"Please guide me on treatment options for
idiopathic cyclic edema". D.R.S.
I see why she asks the question. There is not very
much written about this uncommon disease which occurs
primarily in women.
What is idiopathic cyclic edema?
This is a condition primarily of young menstruating
women in which large amounts of tissue swelling (edema)
occurs in the legs and abdomen after sitting or standing
for periods of time and swelling of the face and eyelids
upon lying down (1). It is felt to be a problem of
leakage of blood fluids from capillaries into fat
and skin tissue especially when gravity (standing
up) is added to the pressure in the vascular system.
It results in large weight gain shifts from morning
to evening. Sometimes the condition is called idiopathic
orthostatic (standing upright) edema or just idiopathic
edema. Other names include fluid retention syndrome
and cyclical edema (2).
This condition can result in moderate discomfort
or pain in any of the areas of excess fluid accumulation.
Carpal tunnel syndrome symptoms, diffuse aching, morning
stiffness and muscle and bony pains as well as headaches
often accompany the swelling. It can also masquerade
as premenstrual syndrome or make existing premenstrual
syndrome worse. It exacerbates the swelling, abdominal
bloating and general physical discomfort but it does
not usually cause irritability and depressive symptoms
as classic PMS does.
Sometimes the syndrome can occur in women with eating
disorders who are taking diuretics or even laxatives
in order to lose weight (3).
Some treatments seem to worsen idiopathic cyclic
edema.
While one would think that taking a "water pill"
or diuretic would improve this edematous condition,
it turns out that in most cases this is the wrong
long term treatment. In fact chronic diuretic use
will increase the secretion of the body's aldosterone
which in turn produces more edema (4). If the chronic
use of diuretics is discontinued, the cyclical swelling
disappears in most cases within about 3 weeks.
Treatments for idiopathic cyclic edema
There is no single, accepted gold standard treatment
for idiopathic cyclic edema. Several different treatments
have been reported. An older report indicates that
the herb ginkgo biloba may be useful in treating this
condition. An agent used for treating high blood pressure
called Captopril has also been used with success (5,
6). It works against a kidney hormone called aldosterone
which is elevated in this condition and causes excess
salt and water retention.
Progesterone has also been used in the treatment
of idiopathic edema under the premise that some women
with idiopathic edema either do not ovulate or have
a luteal phase deficiency (7).
So how should idiopathic cyclic edema be treated?
There are no clear cut answers. Birth control pills
have been used (progesterone). It might well be worth
trying captopril and ginkgo biloba. It is evident
that diuretic pills should not be used.
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