Impact of high altitude on key determinants of female reproductive health: a review

Abstract

Imperishable research work was done on females visiting high-altitude (HA) areas for recreational activities or job purposes as well as on female HA natives. Hypoxia at HA is an unavoidable condition that affects the determinants of female reproductive functions like, the age of menarche and menopause, whole reproductive span, hormone synthesis, and fertility. This review will emphasize whether HA hypoxia is a threat to women: residents or visitors by analyzing these proximate determinants. Delayed menarcheal and advanced menopausal age was found to shorten the reproductive span in some HA populations, whereas in some cases, menstrual cycle was also reported to be irregular. In addition, the completed fertility rate (CFR) was increased when people migrated to lower altitude. Altered stress hormones and reproductive hormones were observed in sea-level females exposed to HA. Oxidative stress (OS) at HA was also reviewed to explain the probable reasons for the observed changes in these determinants because disturbed redox homeostasis may be a connecting link, affecting the reproductive functions. In conclusion, HA hypoxia plays a crucial role on various determinants of female reproductive health and this review will be helpful for more precise study along with the probable underlying mechanisms responsible for the changes in female reproductive functions at HA.

Women’s reproductive span: a systematic scoping review

“…The biological reproductive span broadly constitutes the interval between age at menarche and age at menopause ( Singh and Ahuja, 1980 ; Beall, 1983 ; Goodman et al , 1985 ; Kapoor and Kapoor, 1986 ; Menken, 1987 ; Wood and Weinstein, 1988 ; Thomas et al , 2001 ; Padmadas et al , 2004 ; Riener et al , 2004 ; Aydos et al , 2005 ; Kalichman et al , 2007 ; Dorjgochoo et al , 2008 ; Liu et al , 2010 ; Lu et al , 2010 ; Cerne et al , 2011 ; Fukuda et al , 2011 ; Forman et al , 2013 ; Tea et al , 2013 ; Pyun et al , 2014 ; Duarte et al , 2017 ; Bjelland et al , 2018 ; Shaw et al , 2018 ; Demakakos et al , 2019 ; Gottschalk et al , 2020 ; Singh et al , 2020 ; Sinha et al , 2021 ). The end of the biological span might be age at natural menopause ( Pavia et al , 1994 ; Morabia et al , 1996 ; Morabia and Costanza, 1998 ; Johnston, 2001 ; Hefler et al , 2002 ; Worda et al , 2004 ; Bartmann et al , 2005 ; Long et al , 2006 ; Nichols et al , 2006 ; He et al , 2007 , 2009b ; Kalichman et al , 2007 ; Kevenaar et al , 2007 ; Dorjgochoo et al , 2008 ; Mitchell ...…”

“…Urban residence might be associated with a longer biological reproductive span ( Lewington et al , 2014 ), while another study found no association ( Duarte et al , 2017 ). Living in high altitude was also investigated in a few studies ( Beall, 1983 ; Kapoor and Kapoor, 1986 ; Shaw et al , 2018 ).…”

Maca extracts and estrogen replacement therapy in ovariectomized rats exposed at high altitude

“…Lowland women exposed to chronic or intermittent hypoxia have disturbances in the menstrual cycle more than native people from the highlands 25 . In addition, highland native women presented with an increase in FSH level, early perimenopause, 26 delayed menarcheal, and advanced menopausal age 27 . This study compared the effect between estradiol replacement therapy (ERT) and supplementation with L. meyenii extracts, a plant rich in phytoestrogens, in animals exposed to hypobaric hypoxia.…”

“…25 In addition, highland native women presented with an increase in FSH level, early perimenopause, 26 delayed menarcheal, and advanced menopausal age. 27 This study compared the effect between estradiol replacement therapy (ERT) and supplementation with L. meyenii extracts, a plant rich in phytoestrogens, in animals exposed to hypobaric hypoxia. We found that treatment with L. meyenii extract decreased oxidative stress, recovered cornified cell number, and uterine weight in OVX rats Using ovariectomized rats as our experimental menopause model, 28 our studies confirmed that ovariectomy of rats increased the lipid peroxidation, 29 especially in hypoxia-exposed group.…”

Enhanced Placental Mitochondrial Respiration in Tibetan Women at High Altitude

“…Fetal growth restriction is a condition in which the fetus fails to reach its full growth potential, related to the increased risk of development of metabolic syndrome in childhood and multiple diseases in adulthood; therefore, it has received increasing attention (de Rooij et al, 2007;Veenendaal et al, 2013;Sayama et al, 2020). The placenta plays an essential role in fetal growth (Shaw et al, 2018;Sferruzzi-Perri et al, 2019). It has long been speculated that fetal growth restriction is initially caused by abnormal placental development and functional deficiency (Tong and Giussani, 2019;Sangkhae et al, 2020;Turner et al, 2020).…”