Revista Colombiana de Cardiología
versão impressa ISSN 0120-5633
GUZMAN, Juan C et al. Effects of estrogen replacement therapy on autonomic function of post-menopausal women. Rev. Col. Cardiol. [online]. 2007, vol.14, n.1, pp. 9-17. ISSN 0120-5633.
Background: estrogen deficit during menopause may be related to cardiac autonomic function imbalance, reducing the cardiovagal reflex response that could potentially increase cardiovascular risk. The physiological mechanisms that lead to this alteration in postmenopausal women remain unclear. In this article, the effect of hormonal replacement therapy on autonomic function in women submitted to hysterectomy is discussed. Methods: Fifty women with a previous hysterectomy and amenorrhea for 1 year prior to surgery were enrolled in a prospective randomized crossover double-blind placebo controlled trial. Either oral estrogen replacement therapy (ERT) conjugated estrogens 0.625 mg once a day or placebo, were randomly administered in a crossover design during 12 weeks with a 2 week washout period. Cardiovagal autonomic function was assessed by conventional techniques and through venous occlusion plethysmography in order to evaluate vascular autonomic function calculating forearm blood flow (FBF) and peripheral vascular resistance (PVR) at baseline, and during head-up tilt (HUT) and a non-hypotensive stimuli (-10mmHg) lower-body negative pressure (LBNP). Results: No differences were found in cardiovagal autonomic function comparing ERT vs. placebo at baseline resting conditions, nor during HUT and LBNP. A significant difference was identified in supine FBF [1.9(0.5) vs. 1.5(0.5), p=0.02] as well as in PVR [53.5(18.2) vs. 68.6(34), p=0.02] comparing ERT vs. placebo interventions. Conclusions: Short term ERT did not improve cardiovascular autonomic reflex responses in postmenopausal women, but increased vascular relaxation primarily by reducing peripheral vascular resistance. Hormone replacement therapy can be used under adequate supervision in order to improve menopausal symptoms during a short period of time, mainly in young non-hypertensive post-menopausal women.
Palavras-chave : menopause; autonomic nervous system; estrogen replacement therapy; plethysmography.