Transdermal HRT and Doppler findings in normotensive and hypertensive postmenopausal patients

Persico, Nicola; Mancini, Fulvia; Artini, Paolo Giovanni; Iaco, Pierandrea De; Volpe, Annibale; Aloysio, Domenico De; Battaglia, Cristina

doi:10.1002/uog.2585

Cited by 11 publications

(5 citation statements)

References 33 publications

(26 reference statements)

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“…Potential mechanisms underlying these alterations are likely multifactorial and include augmented vasoconstriction secondary to elevated autonomic activity (sympathetic tone) or mechanical abnormalities leading to reduced compliance or remodeling of the vessel wall limiting vasodilatory capacity. There is evidence that local vasoregulatory mechanisms can contribute to augment vasoconstriction resulting from E 2 deficiency, including endothelial dysfunction, leading to increased synthesis and release of vasoconstrictor substances such as endothelin-1 or thromboxane A 2 , or conversely reduced bioavailability of endothelial-derived vasodilators, including nitric oxide and prostacyclin (5,36).…”

Section: Discussionmentioning

confidence: 99%

Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women

O’Donnell

Harvey²,

Goodman³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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The cardiovascular consequences of hypoestrogenism in premenopausal women are unclear. Accordingly, the influence of menstrual status and endogenous estrogen (E2) exposure on blood pressure (BP), heart rate (HR), and calf blood flow in young (18 -35 yr) regularly exercising premenopausal women with exercise-associated menstrual aberrations was investigated. Across consecutive menstrual cycles, daily urinary ovarian steroid levels were analyzed, and the area under the curve was calculated to determine menstrual status and E2 exposure. BP, HR, blood flow, vascular conductance, and resistance were measured at baseline and following ischemic calf exercise. Exercising subjects consisted of 14 ovulatory (ExOv), 10 short-term (anovulatory and Յ100 days amenorrhea; ST-E 2 Def), and 8 long-term (Ͼ100 days amenorrhea; LT-E2 Def) E2-deficient women. Nine sedentary ovulatory subjects (SedOv) were also studied. All groups were similar in age (24.8 Ϯ 0.7 yr), height (164.8 Ϯ 1.3 cm), weight (57.9 Ϯ 0.9 kg), and body mass index (21.3 Ϯ 0.3 kg/m 2 ). E2-deficient groups had lower (P Ͻ 0.002) E2 exposure compared with ovulatory groups. Resting systolic BP, HR, blood flow, and vascular conductance were lower (P Ͻ 0.05) and vascular resistance higher (P Ͻ 0.05) in LT-E2 Def compared with both ovulatory groups. Peak ischemic blood flow, vascular conductance, and HR were also lower (P Ͻ 0.05) and vascular resistance higher (P Ͻ 0.05) in LT-E2 Def compared with all other groups. Our findings show that exercising women with longterm E2 deficiency have impaired regional blood flow and lower systolic BP and HR compared with exercising and sedentary ovulatory women. These cardiovascular alterations represent markers of altered vascular function and autonomic regulation of which the long-term effects remain unknown.exercise-associated amenorrhea; menstrual aberrations; vascular resistance EXERCISE-ASSOCIATED AMENORRHEA (EAA) is the most severe of menstrual disturbances (10, 11). The etiology of EAA is linked to chronic energy deficiency that is communicated as inhibitory signals to the reproductive axis (11). Chronic suppression of ovarian steroids in postmenopausal women is associated with an increased risk of premature chronic diseases, including cardiovascular disease (9). Little is known of the short-and long-term cardiovascular consequences of hypoestrogenism in otherwise healthy premenopausal exercising women.Preliminary data suggest that women with EAA may develop a proatherogenic phenotype, including increases in total cholesterol, low density lipoprotein (LDL)-cholesterol, and apolipoprotein (apo)B, with concurrent decreases in apoAI and the apoAI-to-apoB ratio (24, 38), increased susceptibility of LDL-cholesterol to peroxidation (2), and impaired brachial artery endothelium-dependent flow-mediated vasodilation (38,45,46). Alarmingly, the severity of endothelial dysfunction in EAA (38,45,46) is similar to that previously observed in postmenopausal women (6) and coronary artery diseased patients (7). Reversibility of endothelial d...

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Section: Discussionmentioning

confidence: 99%

Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women

O’Donnell

Harvey²,

Goodman³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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“…Both vaginal preparations 22 and transdermal HRT 23 have been shown to be as effective as oral therapy with respect to vascular changes. Transdermal estrogen may be more effective than the oral form with respect to modifying vascular symptoms of menopause, including incontinence, and may be safer with respect to thrombotic risk, 24 and specific estrogen receptor modulators may increase the vascular benefits while reducing the risk of breast cancer.…”

Section: Hrt and Postmenopausal Voiding Dysfunctionmentioning

confidence: 99%

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

Stothers

2013

CUAJ

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“…Estrogens have multiple beneficial effects on the cardiovascular system, including vasodilation and increased cerebral blood flow [55] by decreasing cerebral vascular tone and increasing arterial compliance [56]. …”

Section: Stroke During Mid-lifementioning

confidence: 99%

Stroke in Women: Risk and Prevention Throughout the Lifespan

Bushnell

2008

Neurologic Clinics

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Women have a one in five chance of having a stroke during their lifetime. Although the majority of strokes occur in the oldest age groups, younger women have unique risks during their childbearing years because of pregnancy, preeclampsia, and the use of oral contraceptives. Fortunately, the absolute risk of stroke in these young women is low, but a history of preeclampsia during pregnancy or postpartum may be an indication of risk that carries over into later years after childbearing. In addition, menopause represents a risk because of the potential for increasing blood pressure, low-density lipoprotein cholesterol, abdominal obesity, insulin resistance, and decreasing high-density lipoprotein cholesterol. Early identification of stroke risk in women will help to minimize the effect of the stroke epidemic in older women.

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Transdermal HRT and Doppler findings in normotensive and hypertensive postmenopausal patients

Abstract: ABSTRACT

Cited by 11 publications

References 33 publications

Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women

Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

Stroke in Women: Risk and Prevention Throughout the Lifespan

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