Chronic Hives and Menstruation: What You Need to Know

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Can red, itchy, swelling skin be another symptom of premenstrual syndrome (PMS)? Chronic hives, or urticaria, is about twice as common in women as in men. And for some women, their hives outbreaks seem to be consistently connected to their menstrual cycle. Read on to find out what can cause your skin to flare during that time of the month, what treatment options are available, and when to seek medical help.


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The connection between hives and PMS

For many women, PMS symptoms include mood swings, bloating, weight gain, and acne. PMS symptoms are influenced by hormones that fluctuate throughout the month. If you are noticing a link between your hives and your cycle, it may be that your hormones are also behind your hives outbreaks. Sometimes this connection is overlooked or dismissed. Taking note of the timing of your hives can help you and your doctor find effective treatments.


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Chronic hives are more common among women

Although anyone can develop hives, this skin condition is more common in women, especially those in their childbearing years. Hives are caused when certain cells, called mast cells, release histamine or other chemicals in your bloodstream. This can be from an allergic reaction from certain foods, insect stings, sunlight exposure, or medication. But for women whose hives are linked to their menstrual cycles, certain hormones may be triggering this allergic reaction.


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'Hormone allergies' and hives

Studies have found that some women suffer from a “hormone allergy.” This is a hypersensitivity to certain sex hormones which regulate bodily functions such as menstruation, which can trigger allergic reactions within the body, including hives. In particular, women may be sensitive to progesterone or estrogen, hormones which rise and fall at various points in a woman’s cycle.


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When your body overacts to spiking hormones

While it’s not clear what causes hormones to trigger hives, researchers believe that some women’s bodies overact to these hormones, causing an autoimmune response, when the immune system begins to attack healthy cells and tissues. It may also be that for some women, spiking hormone levels cause a heightened response to other allergens they may come in contact with, opening the door to a hives outbreak.


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Progestogen sensitivity in the last half of your cycle

Women with a progestogen sensitivity are often prone to have a hives outbreak during the last half of their cycle, particularly during week three, or about a week before menstruation. This is when progestogen levels are at their highest. The outbreak should then start to diminish around the start of menstruation, as progestogen levels drop.


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Autoimmune progesterone dermatitis – rare and severe

For some woman, the condition may become chronic and severe enough to be diagnosed as autoimmune progesterone dermatitis (APD). This is a rare condition where the menstrual cycle is linked to chronic hives, angioedema (swelling beneath the skin), eczema, and other skin ailments, such as erythema (abnormal redness and inflammation). When the case is specific to hives, some doctors may refer to it as menstrual cycle dependent urticaria or autoimmune progesterone urticaria.


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A recurring rash linked to the rise and fall of progesterone

With APD, hives and skin rashes usually appear and dissipate on a monthly cycle. This can be a frustrating condition, greatly impacting a woman’s quality of life. Hives usually appear three days to a week before menstruation and will either greatly improve or completely go away shortly after menstruation, when progesterone levels fall. It’s important to note that this connection can be easy to miss for those women who have an irregular cycle.


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Risk factors for developing progesterone hypersensitivity

Risk factors for developing progesterone hypersensitivity include women who have taken medication with progesterone over a prolonged period, such as oral contraception or postmenopausal hormone therapy. Women who have had infertility treatments may also be at higher risk. Pregnancy may aggravate the condition for some. But for some woman, symptoms are brought on because they aren’t able to tolerate their own natural rising progesterone levels.


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Symptoms of APD: Hives can appear almost anywhere

A hives outbreak linked to APD can appear quickly and anywhere on the body, including the face, lips, tongue, throat, or ears. These wheals and swellings may begin to fade within a few hours only to be replaced by a fresh crop of hives. In rare cases, this sensitivity can cause angioedema around the throat or airways that can be so severe it can cause progesterone-induced anaphylaxis, a life-threatening condition.


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Diagnosing progesterone sensitivity

A case ADP is suspected based on the timing of symptoms around your menstrual cycle. It can be confirmed through an allergy skin test to see how the skin reacts to progesterone. This would be done through a skin prick or needle injection and would be considered positive if a “wheal-and-flare” develops and continues for 24-48 hours.


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Treatment options for hives linked to progesterone sensitivity

There are various treatment options available. In mild cases, anti-itch creams such as topical steroids or antihistamines can help. Other woman may require hormone therapy to inhibit ovulation and the production of progesterone. In severe cases, removal of the ovaries may be considered. If ADP is confirmed, your doctor may recommend you avoid medications containing progesterone.


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Questions to consider when seeking treatment

If you suspect you have a hormone sensitivity, make an appointment with your doctor. To prepare for your visit, ask yourselves these questions:

  • How often do symptoms appear? Monthly, every few months? A few times a year?
  • Do symptoms reoccur at the same time during each cycle? Do they resolve when menstruation begins?
  • Have you ever taken birth control pills or other medications that have progesterone in it? Have you been treated for infertility?
  • Have you been diagnosed or treated for hives in the past?


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Organization that offer support

These organizations may be able to offer additional support:

Hormone Health Network

Toll-free: 800-HORMONE (1-800-467-6663)

E-mail: hormone@endocrine.org

Website: http://www.hormone.org

American Autoimmune Related Diseases Association (AARDA)

Toll-free: 800-598-4668

E-mail: aarda@aarda.org

Website: https://www.aarda.org/