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It is important to alleviate any factors that tend to precipitate or exacerbate nausea and vomiting in patients with gastroparesis. Women appear to be disproportionately susceptible to gastroparesis of any cause. One theory suggests that because progesterone inhibits smooth muscle function, then any insult to gastric smooth muscle control is accentuated in women, who have naturally higher levels of this hormone. Therefore, premenopausal women with gastroparesis sometimes have worse symptoms perimen-strually. Often blocking menses with the gonadotropin-releasing hormone agonist leuprolide acetate injections can alleviate these premenstrual problems. Monthly injections of 3.75 mg intramuscularly is the long-acting form. Migraine headaches can also cause nausea and vomiting in gastroparetic patients, as in normal individuals. If they are occurring frequently, prophylactic migraine therapy may be warranted. In diabetic gastroparesis, glucose control is very important in contributing to nausea and vomiting exacerbations. Glucose levels above 180 mg/dL have been shown to induce gastric dysrhythmias that impair gastric motility, as well as having a direct emetic effect on central control mechanisms. Every effort should be made to address glucose control by identifying underlying infections and addressing insulin use and dietary issues.

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