Exercise-associated secondary amenorrhea in physically active women linked to cardiovascular disease: JAHA
Canada: A recent systematic review and meta-analysis has shed light on the impact of secondary amenorrhea on cardiovascular disease (CVD) risk in physically active women. The findings were published online in the Journal of the American Heart Association.
Observational studies linked secondary amenorrhea to several cardiovascular (CV) risk factors in physically active women.
"Estrogen deficiency resulting from exercise-associated secondary amenorrhea in physically active women may affect CV physiology and certain CVD risk factors," the researchers wrote. However, they noted that research in the area is observational, and findings should be interpreted cautiously.
They add, "As exercise-associated amenorrhea is reversible and primary prevention of cardiovascular disease is important for public health, it may be important to treat secondary amenorrhea and restore estrogen levels.
Exercise-associated secondary amenorrhea leads to estrogen deficiency, which may result in dysfunction in estrogen's normal cardioprotective pathways. Estrogen may be essential in a woman's endothelial adaptations to exercise. Nicole L. Tegg, Faculty of Nursing University of Alberta Edmonton Alberta Canada, and colleagues aimed to assess the association between secondary amenorrhea in physically active women and CVD risk.
For this purpose, the researchers performed a literature search in January 2023 and updated in August 2023 of the online databases from inception to present with no date or language limitations. Citation chaining was done to screen for additional studies. Eight sources were searched for gray literature.
The review included studies that compared physically active women with amenorrhea to physically active women with eumenorrhea aged 18 to 35 years with evidence of cardiovascular disease, alterations to cardiovascular physiology, or CVD risks. Eighteen observational studies from three countries were included. The quality of evidence was good overall.
"Physically active women with secondary amenorrhea had significantly lower estradiol, resting heart rate, flow-mediated dilation, systolic blood pressure, and diastolic blood pressure and higher total cholesterol, high-density lipoprotein, triglycerides, and low-density lipoprotein cholesterol," the researchers reported.
In conclusion, the systematic review and meta-analysis found that functional hypothalamic amenorrhea may obviate CV benefits of exercise and may adversely impact CV physiology and certain CVD risk factors, including, endothelial function and lipid profiles.
The findings highlight a need to further investigate the long-term CV consequences of hypoestrogenemia. Given the hormonal profiles of athletes with amenorrhea (AAs) and the evidence suggesting AAs may demonstrate increased CVD risk factors, determining the causative factor of amenorrhea is important so that appropriate interventions may be explored to restore menses and thereby, estrogen levels.
.Finally, increasing awareness of the CV health consequences linked with energy deficiency is of paramount importance.
"There is a need for high-quality, large‐scale longitudinal studies to investigate the underlying relationships between secondary amenorrhea and the development of cardiovascular diseases and to increase the understanding of the clinical relevance of findings in this area," the researchers wrote.
Reference:
Tegg NL, Myburgh C, O'Donnell E, Kennedy M, Norris CM. Impact of Secondary Amenorrhea on Cardiovascular Disease Risk in Physically Active Women: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2024 Mar 18:e033154. doi: 10.1161/JAHA.123.033154. Epub ahead of print. PMID: 38497482.
Next Story