(132) Respiratory Symptoms Changes During Menstrual Cycles in Women with Cystic Fibrosis

Thursday, November 3, 2022

12:00 PM – 12:40 PM ET

Presenting Author(s)

Isabella Iupe, MD

MD / Fellow
University of Miami / Jackson Memorial Hospital
Miami, Florida, United States

Co-Author(s)

LD

Lisa Domaradzki, MD

Pulmonologist & Critical Care Medicine / Cystic Fibrosis Specialist
University of Miami Hospital
Miami, Florida, United States
HG

Hayley B. Gershengorn, MD

Professor
University of Miami Miller School of Medicine
Miami, Florida, United States
MT

Maria G. Tupayachi Ortiz, MD

Pulmonologist & Critical Care Medicine / Cystic Fibrosis Specialist
University of Miami Hospital, United States

Background: Women with Cystic Fibrosis (WwCF) have worse outcomes than their male counterparts. After puberty, WwCF have higher rates of pulmonary exacerbations, faster decline in lung function and poorer nutrition [1]. The etiology of this gender gap is unclear and likely multifactorial; given the estrogen and progesterone receptors in lung tissue, sex hormones and their changes play a role. Inflammatory lung biomarkers and lung function fluctuate during the menstrual cycle of WwCF [2]. With this study, we aimed to determine the changes in respiratory symptoms in WwCF throughout their menstrual cycle.

Methods: We included WwCF with regular menstrual cycles who were not taking any hormonal contraceptives. Participants notified the investigator when their menstrual cycle started and were sent RedCap surveys to assess respiratory symptoms at different menstrual cycle phases over a 6 month period. Time points correlated with the different phases of the menstrual cycle: day1 (start of follicular phase, menstrual period), day 13 (ovulation phase) and day 21 (luteal phase). Ten symptoms were evaluated to calculate a Respiratory Symptom Menstrual Cycle (RSMC) score. The self-reported symptoms were compared with their subjective baseline: improved from baseline (-1), at baseline (0), mildly (1), moderately (2) and severely increased from baseline (3). With total symptom scores ranging from -10 to 30. We determined changes in RSMC score between points in their cycles. We constructed a mixed effects linear regression model to explore the association of menstrual cycle day (13 vs 21 vs 1) with total symptom score (dependent variable = RSMC score; independent variable = menstrual cycle day; random effect = patient).

Results: A total of 13 WwCF signed consent, despite multiple contact attempts, only 7 completed at least 3 surveys. We analyzed data of these 7 patients. These 7 participants were 20-45 years old with a mean BMI of 22.6, mean ppFEV1 of 71.5%, all had chronic pseudomonas infection, 86% had at least one copy of F508del and 86% were on HEMT. The most common reported symptom changes were cough, sputum changes and overall sputum quality, each reported in 57% of patients. There was a large variation in overall RSMC scores across participants with no clear worsening for the cohort at any point in the cycle. There was no statistical association between day and RSMC score when each day was compared to day 1 or day 13 or day 22 (day 13 vs day 1, regression coefficient [95% confidence interval]: 0.00 (-1.77,1.77), p=0.998; day 21 vs day 1, -0.41 [-2.15,1.32], p=0.64).

Conclusions: Our results show that there is a large variation of RSMC scores among WwCF with no association between the RSMC score with the different time points of the menstrual cycle. Our study was limited by a poor survey response resulting in a small sample size. Most patients had been started on HEMT which decreased their overall respiratory symptoms. Online surveys may not be the best way to engage participants and tracker phone applications may be a better option for several cycles. Larger studies are needed to evaluate the impact of sex hormones on respiratory symptoms and other physiologic parameters in WwCF in order to understand better the gender gap.

Acknowledgements:

References: [1] Sweezey NB. The cystic fibrosis gender gap: potential roles of estrogen. Pediatr Pulmonol. 2014 Apr;49(4):309-17. doi: 10.1002/ppul.22967
[2] Ann Am Thorac Soc. 2021 Jul;18(7):1158-1166.doi: 10.1513/AnnalsATS.202008-1064OC. https://pubmed.ncbi.nlm.nih.gov/33544657/