The Long-Term Cardiovascular Risks Associated with Amenorrhea

Abstract

Gonadal steroids are important for healthy functioning of the reproductive tract, but also for general women’s health issues such as maintenance of bone mass, the cardiovascular system, cognition, wellbeing, and sexuality. Hypoestrogenism can interfere with the cardiovascular system function in many ways, this is the reason why Cardiovascular disease (CVD) is the leading cause of death in women in developed countries and, interestingly, proportionally more women die from CVD than men. Several investigators have demonstrated a correlation between functional hypothalamic amenorrhea (FHA) and endothelial dysfunction. It was clearly shown that the flow-mediated dilation of the brachial artery, a precise predictor of coronary endothelial dysfunction, is impaired in women with FHA, on the contrary, little is known about the cardiovascular effects of Premature Ovarian Failure (POF) in young women and in patients affected by Polycystic Ovarian Syndrome (PCOS). Different long-term follow-up studies have been done to investigate the general health implications of amenorrhea condition in surgical menopause after bilateral oophorectomy. In this view, further studies are needed to exactly elucidate both pathophysiological mechanisms affecting cardiovascular system and new therapies aiming to prevent premature atherosclerotic process of the early and later impact of amenorrhea and subsequent hormonal withdrawal in young women, during menopausal transition and in postmenopausal period.