title: Gynecological and menstrual disorders in women with vasovagal syncope.
abstract: OBJECTIVE
  Vasovagal syncope (VVS) is a chronic debilitating condition seen mostly in young women of reproductive age. There are anecdotal reports of increased syncope and presyncope around menstruation. This case-control study assessed the effects of the menstrual cycle on lightheadedness episodes and compared the gynecological and pregnancy history of VVS patients to healthy subjects.
  
  
  METHODS
  A custom-designed gynecological and menstrual cycle questionnaire was previously developed for patients with orthostatic intolerance. This questionnaire was administered to female patients with VVS (n = 128) as a part of the multicenter Second Prevention of Syncope Trial, and to gender-matched healthy subjects (n = 92).
  
  
  RESULTS
  VVS patients and healthy subjects reported significant variability in self-reported lightheadedness throughout the menstrual cycle. Both cohorts experienced greatest lightheadedness during menses (53 ± 2 vs. 56 ± 4), which decreased during the follicular phase (44 ± 2 vs. 41 ± 4). VVS patients reported less severity in premenstrual symptoms (Fisher's method P = 2.7E-06) compared to healthy controls. There is no difference in the incidence of gynecological abnormalities (Fisher's exact P = 0.193) and pregnancy complications (P = 1.0) between the two cohorts. VVS patients have similar pregnancy rates compared to healthy subjects (P = 0.674).
  
  
  CONCLUSIONS
  The severity of lightheadedness varies during the menstrual cycle and is similar in both VVS patients and healthy controls. VVS patients have no greater risk of gynecological abnormalities and pregnancy complications than healthy subjects.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, AA3228 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2195, USA.
authors.forename: Prasuna
authors.initials: P
authors.lastname: Muppa
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sheldon
authors.forename: Maureen
authors.initials: M
authors.lastname: McRae
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Keller
authors.forename: Deborah
authors.initials: D
authors.lastname: Ritchie
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.forename: Teresa
authors.initials: T
authors.lastname: Kus
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000453:epidemiology*; D006176:Gynecology; D006801:Humans; D008597:Menstrual Cycle; D008599:Menstruation Disturbances / Q000150:complications / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D019462:Syncope, Vasovagal / Q000150:complications*