantly lower, whilst the oestrogen concentration was significantly higher in the luteal phase when compared to the follicular phase in patients. There was no significant relationship of symptoms to any parameter measured apart from the finding that weight change from the follicular to luteal phase being related to breast and bloatedness scores in patients. The results presented contradict the widely held view that PMS is associated with substantial sodium and water retention or fluid shifts. However possible changes of vascular permeability and exchangeable sodium were detected in the patients which is likely to be related to the hormonal changes demonstrated in the studies.

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