Your Period and Chronic Hives: What To Know

When you have premenstrual syndrome, or PMS, you may think of symptoms like bloating, breast pain and cramps.

But can chronic hives (also known as chronic idiopathic urticaria) — those itchy, red welts on your skin — also be caused by your menstrual cycle?

Allergist Rim Ishak, MD, explains the connection between chronic hives and hormones and what treatment options are available.

Can your period trigger chronic hives?

Chronic hives are more common in women and people assigned female at birth (AFAB) than men and people assigned men at birth (AMAB) — and the cause is likely due to the different hormones present.

“We know that mast cells, which are the cells responsible for hives, have estrogen and progesterone receptors on them,” explains Dr. Ishak. “They don’t have testosterone receptors.”

During your menstrual cycle, estrogen and progesterone levels can rise and fall. It can be common to experience an outbreak of chronic hives around your time of menstruation thanks to that hormone fluctuation, which triggers the release of histamine. You may notice hives flaring up about three to five days before menstruation.

“Your hives can peak during the menstruation, and then, it typically gets a lot better once the menstrual cycle is done,” outlines Dr. Ishak. “There are some reports of chronic hives also occurring during ovulation. Your hives should get better within a week of menses or your period.”

Another factor that may contribute to your chronic hives during your period? The pain medication you take.

“A lot of people use NSAIDs (nonsteroidal anti-inflammatory drugs) during menstruation, so ibuprofen or naproxen,” she continues. “Data shows that NSAIDs lower the threshold to activating mast cells, and actually worsen hives. They’re one of the drugs that we recommend people stop when they have chronic hives.”

While your hives may be triggered by your menstrual cycle, if you’re pregnant, there’s also a chance you may see a spike in your chronic hives.

“We also know that about 30% of pregnant people will see a worsening of their hives during pregnancy,” adds Dr. Ishak. “But about 50% of pregnant people will see an improvement of their hives, so it can go either way.”

Progesterone hypersensitivity and chronic hives

Menstrual hives and rashes may also be the result of progesterone hypersensitivity (PH), a rare and underdiagnosed disorder. It’s also known as autoimmune progesterone dermatitis. This condition is thought to be due to an allergic skin reaction to the progesterone in your body.

“Progesterone hypersensitivity and chronic hives aren’t the same conditions, but progesterone hypersensitivity can cause symptoms like chronic hives, rashes, itching and swelling — and in some severe cases, anaphylaxis,” clarifies Dr. Ishak. “It’s a very rare disorder, but we think it’s rare because it’s underreported.”

Progesterone hypersensitivity can cause rashes to show up around certain areas of your body, including your:

• Arms.
• Legs.
• Face.
• Ears.
• Lips.
• Tongue.
• Throat.
• Torso.

So, what causes progesterone hypersensitivity? It typically occurs when there’s an overload of progesterone in your system. Risk factors for developing progesterone hypersensitivity include:

• People who take medication containing progesterone, such as birth control and postmenopausal hormone therapy, over a long period of time.
• People who’ve had infertility treatments.
• People who are pregnant.

“Research shows that of the people who develop progesterone insensitivity, 45% received progesterone from an outside source such as oral contraceptives or infertility treatments,” says Dr. Ishak.

Will chronic hives go away after menopause?

If you experience chronic hives during your period, you may wonder if they’ll go away after menopause.

The answer isn’t so straightforward, says Dr. Ishak.

“We can’t promise that your hives will go away with menopause because your hives may have other intrinsic causes or other autoimmune triggers,” she states. “But if your hives are due to hormonal imbalances, then, yes, we would expect your hives to improve.”

Chronic hives diagnosis and treatment

If you’re experiencing chronic hives during your period, don’t hesitate to talk to a healthcare provider.

And before your doctor’s appointment, it can also be helpful if you keep a symptom diary or journal, suggests Dr. Ishak. That way, your doctor can see if your chronic hive symptoms are related to your menstrual cycle. If you tend to have an irregular period, it can be a little tricky to link the cause of your chronic hives to your menstrual cycle.

After examining your skin and discussing your symptoms, your provider may suggest a diagnostic test such as an allergy test, blood test or urine test.

“If you think you have progesterone hypersensitivity, your doctor can perform scratch tests and intradermal tests, where we inject progesterone in tiny amounts under the skin and watch for small hives to develop,” says Dr. Ishak.

If you’re diagnosed with chronic hives, your healthcare provider may suggest medication like antihistamines and corticosteroids. Birth control pills can also be used to help regulate your hormones.

And while most chronic hive treatment options just manage symptoms, Dr. Ishak says some medications work by preventing the release of histamine. And in severe and resistant cases, the removal of your ovaries may be necessary.

Bottom line?

It can be frustrating and scary to deal with chronic hives, especially during your period when you’re already dealing with other unpleasant symptoms.

But Dr. Ishak stresses the importance of talking to your doctor who can help pinpoint what’s going on and suggest treatment options to provide relief.

“It’s important to know that chronic hives aren’t caused by allergies or infections, but rather by an immune reaction to an unknown trigger,” she emphasizes. “Even though we don’t know exactly what causes chronic hives, there are known triggers that make them worse, including heat, tight clothing, stress, viral infections, hormonal changes and NSAIDs.

“It’s important to see your doctor and see an allergist, not for allergy testing, but for help with diagnosis and management. Make sure to take photos of your rashes, and a symptom diary to help make the diagnosis clearer.”