The Cardiovascular Effects of Chronic Hypoestrogenism in Amenorrhoeic Athletes

Abstract

In premenopausal women, the most severe menstrual dysfunction is amenorrhea and is associated with chronic hypoestrogenism. In postmenopausal women, the coincident hypoestrogenism observed is associated with a number of clinical sequelae related to cardiovascular health. Due to an observed cardioprotective effect of E2, persistently low E2 levels in amenorrheic (AM) athletes may confer deleterious effects on cardiovascular health.The incidence of amenorrhea among athletes is much greater than that observed among sedentary women. Recent data in AM athletes demonstrate impaired endothelial function, elevated low-and high-density lipoprotein levels, reduced circulating nitrates and nitrites, and increased susceptibility to lipid peroxidation. An improvement in endothelial function has also been reported during the recovery of menstrual cyclicity in a small sample of previously AM athletes. Although no longitudinal studies exist, these findings are suggestive of increased risk of premature cardiovascular disease in AM athletes. These issues are explored and discussed in detail in this comprehensive review paper. Future research should focus on the presentation and progression of these adverse cardiovascular parameters in physically active women and athletes with hypoestrogenism to determine their effect on long-term health outcomes.

Association of recreational physical activity with homocysteine, folate and lipid markers in young women

“…Additionally, in fertile age women hyperhomocysteinemia has been associated with amenorrhea, especially in female athletes (O'Donnell and De Souza 2004).…”

Women, the menopause, hormone replacement therapy and coronary heart disease

“…Despite the accepted cardiovascular benefits of exercise, studies of amenorrheic female athletes suggest an increased risk for early cardiovascular disease [31], whereas reports from observational studies have suggested that HRT decreases cardiovascular mortality in postmenopausal women [32]. However, the large randomized trial with placebo control, Heart and Estrogen/progestin Replacement Study (HERS), found that women with known cardiovascular disease had increased cardiovascular disease events during the first year of HRT use despite reported favourable benefit from randomized trials of HRT on total cholesterol (C), lipoproteins [increased high-density lipoproteins (HDLs) and decreased low-density lipoproteins (LDLs)], vasodilatation and reduced inflammation [32].…”

The Female Athlete Triad

“…Athletes with luteal deficiency may also be at risk for infertility due to poor follicular development or failure of implantation. Consequences of hypoestrogenism seen in amenorrheic athletes include impaired endotheliumdependent arterial vasodilation (78), which reduces the perfusion of working muscle, impaired skeletal muscle oxidative metabolism (75), elevated low-density lipoprotein cholesterol levels (59,154), and vaginal dryness (73).…”