Premenopausal women have a lower risk and incidence of hypertension and cardiovascular disease (CVD) compared to age-matched men and this sex advantage for women gradually disappears after menopause, suggesting that sexual hormones play a cardioprotective role in women. However, randomized prospective primary or secondary prevention trials failed to confirm that hormone replacement therapy (HRT) affords cardioprotection. In addition to the two classical estrogen receptors, ERα and ERβ, a third, G-protein-coupled estrogen receptor GPR30, has been identified. New intracellular signaling pathways and actions for the cardiovascular protective properties of estrogen have been proposed.

Observational studies have demonstrated that both the incidence of CVD and resultant morbidity and mortality are much less in premenopausal women compared to Blood pressure is typically lower in premenopausal women than men; however, after menopause it increases to levels similar to or higher than age-matched menage-matched men, and this sex advantage for women becomes far less or disappears with increased age and reduced estrogen levels after menopause.

• In addition to the two classical estrogen receptors, ERα and ERβ, a third, G-protein-coupled estrogen receptor GPR30, has been identified. New intracellular signaling pathways and actions for the cardiovascular protective properties of estrogen have been proposed.
• . Observational studies have demonstrated that both the incidence of CVD and resultant morbidity and mortality are much less in premenopausal women compared to Blood pressure is typically lower in premenopausal women than men; however, after menopause it increases to levels similar to or higher than age-matched menage-matched men, and this sex advantage for women becomes far less or disappears with increased age and reduced estrogen levels after menopause
• Premenopausal women also have a much lower incidence and prevalence of heart and renal disease compared to men of the same age . This sex difference in favor of women also gradually disappears after menopause, indeed cardiovascular risk becomes even higher in older women Although it has been debated whether the loss of cardiorenal protection in postmenopausal women is related to aging, loss of female hormones or both, substantial studies indicate that reduced levels of ovarian hormones constitute a major risk factor for development of CVD
• Although it has been debated whether the loss of cardiorenal protection in postmenopausal women is related to aging, loss of female hormones or both, substantial studies indicate that reduced levels of ovarian hormones constitute a major risk factor for development of CVD
• early menopause in young women due to ovarian dysfunction or bilateral oophorectomy is associated with increased risk of CVD compared to women with normal endogenous estrogen levels

• There are other recently discovered mechanisms by which estrogens could provide cardioprotection. Estrogen has been shown to increase expression of superoxide dismutase and inhibit NADPH oxidase activity, thereby reducing oxidative stress . Estrogen acting via ERβ increases protein S-nitrosylation, a common post-translational protein modification, leading to cardioprotection Inflammation is considered a key element in the pathogenesis of hypertension, atherosclerosis and development of coronary heart disease (CHD), and estrogen has been reported to reduce inflammatory markers  Estrogen also attenuates afterload- or agonist-induced cardiac hypertrophy via inhibition of calcineurin, hypertrophic transcription factor NF-AT, and MAPK signaling pathways . In addition, estrogen has a profound antiapoptotic and pro-survival effect on cardiomyocytes via activation of Akt and inhibition of caspase-3, GSK-3β , p38α-mediated p53 phosphorylation, and JNK1/2-mediated NF-κB activation  Moreover, estrogen has been shown to promote endothelial progenitor cell mobilization and enhance mesenchymal stem cell-mediated vascular endothelial growth factor (VEGF) release  improving endothelial and myocardial functional after ischemia.

There is evidence that atherosclerosis involves an ongoing inflammatory response, which is more profound during the early years of menopause. Cytokine production has been shown to increase in the early years following menopause but thereafter declines to within the premenopausal range . Estrogen reportedly reduces interleukin (IL)-1, IL-6, IL-18, C-reactive protein, tissue necrosis factor (TNF)-α and increases macrophage colony-stimulating factor, a cytokine that lowers plasma cholesterol levels by enhancing clearance of low-density lipoprotein. Thus since inflammatory responses are higher in early postmenopause while absence or reduction of endogenous estrogen may accelerate the progression of atherosclerosis, the timing of HRT with respect to onset of menopause may have important ramifications regarding its efficacy in preventing or delaying the progression of atherosclerosis and CVD

• Hormone replacement therapy has greatly impacted the medical field and bridged gaps in our healthcare, but the positive and negative consequences of these advances are not fully known.    Early on in the discovery of HRT, studies showed that it was a significant leap in treating the symptoms of menopause, but it also could prove beneficial for reducing the risk of heart disease and osteoporosis induced bone fractures.  The function of estrogen in the body is to increase the “good” cholesterol in the bloodstream while decreasing the levels or “bad” cholesterol.  The good cholesterol is the high-density lipoprotein (HDL) and the bad cholesterol is officially known as low-density lipoprotein (LDL).  Therefore estrogen, one of the main components of HRT, would seem to be a beneficial component in the makeup of beneficial drugs for menopausal symptoms
• THERAPY Choosing a complementary or alternative therapy can be a challenge; so many different ones exist. Acupuncture, aromatherapy, herbal treatments, homeopathy, hypnotherapy, yoga and reflexology have all been reported as being helpful in the menopause.
• Some women breeze through a problem-free menopause, but most experience some symptoms ranging from mild to severe

BY

M SRINIDHI