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.

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. 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.

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.

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. If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks.

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. 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.

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.

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