EXPERIENCED INFLUENCE OF MENSTRUAL CYCLE IN WOMEN WITH HYPERMOBILITY SPECTRUM DISORDER: A QUALITATIVE STUDY

G. Luder¹, M. Anneler², F. Kölliker²

¹Bern University Hospital, Insel Group, Department of Physiotherapy, Bern, Switzerland, ²Bern University of Applied Sciences, School of Health Professions, BSc Physiotherapy, Bern, Switzerland

Background: Women with Hypermobility Spectrum Disorder (HSD) often show a wide range of signs and symptoms. Since also younger woman are often affected by HSD, the influence of the menstrual cycle (MC) and the related hormonal changes might be an issue. There are few studies reporting changes in joint mobility by the MC and some studies indicating for abnormalities in the MC in women with HSD. To our knowledge, so far, no study has examined the subjective experience of women with HSD regarding the associations of their symptoms with their MC.

Purpose: The aim of the study was to capture the personal experience of women with HSD regarding the influence of the MC on symptoms, disability and daily-life activity.

Methods: Semi-structured interviews were conducted in personal with seven women aged 19-43 (mean 32) years with HSD, recruited from a physiotherapy practice in Berne, Switzerland. Open questions asking for signs and symptoms due to their HSD and the influence by the MC were asked. All interviews were recorded and transcribed into standard German language. The transcripts were independently analysed by two physiotherapists, categorizing the statements, and keeping typical quotes per issue. Differences were discussed with a third physiotherapist until consensus was reached.

Results: In general, the women experienced symptoms associated with their HSD more intense at the beginning of the MC and during menstruation. Due to increased pain and fatigue, they felt powerless at that time. Their feeling of instability in some joints or when performing specific activities was more pronounced. The symptoms triggered by their hypermobility and the MC presented very variable and were experienced very individual. Often mentioned were low back pain and problems with the knee joints, as well as generalized pain in the body. Five of seven women clearly felt an influence of the menstrual cycle on their musculoskeletal symptoms. Three women had given birth and only one woman took oral contraceptives, whereas six had earlier experience with contraceptives. In some cases, these were used to alleviate symptoms, while for others they have increased symptoms.

Conclusions: The interviews allowed a first insight into the association between HSD and the MC. At least some women experienced a worsening of symptoms during menstruation, possibly related to hormonal changes. Also, oral contraceptives were described to have an influence on the symptoms, sometimes positive and in some women negative. This supports the hypothesis that hormonal changes might have a direct influence on the musculoskeletal system. Limitations of this small study were a focus on symptoms of the musculoskeletal system and that no objective measurement of the hormonal state could be incorporated. Additionally, the interviews were performed at one time point, thus recall bias and subjective memories for the symptoms in earlier years might have occurred.

Implications: The results point to the possible influence of the MC on musculoskeletal symptoms in women with hypermobility. Thus, in clinical practice patients might be encouraged to keep the MC in mind and possibly to adapt activities and exercise. Oral contraceptives may also have an influence and could be discussed with patients.

Funding acknowledgements: No funding.

Keywords:
Hormonal influence
Oral contraceptives
Musculoskeletal symptoms

Topics:
Musculoskeletal
Disability & rehabilitation
Non-communicable diseases (NCDs) & risk factors

Did this work require ethics approval? No

Reason: Ethics committe declared "Not responsible", i.e. the project does not require a permit. Justification: The project does not fall under the Human Research Act, Article 2, Paragraph 1. (Attached official document in German)