Throughout life, women are subjected to both acute fluctuations in sex hormones, associated with the menstrual cycle, and chronic changes following the onset of menopause. Female sex hormones, and in particular estrogen, strongly influence cardiovascular function such as the regulation of vascular tone and oxidative stress and thereby functions such as oxygen delivery and blood pressure. The acute hormonal fluctuations do not substantially impact health, but their influence should be considered with regard to measurements of vascular function. The chronic hormonal change with menopause strongly impacts the vasculature and markedly increases the risk of cardiovascular events. Physical activity activates signaling pathways also triggered by estrogen; therefore, exercise training could be an effective means of reducing the deleterious effects of estrogen loss at menopause. However, findings are divergent with some reporting marked improvements in vascular health with physical activity and others showing lower gains compared to age-matched males. Potential explanations for this discrepancy in findings are timing after menopause and training mode, aspects that should be further addressed in future studies. Physical activity should be recommended for women of all ages, but the most essential timing for maintenance of vascular health may be from menopause and onwards.
K E Y W O R D Sblood vessel, estrogen, exercise, nitric oxide, prostacyclin
| INTRODUCTIONFemale sex hormones, and in particular estrogen, are known to have numerous protective and functional roles in the vasculature including regulation of vasodilator systems, vascular growth, reduction in platelet reactivity, and vascular inflammation. 1,2 Alterations in the levels of sex hormones occur short term during the menstrual cycle and chronically at menopause with an almost complete loss of progesterone and estrogen. The chronic alterations in sex hormones at menopause greatly influence a number of aspects in women's health and substantially impact on the cardiovascular system resulting in impairment in vascular function 3,4 and a markedly increased prevalence of cardiovascular disease. 5 In this overview, we focus on how the short-term changes in sex hormones during the menstrual cycle and the chronic changes with menopause affect the vascular system in women. Focus lies primarily on basal regulation of vascular tone and the role of physical activity on the blood vessels supplying skeletal muscle tissue. After a brief overview of the physiology and molecular mechanisms underlying regulation of vascular tone, the influence of sex hormones is briefly addressed. We then discuss the effect of exercise and exercise training on vascular function during acute and chronic changes in female sex hormones, with an emphasis on estrogen. The main focus of this review was on humans but includes data from studies on laboratory animals and cell culture where relevant.