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Percentage of women developing symptoms of DCS during each week of the menstrual cycle (bar chart), together with cumulative frequency.
Source publication
Women are increasingly participating in recreational scuba diving and the professional roles of women are expanding in the fields of aviation, space, and diving. Evidence exists that there may be a relationship between altitude decompression sickness (DCS) and the menstrual cycle, although diving studies to support such findings are limited. The ai...
Context in source publication
Context 1
... number of OCP and non-OCP respondents de- veloping symptoms by phase of the menstrual cycle is shown in Fig. 1. The number of respondents developing symptoms during each of the 4 wk of the standardized menstrual cycle was calculated. Fig. 2 shows the per- centage of all respondents developing DCS during each of the 4 wk of the standardized menstrual cycle. The greatest percentage of DCS symptoms occurred during the first week of the menstrual cycle, the incidence of DCS then appears to fall with the greatest reduction being in week 3, the incidence then rises again in ...
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Citations
... There is evidence that the incidence of DCS is increased in women in the first week of the menstrual cycle and that the oral contraceptive may be protective during this time. 17 A similar association has been found in US Air Force personnel who were exposed to hypobaric conditions. 18 The reason is unclear, but it is probably hormonal. ...
... A similar explanation could be used to understand why women are more subject to DCS even without marked (St. Leger Dowse et al., 2002;Lee et al., 2003) difference in bubble formation as compared to similar dives in men. As already claimed in the literature, different moments of the menstrual cycle can be considered as increasing the risk of DCS (Lee et al., 2003) in fact the DCS incidents were unevenly distributed throughout the cycle with the greatest percentage of incidents occurring in the first week of the menstrual cycle. ...
... Leger Dowse et al., 2002;Lee et al., 2003) difference in bubble formation as compared to similar dives in men. As already claimed in the literature, different moments of the menstrual cycle can be considered as increasing the risk of DCS (Lee et al., 2003) in fact the DCS incidents were unevenly distributed throughout the cycle with the greatest percentage of incidents occurring in the first week of the menstrual cycle. Use of oral contraceptive pill (OCP) appeared to reduce the risk. ...
Introduction: The popularity of SCUBA diving is steadily increasing together with the number of dives and correlated diseases per year. The rules that govern correct decompression procedures are considered well known even if the majority of Decompression Sickness (DCS) cases are considered unexpected confirming a bias in the “mathematical ability” to predict DCS by the current algorithms. Furthermore, little is still known about diving risk factors and any individual predisposition to DCS. This study provides an in-depth epidemiological analysis of the diving community, to include additional risk factors correlated with the development of circulating bubbles and DCS.
Materials and Methods: An originally developed database (DAN DB) including specific questionnaires for data collection allowed the statistical analysis of 39,099 electronically recorded open circuit dives made by 2,629 European divers (2,189 males 83.3%, 440 females 16.7%) over 5 years. The same dive parameters and risk factors were investigated also in 970 out of the 39,099 collected dives investigated for bubble formation, by 1-min precordial Doppler, and in 320 sea-level dives followed by DCS symptoms.
Results: Mean depth and GF high of all the recorded dives were 27.1 m, and 0.66, respectively; the average ascent speed was lower than the currently recommended “safe” one (9–10 m/min). We found statistically significant relationships between higher bubble grades and BMI, fat mass, age, and diving exposure. Regarding incidence of DCS, we identified additional non-bubble related risk factors, which appear significantly related to a higher DCS incidence, namely: gender, strong current, heavy exercise, and workload during diving. We found that the majority of the recorded DCS cases were not predicted by the adopted decompression algorithm and would have therefore been defined as “undeserved.”
Conclusion: The DAN DB analysis shows that most dives were made in a “safe zone,” even if data show an evident “gray area” in the “mathematical” ability to predict DCS by the current algorithms. Some other risk factors seem to influence the possibility to develop DCS, irrespective of their effect on bubble formation, thus suggesting the existence of some factors influencing or enhancing the effects of bubbles.
... 7 Moreover, there are studies showing that the incidence of DCS may increase during the first phase of menstruation. 27,32 However, the women in our study did not report any diving-related diseases while menstruating. ...
INTRODUCTION:
In Turkey, scuba diving has become more popular and accessible in the past decade and there has been a commensurate rise in the number of certified divers. This new generation of recreational divers has not been described in detail previously. The aim of this study was to profile this group, while investigating any gender differences and making comparisons with the global diving community.
METHODS:
Turkish dive club members and diving forum⁄blog readers were invited to complete an online questionnaire investigating their demography, medical issues and diving history and habits.
RESULTS:
The questionnaire was completed by 303 female and 363 male divers. Significant differences were found between the sexes in terms of demographics, diving experience and attitudes toward safety. Previous or ongoing medical conditions were reported by 100 female divers and 141 males. Only 29% of females and 22% of males had been examined by a physician trained to conduct assessments of fitness to dive. Female divers did not report problems while diving during menstruation or while taking oral contraceptives. There was no significant difference in the occurrence of decompression sickness (DCS) and DCS-like symptoms between the sexes.
CONCLUSION:
This is the largest study to date conducted on recreational divers in Turkey and so carries some value. It profiles their physical and behavioral attributes as well as differences in diving practices between the sexes in Turkey. Our findings should have implications for medical screening and dive training standards.
KEYWORDS:
Decompression sickness; Medical conditions; Menstruation; Pregnancy; Scuba diving; Sex; Survey
... Research does not support menstruation as a DCS risk factor (26). Questionnaires and self-reported problems during diving in female recreational and sport divers show that diving-related problems were not evenly distributed over the menstrual cycle and varied with oral contraceptives (OC) use (12,27,37), but no randomized controlled trials have (40) assessed the risk of DCS between menstrual cycle phases or with OC use or, more importantly, (1) directly compared any difference in risk with that of men. Also, because it always seems to be asked, there is no evidence that sharks are attracted to menstruating divers or that sharks associate the small amount of menstruation fluid with feeding opportunities. ...
... Bubble formation is either the same (Cameron et al. 2007) or lower (Boussuges et al. 2009) in women than in men. On the other hand, occurrence of DCS incidents vary across the menstrual cycle in women with the greatest percentage of incidents occurring in the first week of the menstrual cycle (Lee et al. 2003). Additionally, women using hormonal contraception showed significantly greater susceptibility to DCS than those not using hormonal contraception during the latter 2 weeks of the menstrual cycle (Webb et al. 2003). ...
Vascular bubble formation results from supersaturation during inadequate decompression contributes to endothelial injuries, which form the basis for the development of decompression sickness (DCS). Risk factors for DCS include increased age, weight-fat mass, decreased maximal oxygen uptake, chronic diseases, dehydration, and nitric oxide (NO) bioavailability. Production of NO is often affected by diving and its expression-activity varies between the genders. Little is known about the influence of sex on the risk of DCS. To study this relationship we used an animal model of Nω-nitro-l-arginine methyl ester (l-NAME) to induce decreased NO production. Male and female rats with diverse ages and weights were divided into 2 groups: treated with l-NAME (in tap water; 0.05 mg·mL(-1) for 7 days) and a control group. To control the distribution of nitrogen among tissues, 2 different compression-decompression protocols were used. Results showed that l-NAME was significantly associated with increased DCS in female rats (p = 0.039) only. Weight was significant for both sexes (p = 0.01). The protocol with the highest estimated tissue pressures in the slower compartments was 2.6 times more likely to produce DCS than the protocol with the highest estimated tissue pressures in faster compartments. The outcome of this study had significantly different susceptibility to DCS after l-NAME treatment between the sexes, while l-NAME per se had no effect on the likelihood of DCS. The analysis also showed that for the appearance of DCS, the most significant factors were type of protocol and weight.
... In the light of Desola and Masurel's data (Desola & 5 Masurel, 1985), we surmised that the women divers would have fewer circulating bubbles than the men divers. Since relationships between the risk of DCS and the phase of the menstrual cycle (lesser risk in the third week) or the use of oral contraceptive pill have been reported (Lee et al., 2003;Webb et al., 2003;St Leger Dowse et al., 2006) we investigated the female divers in more detail to search for relationships between these factors and circulating bubble quantity. ...
Differences in circulating bubble production have been described after exposures in altitude chambers between men and women. The present study was designed to examine gender differences in circulating bubble production after a dive.
Fifty-two men and 52 women performed the same dive profile (25 min to 35 m). Circulating bubbles were detected by continuous wave Doppler. Tests were conducted at sea in a boat, at 10-min intervals for 1 h after surfacing. Signals were graded according to the Spencer scale. The categorical data were then converted to a single number reflecting total bubble activity using the KISS index.
Considering each measurement period, bubble grade was higher in men than women 30, 40 and 50 min postdive. On the contrary, bubble grade was comparable between men and women 10, 20 and 60 min after the dive. KISS index was significantly higher in men than women (6.77 [0.65-32.3] versus 0.91 [0-22.9], P<0.02). KISS index was significantly correlated with age, weight and body fat mass in the whole population and in the men and women separately. Postmenopausal women had a higher KISS index (42 [15-47]) when compared with premenopausal women and men older than 50 years. No difference in bubble production was found according to the use of oral contraceptive pills or the phase of the menstrual cycle.
Overall, we observed fewer circulating bubbles in women than in men after an open sea SCUBA dive. This difference disappeared in the postmenopausal women.
... The present results are consistent with Grunfeld and Gresty's (1998) study that employed female sailors in a yacht race as participants, perhaps lending some external validity to the current findings. Our results are also consistent with laboratory studies using Coriolis-induced sickness (e.g., Golding et al., 2005) and various studies finding more PONV near menses (e.g., Beattie et al., 1991; Beattie et al., 1993), as well as more decompression sickness near menses (Lee et al., 2003). Our results also indicate that reported symptoms of nausea and motion sickness did not vary across the menstrual cycle for women who were taking oral contraceptives, congruent with prior research (e.g., Clemes & Howarth, 2005; Lee et al., 2003). ...
... Our results are also consistent with laboratory studies using Coriolis-induced sickness (e.g., Golding et al., 2005) and various studies finding more PONV near menses (e.g., Beattie et al., 1991; Beattie et al., 1993), as well as more decompression sickness near menses (Lee et al., 2003). Our results also indicate that reported symptoms of nausea and motion sickness did not vary across the menstrual cycle for women who were taking oral contraceptives, congruent with prior research (e.g., Clemes & Howarth, 2005; Lee et al., 2003). In addition to our current report, there are three recent studies on the menstrual cycle and motion sickness, all three with conflicting results (e.g., Golding et al., 2005 – more nausea during menses; Cheung et al., 2005 – no change in nausea across the menstrual cycle; Clemes & Howarth, 2005 – more nausea near ovulation). ...
The present study examined whether susceptibility to nausea and other symptoms of vection-induced motion sickness vary as a function of phase of the menstrual cycle, as research findings in this area are sparse and contradictory.
Ninety young women (42 current users of oral contraceptives) were exposed to a rotating optokinetic drum during the peri-menses or peri-ovulatory phase of the menstrual cycle in an independent-groups, quasi-experimental design. Nausea and motion sickness symptoms were assessed using the Nausea Profile (NP) and the Subjective Symptoms of Motion Sickness (SSMS) questionnaire.
Among women not on oral contraceptives, reports of nausea and motion sickness by women in the peri-menses phase were more severe than reports by women in the peri-ovulatory phase. By contrast, among women taking oral contraceptives, reports of nausea and motion sickness did not differ by the same categorical phase of the menstrual cycle.
We speculate that fluctuating estrogen levels over the course of the menstrual cycle may influence the experience of or susceptibility to nausea and motion sickness during illusory self-motion and other nauseogenic contexts.
... 43 The study found that in the second half of the menstrual cycle, users of the COC were twice as likely to suffer from DCS symptoms as non-users ( Figure 2). The second study reported on retrospective questionnaires completed by 150 women who had suffered from DCS. 44 This study found a significantly increased incidence of DCS in women over the age of 33 years who used the COC. Since many female astronauts will be over the age of 33 years by the time they enter space, such a finding could be significant. ...
... When comparing women on the combined oral contraceptive pill (COCP) with women not on the COCP (non-COCP) some investigators have assumed the COCP group to have a rigid 28-day pharmaceutically driven cycle, or relied on retrospective information from respondents regarding 'average length of cycle' (Rudge 1990; Doyle et al. 1997; Lee et al. 2003). Numerous studies observing reliability of recall of the date of the last menstrual period (LMP), or compliance and reasons for ceasing to take the COCP exist (Bean et al. 1979; Aubeny et al. 2002 Aubeny et al. , 2004 Wegienka and Baird 2005). ...
... We analysed the data using actual recorded data regardless of length, normalised data, and data from cycles of only 28 days. To normalise the menstrual cycles the observed number of days from the first day of the last menstrual period (LMP) to RPDD was transformed into the relative position (the normalised day) in a normalised cycle with a length of 28 days (Sibley et al. 1999; Lee et al. 2003; Ross et al. 2003). The normalised day in which each RPDD occurred was calculated using the following formula: Normalised day ¼ 28 6 D/L where D is number of days between the RPDD and the first day of the LMP, and L is the recorded actual length of the cycle in which the RPDD occurred. ...
... Anecdotal evidence also suggests that a 28-day COCP cycle is often assumed by clinicians. Some studies have assumed women on the COCP to have a classic pharmaceutically driven cycle, have truncated the data to 28 days, or have omitted to define the COCP criteria in the methodology of the investigations, thereby implying that a 28-day cycle could have been assumed (Rudge 1990; Doyle et al. 1997; Krause et al. 1998; Lee et al. 2003). The methodology and data storage systems in the St Leger Dowse (2006) study allowed the ability to analyse data from COCP users. ...
Some studies involving women taking the combined oral contraceptive pill (COCP) have on occasion assumed the COCP group to have a rigid 28-day pharmaceutically driven cycle. Anecdotal evidence suggests otherwise, with many women adjusting their COCP usage to alter the time between break-through bleeds for sporting and social reasons. A prospective field study involving 533 scuba diving females allowed all menstrual cycle lengths (COCP and non-COCP) to be observed for up to three consecutive years (St Leger Dowse et al. 2006). A total of 29% of women were COCP users who reported 3,241 cycles. Of these cycles, only 42% had a rigid 28-day cycle, with the remainder varying in length from 21 to 60 days. When performing studies involving the menstrual cycle, it should not be assumed that COCP users have a rigid confirmed 28-day cycle and careful consideration should be given to data collection and analysis. The effects of differing data interpretations are shown.
... A total of 21% of the menstrual cycles were 521 days or 440 days and therefore considered outside the normal parameters for inclusion and were excluded from analysis (Treloar et al. 1967;Cooper et al. 1996;Guyton and Hall 1997). To enable inclusion of all the remaining menstrual cycles, the observed number of days from LMP to RPDD was transformed into the relative position (the normalised day) in a normalised cycle with length 28 days (Sibley et al. 1999;Lee et al. 2003;Ross et al. 2003). The normalised day in which each RPDD occurred was calculated using the following formula: normalised day ¼ 28 6 D/L, where D is number of days between the RPDD and the first day of the LMP, L is the recorded actual length of the cycle in which the RPDD occurred. ...
... Our field data showed RPDDs were not evenly distributed over the menstrual cycle in this study population, despite diving taking place consistently over the cycle. The trends demonstrated in this study are similar to two separate studies showing a relationship with the menstrual cycle and DCI (Rudge 1990;Lee et al. 2003). ...
... The women did not change their diving habits as a result of this study (St Leger Dowse et al. 2004), as evidenced by the style of diving recorded and the even distribution of diving over the time of the study. The associations with RPDD and the position in the menstrual cycle in our study followed similar trends to that of two DCI studies (Rudge 1990;Lee et al. 2003). The trends Figure 3. ...
The problems encountered during scuba diving may be a contributing factor in an episode of decompression illness (DCI). Evidence exists that there may be a relationship between the position in the menstrual cycle and the occurrence of DCI. We examined, by prospective observation in female recreational scuba divers, any interaction between reported problems during diving (RPDD) and the position in the menstrual cycle. A total of 533 women, aged between 14 and 57 years, returned diaries for >6 months, with 61% returning diaries for 3 consecutive years. A total of 34,625 dives were reported within 11,461 menstrual cycles between 21 and 40 days in length, with 65% of women reporting at least one RPDD. Logistic regression showed a significant non-linear relationship between the position in the menstrual cycle and RPDD (p = 0.004). RPDD were not evenly distributed over the menstrual cycle; the rate per 1,000 dives varied from 39.2 at start of the cycle to 19.7 during week 3, and 31.9 in week 4. We concluded these field data suggest a possible correlation between the incidence of RPDD and the position in which they occurred in the menstrual cycle.
