Menstrual Cycle Effects on the Neurohumoral and Autonomic Nervous Systems Regulating the Cardiovascular System
Nir Hirshoren,
Inna Tzoran,
Igor Makrienko,
Yehuda Edoute,
Mikahl M. Plawner,
Joseph Itskovitz-Eldor and
Giris Jacob
Jacob Recanati Autonomic Dysfunction Center (N.H., I.T., I.M., Y.E., M.M.P., G.J.), Department of Medicine "C"; and Department of Obstetrics and Gynecology (J.I.-E.), Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
Address all correspondence and requests for reprints to: Giris Jacob, M.D., D.Sc., Director, Jacob Recanati Autonomic Dysfunction Center, and Department of Medicine "C", Rambam Medical Center, PO Box 9602, Haifa 31096, Israel. E-mail: . g_jacob{at}rambam.health.gov.il
Abstract
Gonadal hormones may affect homeostatic mechanisms regulatingthe cardiovascular system. We investigated this relationshipat five different crucial hormonal time points along the menstrualcycle.
Eight eumenorrheic healthy subjects underwent a battery of autonomictests, hemodynamics, and volume-regulatory hormone measurements.Fluid-regulatory hormones, plasma renin activity, and aldosteroneincreased along the luteal phase (P = 0.003 and 0.02, respectively),whereas rest supine-corrected hematocrit declined in the courseof the menstrual cycle (P = 0.001). Plasma norepinephrine decreasedfrom 1.4 ± 0.2 to 0.95 ± 0.1 nmol/liter (P <0.02) [early follicular (EF) to late follicular]. Thereafter,concentrations gradually returned to EF levels. Lf to Hf domainratio (spectral analysis of electrocardiogram) showed a differencefrom that of norepinephrine. The cardiovagal baroreflex sensitivityincreased significantly along the luteal phase (P = 0.04). Thedose of isoproterenol required to increase heart rate (HR) 15beats per minute was 0.19 ± 0.04 µg during theEF time point, and it increased to 0.39 ± 0.06 µgduring the late luteal time point (P = 0.05). However, bloodpressure, HR, and their responses to orthostatic stress remainedunchanged.
Fluctuations in the ovarian hormones along the menstrual cycleare associated with unchanged blood pressure and HR, despitethe significant variations in the different homeostatic mechanismsregulating the cardiovascular system.
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