The Effects of Female Hormones on Postoperative Nausea and Vomiting

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common complaints following laparoscopic surgery, and being female is a risk factor for PONV. Therefore, we conducted this study to determine if the incidence of PONV is associated with variations in the blood concentration of female hormones that occur during different stages of the menstrual cycle.Methods: We recruited 103 women who were undergoing gynecological laparoscopic surgery under general anesthesia and met all of the inclusion criteria for this study. A menstrual history was taken from each patient during the preoperative anesthetic visit and blood samples were collected from all patients to determine the concentration of female hormones (estradiol, progesterone). We then assessed the nausea rating scale (NRS) and the occurrence of retching and vomiting at 0−2 hours, 2−6 hours, and 6−24 hours postoperatively.Results: The overall incidence of PONV was 60.2% within the first 24 hours following surgery. However, no significant differences in the incidence of PONV were observed in women in different menstrual phases (follicular phase, 63.5% vs. luteal phase, 56.9%). In addition, there was no significant difference observed in the female hormonal concentration of the blood of patients who experienced PONV and those that did not, and there was no correlation between the NRS and the blood concentration of female hormones. Conclusions:The results of this study suggest that female hormones (estradiol, progesterone) are not associated with the occurrence of PONV following gynecological laparoscopic surgery.

Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study

“…In the early postoperative period, the incidence of nausea but not of vomiting was decreased during the luteal phase. The results of this study were similar to studies that suggested that the early phase of the cycle increases risk of PONV [9][10][11], but differed with those that determined that the luteal phase was a predictor of PONV [12,13] and likewise to those studies that found no influence of the cycle on PONV [14,16,17]. Small, single-center studies may not have enough power to answer the question, but a subsequent metaanalysis may be helpful.…”

“…This fact may explain the controversial results reported on the influence of menstrual cycle on PONV after gynecological laparoscopy (Table 1). Only three abstracts and one paper have attempted to correlate hormonal levels, with completely different results [5,16,17,20]. One report suggested that higher estradiol levels increased risks for PONV [5]; another showed that the lower levels were associated with PONV in the perimenstrual phase but not across the cycle [20]; a third report stated that PONV patients had lower mean estradiol levels regardless of cycle [16], and finally, the paper (in Korean) that suggested that estradiol had no influence on PONV at all [17].…”