The exacerbation of symptoms in Menière's disease during the premenstrual period.

The pathophysiology of the characteristic episodic symptoms of vertigo, low-frequency hearing loss, and tinnitus in Menière's disease remains poorly understood. It is likely that the manifestation of this condition may be multifactorial and related to elements affecting the inner ear beyond the underlying pathology of endolymphatic hydrops. We have identified a subgroup of female patients with Menière's disease in which the symptoms of this disorder are correlated with the late luteal phase of the menstrual cycle (premenstrual period). Through audiometric and vestibular testing, we have documented these inner ear effects in six women. Although many hormonal effects occur during the premenstrual period, compartmental fluid redistribution within the body may be the most pertinent. Endolymphatic hydrops represents a fluid imbalance within the inner ear and, when combined with an additional fluid shift, may produce symptomatic dysfunction. Case histories demonstrating the correlation of the symptoms of Menière's disease and the premenstrual period will be presented along with theoretical mechanisms of pathophysiology.