Fainting on the First Day of Menstruation: Causes and Solutions

Q: Fainting on the First Day of Menstruation: Causes and Solutions

Hello： During menstruation, the endometrial cells secrete prostaglandins, which cause the smooth muscle cells of the uterus to contract in order to expel menstrual blood from the uterine cavity. <br>In patients with primary dysmenorrhea, due to genetic factors, there is an abnorm

Fainting on the first day of menstruation?

Hello Doctor, first of all, thank you for taking the time to read my question.
I have been experiencing menstrual pain for a long time, occasionally accompanied by dizziness similar to anemia, and during severe episodes, I feel weakness in my limbs and need assistance to get up.
A few weeks ago, on the first day of my period, I initially had only mild menstrual cramps, so I went out to buy dinner.
However, on my way back, I suddenly started feeling dizzy; my fingers began to turn pale.
I thought sitting down for a moment would help, but it only got worse.
I experienced complete weakness, my vision turned white, my hands felt numb, and despite it being a sunny summer day, I felt very cold and was sweating profusely.
Eventually, my boyfriend carried me back to the dorm and called for emergency transport to the hospital.
During the ride, the medical staff asked me questions, and I was conscious, but I couldn't move my body.
When they measured my blood pressure, I felt my fingers were numb due to the pressure, and they were in an unusual position.
After lying down for a while, I gradually felt better without taking any medication or receiving IV fluids or blood transfusions.
I later had blood and urine tests done, and the results from the hospital showed no issues, with no significant anemia.
The doctor diagnosed me with unexplained fainting and mild dehydration.
This is not the first time this has happened, and I feel somewhat scared.
I would like to undergo a comprehensive health check-up since this occurs every time I have my period.
Should I consult a gynecologist, or do I need to see other specialists? Thank you.

Niming, 20~29 year old female. Ask Date: 2017/03/11

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: During menstruation, the endometrial cells secrete prostaglandins, which cause the smooth muscle cells of the uterus to contract in order to expel menstrual blood from the uterine cavity.
In patients with primary dysmenorrhea, due to genetic factors, there is an abnormal increase in prostaglandin secretion, leading to excessive contraction of the uterine smooth muscle cells, resulting in uterine cramps.
This can also cause excessive contraction of the smooth muscle cells in the gastrointestinal tract, leading to symptoms such as diarrhea and abdominal cramps.
Additionally, prostaglandins can have side effects such as hypotension, arrhythmias, and syncope.
If your episodes are consistently related to menstruation, it may be associated with primary dysmenorrhea, and the underlying causes may be at the molecular biology level, making them difficult to diagnose.
Typically, non-steroidal anti-inflammatory drugs (NSAIDs) that we take are prostaglandin inhibitors; starting them a day before menstruation can reduce prostaglandin secretion and may help alleviate the symptoms of syncope.
However, syncope can have many other causes, so at least cardiac and neurological evaluations should be conducted.
Thank you for your message!

Reply Date: 2017/03/11

More Info

Fainting, especially during the first day of menstruation, can be a concerning experience, and it’s understandable that you are seeking answers. Based on your description, it seems that you have a history of menstrual pain (dysmenorrhea) accompanied by symptoms that resemble anemia, such as dizziness and weakness. The episode you experienced, where you felt faint, cold, and sweaty, suggests a possible vasovagal response or other underlying issues that could be exacerbated by your menstrual cycle.

Possible Causes
1. Hormonal Changes: During menstruation, the body undergoes significant hormonal fluctuations, particularly with estrogen and progesterone. These changes can affect blood vessels and blood flow, potentially leading to dizziness or fainting.

2. Pain and Stress Response: Severe menstrual cramps can trigger a stress response in the body, which may lead to a drop in blood pressure and fainting. The pain can cause the body to react by releasing stress hormones, which can affect circulation.

3. Dehydration: You mentioned that the doctors noted mild dehydration. Dehydration can lead to decreased blood volume, which can cause dizziness and fainting, especially when combined with the physical stress of menstrual cramps.

4. Anemia: Although your blood tests did not indicate severe anemia, even mild anemia can contribute to feelings of weakness and dizziness, particularly during menstruation when blood loss occurs.

5. Vasovagal Syncope: This is a common cause of fainting that can be triggered by pain, stress, or standing for long periods. It occurs when the body overreacts to certain triggers, leading to a sudden drop in heart rate and blood pressure.

Recommendations
1. Consult a Gynecologist: Since your symptoms are closely tied to your menstrual cycle, it would be beneficial to consult a gynecologist. They can evaluate your menstrual pain and discuss treatment options, which may include hormonal therapies or pain management strategies.

2. Consider a Comprehensive Evaluation: Given your episodes of fainting, it may be wise to undergo a thorough health check-up. This could include blood tests to check for anemia, electrolyte levels, and hydration status, as well as a cardiovascular evaluation to rule out any heart-related issues.

3. Hydration and Nutrition: Ensure you are well-hydrated, especially during your menstrual cycle. Eating a balanced diet rich in iron (to combat any potential anemia) and staying hydrated can help mitigate some symptoms.

4. Monitor Symptoms: Keep a diary of your menstrual cycle and any symptoms you experience. Note the severity of your cramps, any fainting episodes, and other related symptoms. This information can be valuable for your healthcare provider.

5. Lifestyle Modifications: Incorporating regular exercise, stress management techniques, and adequate rest can help improve overall well-being and potentially reduce the severity of menstrual symptoms.

6. Emergency Plan: Since you have experienced fainting, it may be helpful to have a plan in place for when you feel dizzy or faint. This could include sitting down immediately, having someone accompany you during your menstrual days, and knowing when to seek medical help.

Conclusion
While your recent episode of fainting during menstruation may not indicate a serious underlying condition, it is essential to address these symptoms with a healthcare professional. A gynecologist can provide targeted care for your menstrual issues, while a general practitioner can help rule out other potential causes. By taking proactive steps, you can better manage your symptoms and improve your quality of life during your menstrual cycle.

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