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NEUROCARDIOGENIC SYNCOPE: RESPONSE TO HORMONAL THERAPY. 2

We describe the response to hormonal therapy of a cohort of women with known neurocardiogenic syncope and dysfunctional uterine bleeding. This is a retrospective evaluation of 17 women aged 14 - 55 years of age (12 patients were less than 22 years old) seen in a tertiary care medical center. All had tilt-table tests which were consistent with neurocardiogenic syncope of the classic or dysautonomic pattern, and symptoms which did not completely resolve until the addition of hormonal therapy. All 17 patients were initially treated with at least “standard” therapy which may have included: Florinef, beta-blockers, and methylphenidate. Many were also treated with serotonin re-uptake inhibitors. None experienced full resolution of symptoms on this regimen. All reported disturbances of their menstrual cycle ranging from oligomenorrhea to metromenorrhagia and/or worsening of syncopal symptoms at the time of menses. Their syncopal/presyncopal symptoms improved significantly with the introduction of hormonal therapy either in the form of oral contraceptive pills, Depo Provera, or estrogen replacement. Hormonal therapy may be important not only for the menstrual irregularities associated with dysautonomia but also for management of the syncopal symptoms.