Study Results Link Hormonal Changes During Menopause to Decline in Cardiovascular Health

Levels of low-density lipoprotein (LDL) cholesterol tend to rise during menopause, and 10% of the increase is because of shifts in sex hormones, results of a study published in the European Journal of Preventive Cardiology showed.

Women usually undergo menopause between aged 48 and 52 years, which leads to a decline in estrogen and an increase in follicle-stimulating hormone (FSH). The results of previous studies have shown that there is an association between menopause and heart disease, promoting levels of metabolism. However, the new study results showed a link with changes to the female sex hormones. The metabolite shifts were partially improved with hormone replacement therapy (HRT).

“Menopause is unavoidable, but it is possible that the negative metabolite shift can be diminished by eating healthily and being physically active,” Eija K. Laakkonen, PhD, of the University of Jyväskylä, Finland, said in a statement. “In particular, women should pay attention to the quality of fat in their diet and getting sufficient exercise to maintain cardiorespiratory fitness. HRT is an option that women should discuss with healthcare providers at this point in their lives,” Laakkonen said.

The analysis included 218 perimenopausal women who did not received HRT at baseline. Investigators obtained levels of 2 hormones, estradiol and FSH, and180 metabolites, including amino acids, lipids, and lipoproteins, via blood samples at baseline and every 3 to 6 months until early post-menopause.

The menopausal state was assessed using blood FSH levels and menstrual diaries. Early post-menopause was defined as elevated FSH levels on at least 2 consecutive occasions and no periods for more than 6 months.

A total of 35 women started HRT during the study.

“Our study investigated whether the menopausal hormonal change modulates the metabolite profile measured in blood samples taken before and after menopause. Because the menopausal transition, ie, the time with variable hormone levels and irregular menses, varies tremendously from person to person, the time points for assessment were individualized,” Laakkonen said.

Investigators conducted detailed statistical analyses to determine which changes occur in metabolite levels during the menopausal transition and whether these changes related to the shift in sex hormone levels. Additionally, investigators evaluated whether the metabolite trajectory varied between HRT users and non-users.

Menopause was associated with a statistically significant change in levels of 85 metabolites. The results of the analysis showed that the menopausal hormonal shift directly explained the change in 64 of the 85 metabolites, with the effect sizes ranging from 2.1% to 11.2%, including amino acids, fatty acids, LDL cholesterol, and triglycerides.

Investigators adjusted for age at baseline, alcohol use, diet quality, duration of follow up, education level, physical activity, and smoking status. Results of a second exploratory analysis showed that HRT was associated with an increase in high-density lipoprotein cholesterol and a reduction in LDL cholesterol.

Strong conclusions cannot be drawn about the effects of HRT, because the sample size of women starting the therapy was small, and the study was merely observational, Laakkonen said.

Reference

Hormonal changes during menopause are directly related to decline in cardiovascular health. EurekAlert. News release. May 13, 2022. Accessed May 13, 2022. https://www.eurekalert.org/news-releases/952200