The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Relation between Sodium Balance and Menstrual Cycle Symptoms in Normal Women

Beatriz R. Olson, MD; Michele R. Forman, PhD; Elaine Lanza, PhD; Patricia A. McAdam, PhD; Gary Beecher, PhD; Lorene M. Kimzey, RN; William S. Campbell, RN; Elizabeth G. Raymond, MD; Sandra L. Brentzel, RN; and Bettina Guttsches-Ebeling, MD
[+] Article, Author, and Disclosure Information

From the National Institutes of Health, Bethesda, Maryland, and the U.S. Department of Agriculture, Beltsville, Maryland. Acknowledgments: The authors thank Bruce Nisula, MD, Priscilla Steele, RD, Barbara Filmore, Joseph Schulman, MD (gonadal hormone and luteinizing hormone measures), Candy Davis, BS, Elena Ratinov, PhD, and Jack Yanowski, MD, PhD, for their technical support, and Dr. Peter Schmidt and Dr. Joseph Verbalis for their advice on data analysis and thoughtful review of the manuscript. Grant Support: In part by intramural funds from the National Institute of Child Health and Human Development and the National Cancer Institute of the National Institute of Health after approval from Institutional Review Boards while Dr. Olson was a senior staff fellow at the National Institutes of Health. Requests for Reprints: Beatriz R. Olson, MD, 141 East Main Street, Waterbury, CT 06702. Current Author Addresses: Dr. Olson: 141 East Main Street, Waterbury, CT 06706.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(7):564-567. doi:10.7326/0003-4819-125-7-199610010-00005
Text Size: A A A

Objective: To determine whether sodium balance affects expression of menstrual symptoms.

Design: Prospective study of menstrual symptoms during three cycles: a baseline month (usual intake of sodium, 115 mmol/d) followed by 2 months of sodium restriction (intake of sodium, 73.0 mmol/d). Added salt was allowed during the last month. Investigators were aware of the diet sequence.

Setting: Outpatient. Meals were prepared by a metabolic kitchen during the 2 months that the participants received salt-restricted diets.

Participants: 13 healthy menstruant women.

Measurements: Plasma sodium levels, urinary sodium excretion, and plasma renin activity were measured for five time periods during the baseline cycle and the two cycles of salt-restricted diet. Eleven women completed a questionnaire assessing somatic symptoms and sensory cravings at the same time every day during the 3-month study period.

Results: Sodium restriction was associated with a mean decrease (± one half of the 95% Cl) in plasma sodium levels of 0.9 ± 0.9 mmol/L from a mean of 139.3 mmol/L during the baseline cycle (P = 0.018), a decrease in urinary sodium excretion of 40.3 ± 18 mmol/d from a mean of 117 mmol/d during the baseline cycle (P = 0.001), and an increase in plasma renin activity of 0.14 ± 0.08 ng/(L·s) from a mean of 0.28 ng/(L·s) during the baseline cycle (P = 0.008). During the luteal phase of the sodium restriction cycle, significant decreases in plasma sodium levels of 1.23 ± 0.5 mmol/L (from values of 138.8 mmol/L during the follicular phase) and increases in urinary sodium excretion of 27.2 ± 10 mmol/d (from values of 65.5 mmol/d during the follicular phase) preceded periods when menstrual symptoms were most severe. Ratings of breast tenderness increased sixfold to eightfold in the late luteal phase (P < 0.001) and those of swelling or bloating increased twofold to threefold during early menses (P < 0.001) compared with nadir symptom ratings during each cycle. Sodium cravings increased in the luteal phase of all cycles but were not accompanied by increased sodium intake when access to added salt was allowed.

Conclusions: Breast tenderness and bloating did not result from sodium retention in the luteal phase of the menstrual cycle. During normal and sodium-restricted diet cycles, women actually had urinary sodium loss, not retention, during the luteal phase; severity of menstrual symptoms was unchanged.


Grahic Jump Location
Figure 1. The x-axes represent the five time periods studied for each cycle: I = cycle days 1 to 4; II = cycle days 5 to 8; III = luteinizing hormone surge ± 2 days; IV = mid-luteal phase, days 20 to 25; and V = 4 days before menses. Black rectangles show when menses occurred for each cycle. Variables in the salt-restriction cycle (except for those in the bottom panel) were significantly different from those in the baseline month. For comparisons with values in period II of a given cycle, values marked with an asterisk have a value less than 0.05; those marked with two asterisks have a value less than 0.01. All data are presented as mean ± one half of the 95% CI. Urinary sodium excretion. Upper middle. Plasma sodium levels. Lower middle. Plasma renin activity. For SI units of ng/(L·s), multiply values by 0.2778. Severity ratings for symptoms of bloating or swelling (white ovals) and breast tenderness (black ovals), measured on a scale of 1 to 100 (a higher value represents a worsening of the symptom). Symptom severity varied with cycle time ( < 0.001). Symptoms of bloating or swelling were affected by sodium restriction ( < 0.001).
Variables measured during the baseline cycle, the salt-restriction cycle, and the salt-access cycle; during the latter, women were allowed to add salt to their food.PPTop.Bottom.PP
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.