The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria

Abstract Based on experiences from everyday clinical practice and indications from the literature, the menstrual cycle might impact on metabolic stability in patients with urea cycle disorders and organic acidurias. However, this connection has not yet been systematically investigated. Phenylketonur...

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Main Authors: Laura Horka, Kristin Landolt, Zoran Erlic, Nicole Rimann, Alessio Cremonesi, Michel Hochuli, Felix Beuschlein
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Orphanet Journal of Rare Diseases
Subjects:
Online Access:https://doi.org/10.1186/s13023-025-03890-2
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author Laura Horka
Kristin Landolt
Zoran Erlic
Nicole Rimann
Alessio Cremonesi
Michel Hochuli
Felix Beuschlein
author_facet Laura Horka
Kristin Landolt
Zoran Erlic
Nicole Rimann
Alessio Cremonesi
Michel Hochuli
Felix Beuschlein
author_sort Laura Horka
collection DOAJ
description Abstract Based on experiences from everyday clinical practice and indications from the literature, the menstrual cycle might impact on metabolic stability in patients with urea cycle disorders and organic acidurias. However, this connection has not yet been systematically investigated. Phenylketonuria (PKU) as the most prevalent inborn error of metabolism with its easily determinable biomarker is a suitable model disease to shed light on this question. In ten patients with classic PKU on a low protein diet and on an amino acid mixture, phenylalanine (Phe) was measured from dried blood spots twice a week for 6 months. During this time, the patients documented their menstrual cycle and filled in nutrition protocols since it is known that the menstrual cycle also influences nutritional behavior. Based on this cohort, we found a significant correlation between the phases of the menstrual cycle and Phe concentration, with the lowest concentrations in the early luteal phase and the highest in the early follicular phase, during menstrual bleeding. This effect did not appear to be due to a change in eating behavior, as both protein and calorie intake were not significantly different in relation to the menstrual cycle. Since the increase in Phe began before menstrual bleeding, it does also not appear to be a pure effect of catabolism due to bleeding. Further studies will be required to identify the cause of this effect and to develop possible therapeutic strategies.
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spelling doaj-art-e36e874c681249efac3a1d43473bc1492025-08-20T03:06:05ZengBMCOrphanet Journal of Rare Diseases1750-11722025-07-012011610.1186/s13023-025-03890-2The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuriaLaura Horka0Kristin Landolt1Zoran Erlic2Nicole Rimann3Alessio Cremonesi4Michel Hochuli5Felix Beuschlein6Clinic for Endocrinology, Diabetology and clinical Nutrition, University Hospital of ZurichDepartment of Nursing and MTTB (medical-technical and medical-therapeutic professions), University Hospital ZurichClinic for Endocrinology, Diabetology and clinical Nutrition, University Hospital of ZurichSwiss Newborn Screening Laboratory, University Children’s Hospital Zurich, University of ZurichSwiss Newborn Screening Laboratory, University Children’s Hospital Zurich, University of ZurichDepartment of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital Bern, InselspitalClinic for Endocrinology, Diabetology and clinical Nutrition, University Hospital of ZurichAbstract Based on experiences from everyday clinical practice and indications from the literature, the menstrual cycle might impact on metabolic stability in patients with urea cycle disorders and organic acidurias. However, this connection has not yet been systematically investigated. Phenylketonuria (PKU) as the most prevalent inborn error of metabolism with its easily determinable biomarker is a suitable model disease to shed light on this question. In ten patients with classic PKU on a low protein diet and on an amino acid mixture, phenylalanine (Phe) was measured from dried blood spots twice a week for 6 months. During this time, the patients documented their menstrual cycle and filled in nutrition protocols since it is known that the menstrual cycle also influences nutritional behavior. Based on this cohort, we found a significant correlation between the phases of the menstrual cycle and Phe concentration, with the lowest concentrations in the early luteal phase and the highest in the early follicular phase, during menstrual bleeding. This effect did not appear to be due to a change in eating behavior, as both protein and calorie intake were not significantly different in relation to the menstrual cycle. Since the increase in Phe began before menstrual bleeding, it does also not appear to be a pure effect of catabolism due to bleeding. Further studies will be required to identify the cause of this effect and to develop possible therapeutic strategies.https://doi.org/10.1186/s13023-025-03890-2PhenylketonuriaMenstrual cycleNutrition therapyPhenylalanineCycle dependent metabolic changes
spellingShingle Laura Horka
Kristin Landolt
Zoran Erlic
Nicole Rimann
Alessio Cremonesi
Michel Hochuli
Felix Beuschlein
The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
Orphanet Journal of Rare Diseases
Phenylketonuria
Menstrual cycle
Nutrition therapy
Phenylalanine
Cycle dependent metabolic changes
title The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
title_full The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
title_fullStr The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
title_full_unstemmed The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
title_short The influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
title_sort influence of menstrual cycle on metabolic control and diet in patients with phenylketonuria
topic Phenylketonuria
Menstrual cycle
Nutrition therapy
Phenylalanine
Cycle dependent metabolic changes
url https://doi.org/10.1186/s13023-025-03890-2
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