Dysautonomia and the Menstrual Cycle

Hormones and Flare-Ups: Understanding the Link Between Dysautonomia and the Menstrual Cycle

For many women living with dysautonomia, the days leading up to their menstrual period can feel like hitting a wall. Symptoms worsen, fatigue deepens, and the familiar lightheadedness, brain fog, or heart palpitations intensify. These flare-ups, often referred to as “lows” or “crashes”, are not just coincidental. There’s a strong physiological link between the hormonal fluctuations of the menstrual cycle and the exacerbation of dysautonomia symptoms.

What’s Happening in the Body?

1. Hormonal Fluctuations: Estrogen and Progesterone

The menstrual cycle is orchestrated by a dynamic interplay of hormones. During the luteal phase (which occurs after ovulation and before menstruation), levels of estrogen and progesterone peak and then decline sharply just before a period begins. This rapid drop can disrupt several systems critical for women with dysautonomia:

• Blood Volume and Vascular Regulation: Progesterone promotes fluid retention and vasodilation. Its decline can reduce blood volume, which exacerbates symptoms like orthostatic intolerance (difficulty standing upright without symptoms).

• Sympathetic Nervous System Sensitivity: Estrogen influences norepinephrine sensitivity and blood vessel tone. Its fluctuations can alter the body’s ability to regulate heart rate and blood pressure.

• Electrolyte and Fluid Balance: These hormones also modulate the renin-angiotensin-aldosterone system (RAAS), which controls sodium retention and blood pressure—both crucial in managing dysautonomia.

2. Menstrual Blood Loss

For women with heavy menstrual bleeding, the drop in blood volume from blood loss can directly impact dysautonomia symptoms. Less circulating blood volume means the heart and vessels must work harder to maintain pressure, often resulting in dizziness, fatigue, and even fainting.

3. Inflammation and Pain

The menstrual cycle naturally raises inflammatory prostaglandins, which can cause cramping, bloating, and increased systemic inflammation. This inflammation can stimulate the sympathetic nervous system—already hypersensitive in people with dysautonomia—further worsening symptoms.

Common Symptoms During Menstrual Flares

Many women with dysautonomia report a pattern of worsening symptoms before and during menstruation. These may include:

• Increased fatigue or exhaustion

• Dizziness or worsening orthostatic intolerance

• Palpitations or tachycardia

• Brain fog or difficulty concentrating

• Migraines or headaches

• Gastrointestinal distress such as nausea or bloating

Strategies for Managing Hormone-Related Flares

Understanding that hormone shifts contribute to symptom flares empowers women to take proactive steps. Here are some approaches that may help:

• Hydration and Salt Loading: Increasing fluid and salt intake before and during menstruation can help maintain blood volume.

• Hormonal Birth Control: Some women find that stabilising hormones through birth control—particularly continuous use without a placebo week—reduces symptom variability. This should be discussed with your doctor so that you are aware of your options, taking birth control is a big step for many women and not always properly understood.

• Iron Supplementation: If heavy bleeding causes or contributes to anemia, iron supplements can be vital. Supporting iron stores with nutrition pre-period is helpful.

• Anti-inflammatory Medications: NSAIDs can reduce both cramping and inflammatory responses. Anti-inflammatory food choices are great here too.

• Activity Adjustments: Switching to lower-impact or seated exercises during flare periods can help avoid symptom crashes.

The Bottom Line

Dysautonomia is already a complex condition to manage, and the menstrual cycle adds another challenging layer. But knowledge is power. Recognising that monthly hormone fluctuations can worsen symptoms helps validate what many women already feel—and opens the door to more personalised and effective care strategies.

If you're noticing this monthly pattern, you're not imagining it—your hormones are absolutely playing a role. Tracking your symptoms in relation to your cycle and working with a knowledgeable provider can make a world of difference.

Further Reading & Scientific References

1. Shufelt, C. L., et al. (2017). "Hormone Therapy and Autonomic Nervous System Regulation in Women." Menopause, 24(5), 556–564.
   https://doi.org/10.1097/GME.0000000000000826

2. Parker, W. A., et al. (2021). "The Role of the Menstrual Cycle in Postural Orthostatic Tachycardia Syndrome." Autonomic Neuroscience, 233, 102794.
   https://doi.org/10.1016/j.autneu.2021.102794

3. Fu, Q., et al. (2010). "Menstrual Cycle Effects on Sympathetic Neural Responses to Orthostatic Stress in Women with POTS." Journal of Physiology, 588(20), 3917–3926.
   https://doi.org/10.1113/jphysiol.2010.195412

4. Raj, S. R. (2013). "Postural Tachycardia Syndrome (POTS)." Circulation, 127(23), 2336–2342.
   https://doi.org/10.1161/CIRCULATIONAHA.112.144501