Does the phase of the menstrual cycle really matter to anaesthesia?

Abstract

The menstrual cycle is a physiological phenomenon that is accompanied by several hormonal fluctuations involving oestrogen and progesterone. Oestrogen and progesterone exert several physiological effects. There are many questions pertaining to the influence of the physiology of menstruation on anaesthesia. We attempted to find out whether the phase of the menstrual cycle can alter the physiological functions during anaesthesia, the perioperative management and outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles on the phases of the menstrual cycle and their relation to anaesthesia-related physiological parameters to find an answer to these questions. Many studies have shown that women, perimenstrually, may have increased pain perception, exacerbation of systemic diseases, vocal cord/peripheral oedema and post-operative nausea and vomiting (PONV). Some of the other notable findings in most studies were sleep disturbances in the luteal phase (LP), increased occurrence of PONV in the ovulatory phase and a lower requirement of intravenous sedative and anaesthetic drug requirements in the LP. We found contradictory results concerning pain perception and PONV in relation to the follicular and LPs. However, we found that literature regarding the phase of the menstrual cycle and the haemodynamic response to intubation, anaesthesia-induced hypnosis and perioperative blood loss is relatively scarce. Thus, there is a need to conduct good quality research on these topics.

The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy

“…37 EST reaches the highest level during the proliferative phase, and PRO peak occurs in the secretory and luteal phases, while the levels of both hormones are low in the menstrual phase. 38 This study showed that there was no significant difference between the pain levels of female patients in the follicular and luteal phases. However, although their PRO levels increased numerically, the increase was not statistically different.…”

“…The perception of pain caused by different stimuli varies during the menstrual cycle due to fluctuations in EST and PRO levels 37 . EST reaches the highest level during the proliferative phase, and PRO peak occurs in the secretory and luteal phases, while the levels of both hormones are low in the menstrual phase 38 …”

The impact of female sex on anaesthetic awareness, depth and emergence: A systematic review and meta-analysis

“…Our review suggests that, at least some, females have a relative insensitivity to anaesthetic agents. Some recent research has suggested that variation in sex hormones may have a modulatory role, 96,98 with studies reporting higher end-tidal volatile requirements 13 and higher propofol effect-site concentration requirements 16 in pre-menopausal females during the follicular phase of their menstrual cycle. Oestrogen and progesterone have central nervous system effects, 14 including allosteric modulation of the gamma-aminobutyric acid receptors, a major molecular target of anaesthetic action.…”

Is Menstruation a Valid Reason to Postpone Cardiac Surgery?

“…During luteal phase, the heart rate and systolic blood pressure were elevated with a lower diastolic blood pressure as a result of higher sympathetic activity and estrogen induced nitric oxide production. [ 26 ] The physiological as well as the psychological stress response to hemodynamic stimuli was also heightened. [ 27 ] Rosano et al [ 28 ] noted a higher incidence of arrhythmias particularly paroxysmal supraventricular tachycardia in the menstrual phase than during the follicular phase.…”