Allergic Reactions to Menstrual Hormones

A number of different allergic skin conditions, including eczema, urticaria, angioedema, and erythema multiforme, can worsen during the premenstrual time period. When these conditions worsen three to 10 days prior to the onset of menses, the woman may have progesterone (also called progestogen) hypersensitivity.

Woman scratching her forearm with fingers
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Progesterone hypersensitivity has the ability to progress to anaphylaxis. Another form of anaphylaxis that is related to the menstrual cycle is catamenial anaphylaxis. These are both believed to be rare conditions.

Progesterone Hypersensitivity

Progesterone hypersensitivity occurs as a result of an allergic reaction to a woman's own progesterone and can also be caused by other sources of progestogen.

Symptoms

Symptoms typically occur anywhere from three to 10 days prior to the onset of menses and begin to resolve within one to two days after the onset of menstruation.

Progesterone hypersensitivity can have a variety of different symptoms, although most, if not all, include skin rashes.

Skin rashes that may be seen include eczema, hives, fixed drug eruptions, erythema multiforme, angioedema, and even anaphylaxis.

It may not initially be obvious to the affected person that their symptoms are worsened during the premenstrual period. It often takes a physician to ask the question of worsening symptoms related to the menstrual cycle before the pattern is obvious to the person.

Causes

Why a person develops progestogen hypersensitivity is unknown. Some theories include that it is caused initially by a woman taking birth control pills or another hormone supplement containing progesterone that results in sensitization to the hormone.

Pregnancy can also result in sensitization to progesterone, and pregnancy can have significant effects on the immune system and can dramatically affect a variety of allergic conditions.

Other theories posit that women may develop progesterone hypersensitivity as a result of cross-reactivity with corticosteroids, which have similar molecular structures to hormones. While allergic reactions to other hormones, such as estrogen, can occur, these are far less common than reactions to progesterone.

Diagnosis

Progesterone hypersensitivity is a clinical diagnosis. Skin testing to progesterone is performed by some allergists, but testing reagents and procedures are not validated. The sensitivity and specificity of these tests are yet to be determined.

Skin testing should only be performed under the direction of a physician, ideally, an allergist, experienced in the diagnosis and treatment of anaphylaxis, given the possibility that a dangerous allergic reaction.

Treatment

Treatment of progesterone hypersensitivity may be successful with the use of antihistamines and ​oral or injected corticosteroids, although these medications would only be useful to treat the symptoms rather than correcting the problem.

Therapies that suppress ovulation, such as leuprolide, prevent the rise of progesterone during the menstrual cycle and are another option if antihistamines are not effective. Rarely, surgical removal of the ovaries and uterus is required in severe cases of progesterone hypersensitivity when medications are unable to control the symptoms.

Catamenial Dermatoses and Anaphylaxis

Catamenial anaphylaxis and dermatoses are other conditions that are related to the menstrual cycle.

Symptoms

Women who have catamenial anaphylaxis experience symptoms of anaphylaxis as soon the menstrual flow begins and symptoms continue until the menses flow stops.

With catamenial dermatoses, similar symptoms to progesterone hypersensitivity may occur, but the timing correlates with menses instead of progesterone peaks; a variety of rashes can also occur.

When to See a Doctor/Go to the Emergency Room

While it is important to see if a doctor if you develop an allergy of any sort, you should call 911 or seek emergency care if a rash is accompanied by fever, wheezing, shortness of breath, facial swelling, rapid heart, nausea, vomiting, or fainting. These are all signs of anaphylaxis requiring immediate care.

Causes

Unlike progesterone hypersensitivity, however, catamenial anaphylaxis is not thought to be an allergic condition but rather is caused by prostaglandins released from the lining of the uterus (endometrium), which may be absorbed into the bloodstream.

Diagnosis and Treatment

The diagnosis is usually made on a clinical basis, as allergy testing to progesterone (and other hormones) would be expected to be negative. Prevention of catamenial anaphylaxis has been successful with the use of non-steroidal anti-inflammatory medications (NSAIDs), such as Indocin (indomethacin).

Surgical removal of the ovaries and uterus may be required in severe cases of catamenial anaphylaxis when medications are unable to control the symptoms.

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