Protein Menstruation

Other actions of estrogen include fluid retention, protein anabolism, thinning of the cervical mucus, and the inhibition or facilitation of ovulation. Estrogens contribute to the conservation of calcium and phosphorus, the growth of pubic and axillary hair, and pigmentation of the breast nipples and genitals. Estrogens also stimulate contraction of the fallopian tubes (which promotes movement of the ovum), modify the physical and chemical properties of the cervical mucus, and restore the endometrium after menstruation. 

Iron is stored in intestinal mucosal cells as ferritin (an iron/protein complex) until needed by the body. Iron deficiency results from acute or chronic blood loss, from insufficient intake during periods of accelerated growth in children, or in heavily menstruating or pregnant women. Therefore it essentially results from a negative iron balance due to depletion of iron stores and inadequate intake, culminating in hypochromic microcytic anemia. Supplementation with ferrous sulfate is required to correct the deficiency. Gastrointestinal disturbances caused by local irritation are the most common adverse effects caused by iron supplements. 

With your metabolic team, consider the possibility of a hidden illness or infection. Urinary tract infections, sinus infections, or dental problems often increase leucine concentrations but may not be obvious to the patient. Because of hormonal effects on protein metabolism, some women with MSUD have higher leucine concentrations just before they menstruate (author s personal cUnical experience). Reduction in the leucine prescription and additional calories may be needed during these times. 

Protein load A protein load is done when a diagnosis is unclear or for heterozygote detection in OTC deficiencies. After one has determined a daily profile for pre- and postprandial ammonia and the amino acids in a self chosen diet, the protein content should be estimated per meal. The patient should not be in a catabolic but steady state for at least 4 days. For women, the test should be avoided around the period of menstruation. The protein load is, in contrast to the allopurinol test, also useful for assessing protein tolerance. False negatives have been described in conjunction with OTC heterozygote testing skewed toward a predominance of wild-type OTC. 

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