Influence of Sex, Menstrual Cycle, and Menopause Status on the Exercise Pressor Reflex

Abstract

In this review, we highlight the underlying mechanisms responsible for the sex differences in the exercise pressor reflex, and, importantly, the impact of sex hormones and menopausal status. The exercise pressor reflex is attenuated in pre-menopausal women compared to age-matched men. Specifically, activation of the metaboreflex (a component of the exercise pressor reflex) results in attenuated increases in blood pressure and sympathetic vasomotor outflow compared to agematched men. In addition, pre-menopausal women exhibit less transduction of sympathetic outflow to the peripheral vasculature than men. In stark contrast, post-menopausal women exhibit an augmented exercise pressor reflex arising from exaggerated metaboreflex-induced autonomic and cardiovascular reflexes. We propose that metaboreflex-induced autonomic and cardiovascular changes associated with menopause majorly contribute to the elevated blood pressure response during dynamic exercise in post-menopausal women. In addition, we discuss the potential mechanisms by which sex hormones in pre-menopausal women may impact the exercise pressor reflex as well as metaboreflex.

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

“…12 In terms of sex differences in the SBP regulation and increase during exercise, a few experimental studies are available. [30][31][32] They suggest a difference in the exercise pressor reflex in females, 31 a blunted decrease in peripheral vascular resistance in post-(but not in pre-) menopausal females 30 or a different balance between heart rate, stroke volume and vascular resistance in males and females. 32 Albeit interesting, most studies so far are limited by experimental protocols including exercise with small muscle groups, not reflecting a clinical exercise testing setting.…”

Relationship between trapezius muscle hardness and transverse cervical artery flow in association with neck and upper‐back stiffness

“…Whereas the definitive reason for this discrepancy is uncertain and could vary, differences in ages of the studied subjects might have affected the results. Sympathetic activity in muscles among women could change according to differences in phases of the menstrual cycle (Baker et al, 2016;Smith et al, 2019), particularly among women such as young adults dealt in the present study. Haemodynamic mosaic directions due to differences in phases of the menstrual cycle might have obscured actual correlations in female subjects.…”

“…Correlations of measured values were also analysed between muscle hardness and Doppler parameters, using Spearman's rank correlation coefficient with Bonferroni adjustment for multiple comparisons. Subjects were also analysed after division into male and female subjects, since haemodynamics could change according to differences in phases of the menstrual cycle among young women in the present study (Baker, Limberg, Ranadive, & Joyner, 2016; Smith, Koepp, Berg, Akinsanya, & Olson, 2019). Values of p < .05 were deemed statistically significant, so values of .016 (=.05/3) were used for the analysis of correlation coefficients with the Bonferroni adjustment.…”

Insular functional organization during handgrip in females and males with obstructive sleep apnea

“…The sample was originally powered for OSA-control differences, but not sex-specific effects; nevertheless, since we know there are sex differences in OSA and healthy cardiovascular and neural function, we decided to provide sex-specific results. Another limitation due to the original study intent is the lack of information in females on menstrual cycle, menopausal status, or use of hormones; these factors are all associated with autonomic influences [ 81 , 82 ]. Sleep study parameters were based on the sleep study reports provided, and did not typically include quantification of awakenings, sleep onset latency, sleep efficiency or other parameters.…”