Seeking Insights: Unexplained Symptoms During Luteal Phase
**Demographic Information:** - Female, 46 years of age - Height: 165 cm - Weight: 87 kg - Ethnicity: Caucasian (based in Australia) - Non-smoker, no illicit drug use, infrequent alcohol consumption. **The Concern:** The symptoms manifest exclusively during the luteal phase and can be tracked from day 17 up until menstruation begins. These episodes have consistently appeared monthly since September 8 of the previous year. I will include some medical background at the bottom, which could provide context, though it may not be directly relevant. **Description of Symptoms:** - Symptoms resemble those of hypoglycemia, although my Continuous Glucose Monitor (CGM) indicates otherwise; also, I am not diabetic. - I experience more frequent dizziness, especially when changing posture, alongside heart palpitations. The intensity escalates around days 19-21 of my cycle. - On day 19, the following symptoms typically intensify: pronounced dizziness, heightened heart palpitations, a sensation of pressure in the chest, elevated heart rate (20 bpm above normal levels), impaired vision, dry mouth, extreme fatigue, fainting sensations, compromised cognitive functions, lack of coordination, and difficulty speaking. - In severe incidents—which necessitate calling for emergency help—my body can become immobilized. I have found myself needing to lean heavily on a shopping cart, unable to control my legs, and ultimately collapsing to the floor while remaining partially conscious. During these moments, I focus on regulating my breathing despite feeling starved for air and trying to prevent hyperventilation. - Moderate to severe episodes typically ramp up in intensity around mid-morning and can last several hours, diminishing by the afternoon (around 3-4 PM). **Observational Data:** - Home blood pressure readings and monitoring by paramedics consistently indicate normal or slightly low blood pressure. - Blood glucose levels are generally stable, except for one incident in the hospital where hypoglycemia occurred a few hours after eating. - Heart rate fluctuations are minimal, with no occurrences of tachycardia or bradycardia (increased rates around 20-30 bpm). - Hospitalized cardiac assessments and blood tests for any heart damage have all yielded normal results. - Results from a 24-hour Holter monitor did not raise any alarms. - My current CGM data confirm stable glucose levels throughout episodes, which aligns with handheld glucose readings. - The CGM has highlighted rapid glucose fluctuations following carbohydrate intake, prompting me to adjust my diet accordingly, aiming for more stable glucose levels. Nonetheless, these fluctuations occasionally mimic hypoglycemic reactions. - Symptoms appear to worsen with the use of progesterone HRT; I abstained from it this month and still experienced symptoms. **Completed Tests:** - Hormonal assessments during the mid-luteal phase returned balanced results, but it's uncertain whether levels are sufficient. - ACTH, aldosterone/renin levels, fasting glucose, insulin, HBA1C, and prolactin were all within normal ranges. - Kidney evaluations show an oscillation in eGFR related to symptom severity, with creatinine increasing and GFR decreasing during severe episodes (GFR values range from 67 to 89). - Hematological assessments show temporary changes during symptomatic events returning to baseline later, with minor fluctuations considered normal post-incident. - PTH level is normal; sufficient for all vitamins assessed (A, E, B1, B6, folate, B12). Homocysteine is slightly elevated. Blood counts demonstrate no issues. - Vitamin D was measured at 186 nmol/L. Iron levels following an injection three months ago were noted to be at the lower end; a second injection is planned soon. Remaining iron studies indicate positive results. Copper and zinc levels are balanced and regularly supplemented. Thyroid-stimulating hormone (TSH) and Free T4 levels are normal, with negative TPO antibodies and ThAb at 22.2 IU/mL. A thyroid ultrasound in October 2024 showed no abnormalities. **Pending Test Results:** - Free T3 and rT3 levels. - Multi-point cortisol saliva test results. **My Thoughts and Speculations:** - If my symptoms were linked to fluctuations in cortisol or adrenaline, I would expect subsequent changes in glucose levels, contrary to the stability observed. - The significant impairment in leg function, motor control, and cognition during these episodes suggests they are not simple fight-or-flight responses. - I observe characteristics of reactive hypoglycemia in my daily food consumption and have considered insulin resistance as a possibility; still, I have never experienced post-meal hypoglycemia, only short-lived hyperglycemia followed by a quick drop. - The luteal phase is known to increase insulin resistance, leading to less stable glucose levels compared to the high estrogen phase. - Since symptoms progressively develop throughout the morning, I find it hard to label these occurrences as panic attacks since I do not experience a sensation of impending doom. - Anxiety attacks also do not fit the severity of these episodes. **Medical Background and Treatments:** - Underwent gastric sleeve surgery in May 2021; post-operative meals remain between 1/2 cup and 1 cup in size. - Currently undergoing evaluations for lipedema. - Notable changes in some lymph nodes over the past month, but likely unrelated; no ultrasounds performed yet. - Experienced MCAS-like symptoms for several months last year, likely related to estrogen HRT usage. Discontinuation of estrogen led to an apparent reduction in flare-ups by December 2025. - On a stable dose of 70mg Vyvanse daily for a year, it's evident that an increase in dosage might be needed during the luteal phase. - Maintain a low sodium diet (300-500mg daily) and began sodium supplementation about three weeks ago, raising daily intake to approx. 1g; fluid intake remains challenging, but increased sodium has reduced the frequency of urination to every 30-45 minutes. I am currently postponing a referral to an endocrinologist. Living in a smaller regional city means I'll face long public waitlists, with our local hospital having several years' worth of delays for non-urgent cases. Affording a private specialist is also beyond my means at the moment. Thank you to everyone who has taken the time to read through my post.
Answers (1)
2/13/2026, 10:41:06 AM
OpenHealth AI
I'm sorry to hear about your distressing symptoms during the luteal phase of your menstrual cycle. It's understandable to want clarity on what's happening, especially as these symptoms significantly impact your daily life. Here's a breakdown of your situation:
Main Points
Your symptoms are puzzling but appear to be related to hormonal fluctuations during your luteal phase. They resemble hypoglycemia but occur without corresponding low blood sugar levels. Key symptoms such as dizziness, palpitations, and cognitive difficulties, particularly severe episodes, need careful monitoring and management.
Explanation
The luteal phase can cause various physiological changes that might contribute to your symptoms, including increased insulin resistance, fluid retention, or fluctuating cortisol levels. Symptoms like dizziness and palpitations may indicate a possible autonomic nervous system response or even affective disturbances, rather than just a direct relationship to glucose levels.
Given the detailed nature of your symptoms and the lack of definitive findings from tests, it is important to stay proactive in managing this situation.
Next Steps
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Keep a Detailed Symptom Log: Document symptoms on a daily basis, including their severity, duration, and any potential triggers (like specific foods or stressors). This may provide valuable insights to share with healthcare providers.
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Dietary Adjustments: Continue focusing on balanced meals with a stable release of energy, incorporating complex carbohydrates, proteins, and fiber. Monitor how different foods affect your symptoms to identify any potential links.
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Hydration and Sodium Intake: Ensure you're staying adequately hydrated, especially given your current challenges around fluid intake. You mentioned taking sodium; adjusting sodium levels can help with blood pressure regulation. Keep this in balance to mitigate dizziness.
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Lifestyle Modifications:
- Avoid Rapid Position Changes: Move slowly when changing positions from sitting or lying down to standing to help manage dizziness.
- Regular Physical Activity: Gentle exercises, like walking or yoga, may help improve overall cardiovascular health and could alleviate some symptoms over time.
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Mental Health Support: If you notice increasing levels of anxiety or stress, consider mindfulness techniques, meditation, or support groups as emotional well-being can influence physical symptoms.
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Re-assess the Need for Endocrinology Referral: Even though you're postponing this referral due to access and financial constraints, keep this as a priority for the future if symptoms persist or worsen. Seek out telehealth options, which may be more accessible.
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Review Medications: Keep in contact with the prescribing doctor regarding your Vyvanse dose, especially as you approach your luteal phase, and discuss the timing of dosages to see if adjustments can alleviate symptoms.
Conclusion
It's important to prioritize and take these steps to manage your symptoms. Continue listening to your body and adjusting as necessary, while also keeping an eye on your overall health. If your symptoms escalate or significantly impact your quality of life, further assessment will be essential. You're handling this with great insight and detail, which is commendable. Let me know if you need more specific guidance or if there are updates on your situation.
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