Estrogen-sensitive menstrual cycle-dependent premature ventricular contractions successfully treated with combined...

The effects of estrogen on arrhythmias are controversial. While animal studies suggest complex effects, the hypothesis that higher estrogen levels increase women's arrhythmia susceptibility has not yet been fully validated in human studies.

This case report describes a 30-year-old female patient who frequently experienced palpitations and was initially diagnosed with idiopathic ventricular arrhythmia. However, her symptoms were strongly correlated with her menstrual cycle. She experienced premature ventricular contractions (PVCs) 6 days before menstruation and 5 days before ovulation, which coincided with elevated estrogen levels. After other potential causes were ruled out, a diagnosis of hormone-induced PVCs was established. The patient was treated with a combination of estrogen and progestogen that not only alleviated her palpitations but also relieved her dysmenorrhea and menstrual irregularities. During a 5-month follow-up period, the patient reported no further palpitations.

This case provides clinical support of the hypothesis that elevated estrogen levels can increase vulnerability to ventricular arrhythmias in women. The influence of estrogen on arrhythmias may occur via a biphasic effect that potentially provides antiarrhythmic benefits during phases of low estrogen and increases the risk of arrhythmia during peak estrogen phases. Clinicians should consider hormone-related arrhythmias when young female patients present with palpitations that follow a cyclical pattern that is clearly linked to the menstrual cycle. Such cases warrant thorough history-taking and assessments of sex hormone levels. Hormonal regulation therapy could be an effective treatment strategy; however, its effectiveness and safety require careful evaluation.