Idiopathic Cyclic Edema

Frederick R. Jelovsek MD

“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.

 

Recommendations for Edema (Water Retention):

 

 

 

 

Botanical

  Gingko

 

Idiopathic cyclic edema is characterized by water and sodium retention with secondary hyperaldosteronism (over-production of aldosterone) due to capillary hyperpermeability. This defect is detected and measured by the Landis’ labeled albumin test; correcting it is important. Ginkgo biloba extract administered either orally or by intravenous infusion provided full correction of this biological anomaly in 10 cases in which the Landis’ test was performed before and after oral treatment, and in 5 cases treated by intravenous infusion. [Presse Med 1986 Sep 25;15(31): pp.1550-3 (translated)]

  Grape Seed Extract (Pycnogenol)

 

One month of treatment with Pycnogenol (360mg per day reduced lower limb circumference and improved subjective symptoms better than horse chestnut seed extract in a study of 40 patients with diagnosed chronic venous insufficiency. [Phytother Res 2002;16(2): pp.1-5]

 

Diet

  Therapeutic Fasting

 

Fasting promotes the drying up of abnormal fluid accumulations, such as edema in the ankles and legs and swelling in the abdomen.

 

Drug

  Conventional Drugs

 

There is no single, accepted gold standard treatment for idiopathic cyclic edema. Several different treatments have been reported. An agent used for treating high blood pressure called Captopril has also been used with success. It works against the kidney hormone aldosterone which is elevated in this condition and causes excess salt and water retention.

Sometimes a mild diuretic will help reduce fluid retention but can worsen the edema of 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 aldosterone which in turn produces more edema. If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks.

 

Habits

  Aerobic Exercise

 

Edema can be caused by a sedentary lifestyle – in other words, long periods of standing or sitting. If this is the case for you, regular exercise (not necessarily prolonged or strenuous) should help.

 

Lab Tests/Rule-Outs

  Test for Food Allergies

 

Food sensitivities should be ruled out in cases of edema of unknown cause. “I often recommend an empirical elimination diet in which common allergens (wheat, milk, eggs, corn, coffee, tea, alcohol, yeast, citrus and sugar) are removed for several weeks. Although edema is usually not their primary complaint, many patients report a pronounced diuresis and loss of edema fluid during the first several days of the diet. Foods that cause a return of a patient’s presenting symptoms often cause fluid retention as well”. [Gaby, AR. Idiopathic edema: Letter. Hospital Practice Feb. 15, 1986, p. 21]

Edema is a very reliable and accurate index in detecting a food reaction that may cause the body to suddenly retain as much as 4% of its body weight as edema fluid. This weight is gained within 6-8 hours of ingesting the guilty food and lost within 18-24 hours after the food has been removed from the diet. [Brenerman, JC. Basics of Food Allergy. Springfield, IL, Charles C. Thomas, 1978]

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