[26F] With lightheadedness, numbness, and paresthesia triggered by menstrual cycle and fasting

What might be happening

Based on the symptoms you’ve described—lightheadedness, numbness, tingling, and burning sensations in your feet and hands, especially during your menstrual cycle or after skipping meals—there are a few possible explanations:

1. Iron Deficiency Without Anemia: Even though your bloodwork shows no anemia, it’s possible that your iron stores (measured by ferritin levels) are on the lower side. Heavy menstrual bleeding can deplete iron levels, leading to symptoms like lightheadedness, especially during your period. Iron deficiency can also contribute to nerve-related symptoms like tingling or burning sensations.

2. Reactive Hypoglycemia: Your symptoms improving after eating suggest that low blood sugar levels might be contributing to your lightheadedness and numbness. Skipping meals can cause blood sugar to drop, leading to these symptoms.

3. Vitamin B12 Deficiency: A lack of vitamin B12 can cause nerve-related symptoms like tingling, burning, or numbness in the hands and feet. Even if your diet seems balanced, some people have trouble absorbing B12, especially if they consume plant-based milk or soy products without fortified B12.

4. Peripheral Neuropathy: This refers to nerve damage that can cause burning, tingling, or numbness in the hands and feet. It can be caused by vitamin deficiencies, hormonal imbalances, or other underlying conditions.

5. Hormonal Fluctuations: Changes in estrogen and progesterone during your menstrual cycle can affect blood sugar regulation, blood pressure, and nerve sensitivity, potentially contributing to your symptoms.

Typical Testing and Treatment

• Blood tests to check ferritin (iron stores), vitamin B12, and possibly other nutrients like folate or magnesium.
• Blood sugar testing to rule out reactive hypoglycemia.
• If symptoms persist, your doctor might consider nerve conduction studies or imaging to evaluate for peripheral neuropathy or other nerve-related conditions.
• Treatment may include dietary changes, iron or B12 supplementation, or addressing any underlying hormonal imbalances.

What you can do

Lightheadedness

• Eat Regularly: Avoid skipping meals. Aim for balanced meals with protein, healthy fats, and complex carbohydrates to keep your blood sugar stable.
• Stay Hydrated: Drink plenty of water, especially during your menstrual cycle, to prevent dehydration, which can worsen lightheadedness.
• Iron-Rich Foods: Continue eating iron-rich foods like red meat, spinach, and fortified cereals. Pair them with vitamin C (like citrus fruits) to improve absorption.
• Track Symptoms: Use MDandMe to journal when your lightheadedness occurs, especially in relation to your menstrual cycle and meals. This can help identify patterns.

Numbness, Tingling, and Burning Sensations

• Vitamin B12: Consider adding B12-rich foods like eggs, dairy, or fortified plant-based milk to your diet. If you suspect a deficiency, talk to your doctor about testing and supplementation.
• Foot Care: If the burning sensation in your feet is bothersome, you can try applying a lidocaine cream or patch (available over the counter) for temporary relief.
• Compression Stockings: If you notice swelling or discomfort in your legs, compression stockings can improve circulation and reduce symptoms.

What you should look out for

While your symptoms are not immediately life-threatening, there are some warning signs that should prompt you to seek medical attention sooner:

• Severe or Worsening Symptoms: If your lightheadedness becomes constant or more severe, or if the numbness spreads or worsens.
• Fainting: If you experience fainting or near-fainting episodes, especially during your period.
• Weakness or Loss of Coordination: If you notice muscle weakness, difficulty walking, or loss of coordination.
• Vision Changes or Severe Headaches: These could indicate a more serious underlying issue.

Your symptoms are likely related to a combination of factors, including your menstrual cycle, diet, and possibly nutrient deficiencies. It’s important to follow up with a healthcare provider to confirm the underlying cause and receive appropriate treatment. In the meantime, tracking your symptoms with MDandMe can help you and your doctor better understand what’s happening. Let me know if you’d like help preparing for your next doctor’s visit!