Can PMS worsen reflux symptoms in a 34-year-old?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your symptoms, such as chronic throat clearing, hoarseness, mild esophagitis, and cough, suggest laryngopharyngeal reflux (LPR), also called silent reflux, a variant of GERD (gastroesophageal reflux disease). LPR differs from classic GERD in that it often lacks heartburn and presents with upper airway symptoms.

Endoscopic findings of mild esophagitis and your response to PPIs (proton pump inhibitors) further support a diagnosis of reflux-related disorder.

Hormonal fluctuations during PMS (premenstrual syndrome), especially increased progesterone, relax the lower esophageal sphincter (LES), which can worsen reflux symptoms. This can explain why you feel symptoms more during your PMS phase.

LPR symptoms may take longer to respond to therapy compared to typical GERD and often need more aggressive lifestyle changes and prolonged treatment.

You might be having silent reflux (LPR) with hormonal worsening during PMS and mild esophagitis.

The probable causes include LPR (laryngopharyngeal reflux) due to transient LES relaxation, hormonal variation (progesterone) during PMS, suboptimal PPI timing or dose, or diet or lifestyle factors (late meals, caffeine, and so on).

Investigations include 24-hour esophageal pH monitoring with impedance (if symptoms persist), laryngoscopy (if hoarseness continues or worsens), and consider voice assessment by ENT (ear, nose, and throat) in case of persistent hoarseness.

Other causes may include-

1. Laryngopharyngeal reflux (most likely).
2. Chronic postnasal drip (less likely).
3. Vocal strain or overuse.
4. Allergic rhinitis.
5. Early vocal cord pathology (ENT to evaluate if no improvement).

I suggest the following treatment:

1. Continue PPI therapy. Take it twice daily, 30 minutes before meals for better symptom control (consult your physician before increasing dose).

2. Add alginate-based antacid at bedtime.

3. Consider adding an H2 blocker at night if symptoms persist. Voice rest and hydration, ENT referral if hoarseness persists for more than six weeks.

Some preventive measures include:

1. Avoid late-night meals, caffeine, citrus, carbonated drinks, and chocolate.
2. Eat at least three hours before lying down.
3. Elevate the head end of the bed by six to eight inches.
4. Maintain a healthy weight. Limit alcohol and smoking (if applicable).
5. Track symptom severity during PMS; use a diary.

If your symptoms persist, then do the following:

1. Follow up in four to six weeks for symptom response.
2. Get an ENT evaluation if hoarseness or throat symptoms persist.
3. Consider a pH impedance test if no relief after eight weeks.

I hope this helps.

Thank you and take care.

Regards.