Sore throats, Women’s Periods, and Sleep-Breathing Issues

One of my most popular blog posts is the piece I did about women who have sore throats just before their periods. Take a look at the 45 comments in response to my post. To summarize, the reason why some women have sore throats along with their monthly periods is due to the relative drop in their progesterone levels. One of the positive benefits of progesterone is that it’s an upper airway muscle stimulant. It literally tenses or stiffen your tongue muscle. As progesterone drops, the tongue falls back more easily during deep sleep, causing more frequent obstructions and arousals.

I recently had a woman who told me she gets sore throats when it rains or if she gets wet. How many you have this particular condition?

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17 thoughts on “Sore throats, Women’s Periods, and Sleep-Breathing Issues

  1. I’ve had elevated prolactin since I was a teenager (I’m 40), though they’ve never seen a tumor by MRI. I have had very irregular periods since ~ age 14 (started my period at age 10) I often would go 3 months – 15 months at a time without a period. Since no tumor was visible, I wasn’t treated. In 1990, they didn’t realize that hyperprolactinemia caused long term health issues. My prolactin levels were ~70 for about 25 years. I’ve never slept well even as a child but I also have really bad year-round allergies. I started cabergoline in 2003, which normalized my prolactin, but I still have extremely light periods (spotting really) that only lasts for ~24 hours. Once I started the meds, normalized prolactin and started to have regular periods, I started getting severe migraines the week before my periods. A neurologist at Stanford sent me for a sleep study a year ago and my sleep index was 40 with only 2 short REM cycles for a total of ~20 minutes of REM per night. The morning after the sleep study, the dr said that all night long as soon as I start to have trouble breathing I woke up. I was severely sleep deprived, and I believe I have been since I was very young. I tried the CPAP for ~ 4 months, but it made me feel worse and worse. It also made my lungs hurt like an over-stretched balloon. Stanford was unable to determine my optimum pressure during the sleep titration so Rxd one of those automatically adjusting CPAPs. After about 2 months, I called my dr and he lowered the pressure, but it didn’t help. the longer I used it the worse I felt. It got to the point I couldn’t even function at work and since I work in a medical research lab and handle many toxic chemicals such as glacial acetic acid and hydrochloric acid, I couldn’t “stick with it”. I have also since been diagnosed with asthma and am still working on getting it under control. I’m currently surviving taking ambien every night, no CPAP. The sleep study with ambien showed I still wake up constantly though I am getting a little deeper sleep and more REM. I feel a lot better than I did before being diagnosed and the catamenial migraines are a lot better (though I still don’t feel great). I’ve only had the asthma for about a year and a half, though it may be nocturnal asthma and since I didn’t have daytime symptoms until recently, maybe I just wasn’t diagnosed. I’ve never felt refreshed after sleeping and frequently wake up with headaches and sore throats, even as a child.

    I am curious if the sleep apnea problems could be related to the prolactin imbalance? Or maybe the elevated prolactin was caused by severe sleep deprivation?

  2. Dr. Parks – This issue has lead me to some very significant connections that I’d like to share with you. I have a daugher with down syndrome, who, from a very young age – has gotten many metabolic and blood tests done from a very early age. (There is research that shows DS is a progressive disease that can in part be helped with nutritional / drug therapy – to enhance the altered biochemistry of the individual with DS. (Please see research @ Stanford Research Center for Down syndrome – also William Mobley – UCSD – Research by Garner, etc).

    I have always wondered why from a very young age (around 2 yrs old) my daughters Prolactin levels were excessively high. No doctor has ever had an explanation.
    From my research and reading from this link – I have discovered some interesting connections between many of the biochemical and neuronal anomalies associated with Down syndrome – related to the most recent research.

    First off – high levels of prolactin can lead to a drop in progesterone. Which, relative to my daughter’s current UARS could increase the chance for more tongue and airway collapse. Especially if her progesterone has been low from a very early age. There was research done with regards to Vasoconstrictive Intestinal Peptide in children with DS, autism and developmental delays. All showing abnormal levels. In DS – VIP was increased in Down syndrome. VIP helps to regulate Prolactin secretin as it stimulates prolactin release. (See PubMed abstracts on Vasoconstrive Intestinal Peptide and Down syndrome and developmental delay). Of other great interest is that VIP is a critical component of the circadian timing machinery. (There is recent research looking at the circadian dysfunction in Down syndrome!)

    Another connection is that dopamine inhibits prolactin production. It is well established that Down syndrome individuals have low and abnormal dopamine, serotonin and norephinephrine levels.

    Last connection is that norepinephrine helps regulate PROGESTERONE –
    (Please see recent DS research showing that correcting the levels of norephineprine in the Down syndrome mouse model corrected many aspects of memory and learning – They are looking at the drug L-DOPS as a possible treatment for Down syndrome.

    This is like peeling the layers of an onion……

    As a side note, I did do a trial of loestrin for my daughter hoping to help the airway and I saw positive benefits cognitively from it – although , I did see increased moodiness, irritability and emotionality. I think the ratio of estrogen to progesterone is what is off. And the “pill” was increasing estrogen to a higher degree than progesterone. We are looking into progesterone balance.
    Sincerely
    Linda Strobel

  3. Tanya,

    Various hormone imbalances can wreak havoc on your body. You have to treat these imbalances, but in cases when normalization of hormones is not enough, you have to treat the sleep-breathing problem more definitively. I’m not surprised you didn’t like CPAP and that it didn’t work for you—but it doesn’t mean that sleep-breathing issues are not a major factor. There are many other ways of treating major breathing problems during sleep that don’t even show up as apneas. One very common problem is upper airway resistance syndrome, where you stop breathing and wake up repeatedly, so you can’t stay in deep sleep. This causes a major physiologic stress response leading to elevated cortisol, epinephrine, and norepinephrine levels.

  4. As the physical differences, women’s ovulation period is not fixed, but also by the living, the environment, mental factors and health effects.

  5. My daughter in law gets a sore throat every time it rains, especially when the rain begins at night. Is it due to change in pressure?

  6. Ms. Nielsen,

    Yes. Pressure changes are a major trigger for migraines and pressure sensations. Ear pressure changes (such as flying or going up an elevator) can also give you throat pain (due to an overlap of the nerve endings between the throat and ear).

  7. I have sore throat first my period during several years. I am taking contraceptive pills. When I stopped taking and during pregnancy I was better, but now after his birth I am taking pills and having the period and getting worse. What can I do?
    I am now allergic to antiinflamatories.
    thanks
    Lane

  8. Hello Dr. Park,
    Thank you for the information here re: the cause of sore, scratchy throats before periods. I struggle with this as well. Aside from not eating 3-hours prior to bedtime (including drinking alcohol) and adjusting the way I sleep, if there anything else you can recommend to soothe throat during day and when the scratchiness is present.
    Thanks so much,
    Mary K.

    P.S. I am considering reading your book as well.

  9. Lane,

    Contraceptives by definition can alter your hormone levels. Unfortunately, short of stopping the pills or aggressive anti-relux and OSA management, there’s nothing else that can be done since it’s due to your anatomy.

  10. MaryK,

    One more important thing to remember is to make sure that you’re able to breathe well though your nose. Nasal saline irrigation, allergy meds, and even nasal dilator strips can help. Good luck!

  11. What is the treatment for sore throats before your period? It happens to me and my sister every month and we are tired of suffering.

  12. I get a sore throat, mood swings, chafed tongue every month. Have for years! I now use a c-pap to sleep, it helps. I am menopausal but still experience these symptoms every month, why? Recently got a full hysterectomy, will this help?

  13. Dr Park,
    I believe this has just recently started for me. In September I had a sore throat and my left tonsil looked strange with a lump and it’s hard to describe the rest of it but it doesn’t look normal. I’m not sure if the lump has fully gone away since then, but the sore throat has been recurring and each time, I look and see the lump and other area. It started again this week and I realized it is at the same time as my menstruation. I looked back at my calendar and see I had been menstruating the first time as well. I’ve been trying to gargle salt water, thinking that may help. Now it seems worse and very red. You don’t mention anything beyond a sore throat. Could this still be the cause?

  14. Thank you doctor. Your theory is right on the money. I often get a throat infection as a teen around my menstrual. Then around my mid 30’s sinus infections with migrains and swollen eyelids.

  15. Hi just want to ask i have tonsil for 4 days and I’m taking antibiotics my period is delay for 8 days when I take antibiotics just after 1hr my period came is it possible ok to take antibiotics if I have my period