• The lung function starts with the first moment of life and ceases with death. • In an intermediate period in females life journey, hormonal changes start with the menarche and ends by the menopause. • It seems that the lungs are affected by such biological feminine events. • It had been observed through centuries by many women that some respiratory symptoms and even distinct clinical morbidities associate with their cycles. • Emerging understanding of the role of sex The Menstrual Cycle & The Lung
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The lung function starts with the first moment of life and ceases with death.
The Menstrual Cycle & The Lung . The lung function starts with the first moment of life and ceases with death. In an intermediate period in females life journey, hormonal changes start with the menarche and ends by the menopause. - PowerPoint PPT Presentation
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• The lung function starts with the first moment of life and ceases with death.
• In an intermediate period in females life journey, hormonal changes start with the menarche and ends by the menopause.
• It seems that the lungs are affected by such biological feminine events.
• It had been observed through centuries by many women that some respiratory symptoms and even distinct clinical morbidities associate with their cycles.
• Emerging understanding of the role of sex hormones in respiratory health and disease represents a major advance in personalized treatment planning for menses associated respiratory aliments.
Women who start menstruating early are at a high risk of developing asthma and poor lung function.
The study suggests that women with early menarche have lower lung function and more asthma risk in adulthood reaffirming the role of hormonal and metabolic factors in women's respiratory health.
Early menses lead to asthma, poor lung function
American Journal of Respiratory and Critical Care Medicine, August 2010
Menstruation and the Lungs • Respiratory symptoms during
• Endometrial tissue is located in the pleura, lungs bronchi and or the diaphragm
• Endometrial cells at these sites are affected by the hormonal changes of the menstrual cycle with concomitant active bleeding
• The clinical presentations include :Catamenial pneumothorax 80%Catamenial haemothorax 14%Catamenial haemoptysis 5%Lung nodules rare
Thoracic endometrial syndrome was first described by Barnes J in 1953 in J Obst. Gyncolog. Br. Emp : Endometriosis of the pleura and ovaries 60(6) : 823-24
In the largest review of CP cases, more than 50% (52.1%) of patients with CP assessed with VATS were
diagnosed as having thoracic endometriosis. Diaphragmatic abnormalities (fenestrations or
endometriosis, alone or combined) are the most commonly described
lesions (38.8%), followed by endometriosis of the visceral pleura (29.6%). In the remainder of cases,
discrete lesions, such as bullae, blebs, and scarring (23.1%), or no findings
(8.5%) are noted.
Catamenial PneumothoraxEndoscopy
Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. Oct 2004;128(4):502-508.
Diaphragmatic fenestrations range from a few millimeters to 2 cm. Endometrial deposits in both the diaphragm and pleura have a similar appearance and range from a few millimeters to 1 cm. Their color ranges from violet to brown, depending on the day of menstrual cycle.
Catamenial PneumothoraxEndoscopy
Performance of a combined VATS and laparoscopy procedure in a single session is another diagnostic approach.
Alifano M, Venissac N, Mouroux J. Recurrent pneumothorax associated with thoracic endometriosis. Surg Endosc. Jul 2000;14(7):680.
CP, CHt, CH, and lung nodules represent the main clinical entities in TES. However, they are not the only
manifestations of TES, other manifestations include catamenial phrenic nerve irritation causing a
catamenial pain-only syndrome, namely cyclic shoulder, neck, epigastric, or right
upper quadrant pain
Rare manifestations of TES
Imaging in Thoracic Endometriosis
X ray chest and preferably CT scan can identify menstrual associated pulmonary and bronchial infiltrates and confirm both their amelioration by the end of the cycle and their recurrence with each following cycle. Thus performing imaging studies and bronchoscopy during menses assist in the diagnosis of pleural and bronchopulmonary disease. i.e Repeated imaging studies or bronchoscopy during midcycle typically documents the disappearance of the previously reported findings, thus strengthening the clinical suspicion.
Hope-Gill B, Prathibha BV. Catamenial haemoptysis and clomiphene citrate therapy. Thorax. Jan 2003;58(1):89-90.
A multidisciplinary approach by thoracic and gynecologic surgical teams carries the highest chance of making an accurate diagnosis and providing the appropriate