Women and DCS

[Ladydiver]

Hello Dr. Deco,

I was wondering if there have been any studies done or if you have any information about increased instances of DCS in women who dive while menstruating. I understand that the amount of fluid involve in menstruation is fairly minimal in the grander scheme of things, but does the fluctuation in hormone levels have any effect one way or the other?

Your input on this subject would be greatly appreciated.

Cheers,

[BillP]

Hi Ladydiver:

I'm not aware of any studies that specifically look at the incidence of DCS in menstruating scuba diver. In the chapter on The Female Diver in his book Diving and Subaquatic Medicine Carl Edmonds says, "Aviation DCS was shown to be more frequent during and soon after the menses, suggesting that extra decompression may be needed at that time." He states, "It has been conjectured that the fluid retention and oedema which develop before and during the menstrual period could increase the possibility of decompression sickness (DCS)." He did not give a reference to the study on aviation DCS.

I found the abstracts of a couple of articles. Schirmer and Workman (Aviat Space Environ Med 1992 Jul;63(7):616-8) mention that "Women are reportedly at higher risk for developing DCS during menses" but they did not find this to be true in their study on altitude decompression sickness. (The references at the end of that article might give the source(s) for their statement.) In the abstract of an article by Rush and Wirjosemito (Aviat Space Environ Med 1991 May;62(5):414-7) on use of the monoplace chamber to treat DCS they state, "Also, a newly defined risk factor (menstrual phase) is considered relevant to this case" but I don't have the article to review to see what about the menstrual phase they found significant.

Other than the section in Edmond's book I haven't seen anything in the diving medicine literature about menses and an increased incidence of DCS. It might be wise to dive conservatively when retaining fluid, but it wouldn't stop me from letting my wife dive.

HTH,

Bill

[Ladydiver]

Hi Dr. Bill,

Thank you for the information. Up to this point, I haven't had any problems diving during menses, but I started thinking about all the things that can have an effect on the risk of DCS and I started wondering. At this point, unless someone comes up with something definitive, I will still be in the water as often as possible, regardless of what time of the month it is.

Thanks again for the information.

Cheers,

[Dr Deco]

This is an interesting question, but one in which most of the material appears in abstract form rather than in published papers. It required a bit of time to track down these individual presentations.

Dunford and Hampson (Gender-related risk of decompression sickness in hyperbaric chamber inside attendants: a case control study, Undersea Biomed. Res. 19 (Suppl.), 37, 1992.) reported that in chamber attendants, DCS was 7.6 fold more common during menses. They did not find this correlation in open-water divers, however.

Doyle et al. (Menstruation as a risk factor for decompression illness in female scuba divers taking oral contraceptives, Undersea Hyperbaric Med, 24 (Suppl.) 32, 1997) reported no correlation with menses in SCUBA divers unless they were taking oral contraceptives while diving. The risk increase was very significant.

Krause, Pilmanis, and Webb (The effect of menstruation day on decompression sickness (DCS) incidence in female research subjects, Aerospace Medical Assoc. Meeting, 1998) noted that in altitude chambers, women are at greatest risk on menstrual day 2 and the risk decreases after that.

Similar increased risk in the early phase of the cycle was reported by Lee et al. (The menstrual cycle and decompression illness – what are the risks?, Undersea Hyperbaric Med, 25 (Suppl.) 11, 1998 ) but they did not comment on oral contraceptives.

Since swelling of tissues is common, this would add to the pressure of the growing gas bubbles and increase the chance for pain in a tissue. Gas washout could also be affected. The answer is not known.

Conservative dive procedures with small gas loads would be my first thought.

[scubadoc]

For those of you who are interested - I have a really good indepth article here.

It is a Power Point presentation by one of our consultants, Dr. Martin Quigley. The download takes about seven minutes but is well worth the time. It incorporates most of the great information from Dr Deco and adds some other data concerning the hormonal changes and effects on the female diver.

Here is an outline of the presentation:
Women, Menstrual Cycles, and Decompression Sickness
Martin M. Quigley, MD
Naval Operational Medical Institute
February 4, 1999
Outline
Endocrinology of the Menstrual Cycle
Changes induced by Oral Contraceptives
Coagulation Factor Changes in Menstrual Cycle
Changes induced by Oral Contraceptives
Risk Factors for Decompression Sickness (DCS)
Women and Diving
Effective of Pressure on Menstrual Cycle/Pregnancy
Sex Differences in DCS
Menstrual Cycle Phase and DCS
Summary and Conclusions
Recommendations

The article can be accessed here.