An observational study to find relationship of acute appendicitis to menstruation cycle in northern and northeastern part of india

Background. Diagnosing acute appendicitis correctly in a female patient is a challenge for a practicing surgeon. Rate of misdiagnosis of acute appendicitis is very high among female patients. There are many studies carried out to find incidence of acute appendicitis as per various phases of menstruation cycle but the results were conflicting. Objective. The study was conducted to find the relationship of acute appendicitis with the different phases of the menstruation cycle. Methods. This research was an observational study carried out in two regional hospitals in northern and north-eastern part of India. Duration of study was 24 months between 01 June 2019 and 31 May 2021. Inclusion Criteria were for all female patients, non-pregnant and menstruating, who were histopathologically confirmed as acute appendicitis. All pathologically proven negative appendectomy patients were excluded from this study. All female patients taking oral contraceptive pills (OCP) were excluded from the study. Results. A total of 96 females were hospitalized in both hospitals during the study period; 12 of them did not attain menarche (12.5%), 6 had menopause (6.3%) and 78 were menstruating (81.25%). Of those 78 patients, who had physiological menstrual cycles, 6 were in menstrual phase (7.6%), 18 were in proliferative phase (23%), and 54 in luteal phase (69.2%). In our study, there were only 6 cases of acute appendicitis during menstruation. therefore, the expected ratio of cases was 6/14=0.42. The corresponding expected rate for the proliferative phase was 2.78×9=25 cases, whereas for the luteal phase it was 2.78×14=38.92. The expected ratio was 18/25=0.72 for the proliferative phase and 54/39=1.38 for the luteal phase. There was a significant increase in number of cases of acute appendicitis among the menstruating women in luteal phase with p value <0.05. Mean age of the study participants was 28.31±9.56. Conclusions. According to the result of the study, the incidence of acute appendicitis significantly differs in different phases of menstruation cycle with highest incidence in luteal phase. Hence, female hormones (estrogen and progesterone) are significant in causing acute appendicitis.