Faculty of Nursing University of Alberta Edmonton Alberta Canada.
Faculty of Natural Sciences The Kings University Edmonton Alberta Canada.
J Am Heart Assoc. 2024 Mar 19;13(6):e033154. doi: 10.1161/JAHA.123.033154. Epub 2024 Mar 18.
Exercise-associated secondary amenorrhea results in estrogen deficiency, which may lead to dysfunction in estrogen's normal cardioprotective pathways. Estrogen may be essential in a woman's endothelial adaptations to exercise. The objective of this review was to assess the association between secondary amenorrhea in physically active women and cardiovascular disease (CVD) risk.
A literature search was performed in January 2023 and updated in August 2023 of the Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations. Citation chaining was done to screen for additional studies. Eight sources were searched for gray literature. Studies that compared physically active women with amenorrhea to physically active women with eumenorrhea aged 18 to 35 years with evidence of CVD, alterations to cardiovascular physiology, or CVD risks were included. Eighteen observational studies from 3 countries were included. Overall, the quality of evidence was good. A meta-analysis was performed. Physically active women with secondary amenorrhea had significantly lower estradiol, flow-mediated dilation, resting heart rate, systolic blood pressure, and diastolic blood pressure and higher total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein cholesterol.
Estrogen deficiency resulting from exercise-associated secondary amenorrhea in physically active women may impact cardiovascular physiology and certain CVD risk factors. The research in this area is observational; therefore, findings should be interpreted cautiously. However, as exercise-associated secondary amenorrhea is reversible and the primary prevention of CVD is important for public health, it may be important to treat secondary amenorrhea and restore estrogen levels.
运动相关性继发性闭经会导致雌激素缺乏，这可能导致雌激素正常的心脏保护途径功能障碍。雌激素对于女性的内皮适应运动可能是必不可少的。本综述的目的是评估活跃女性的继发性闭经与心血管疾病（CVD）风险之间的关联。
2023 年 1 月进行了文献检索，并于 2023 年 8 月更新了在 Cumulative Index to Nursing and Allied Health Literature（EBSCOhost）、Cochrane Library、Embase（Ovid）、MEDLINE（Ovid）、SPORTDiscus（EBSCOhost）和 Scopus 中的文献，从开始到现在没有日期或语言限制。进行引文连锁以筛选其他研究。对 8 个灰色文献来源进行了搜索。纳入了比较 18-35 岁有运动且闭经的女性与有运动且月经正常的女性的研究，这些研究有 CVD 证据、心血管生理学改变或 CVD 风险。来自 3 个国家的 18 项观察性研究被纳入。总体而言，证据质量良好。进行了荟萃分析。患有运动相关性继发性闭经的活跃女性的雌二醇、血流介导的扩张、静息心率、收缩压和舒张压明显较低，总胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白胆固醇较高。
运动相关性继发性闭经导致的活跃女性雌激素缺乏可能会影响心血管生理学和某些 CVD 危险因素。该领域的研究是观察性的；因此，应谨慎解释研究结果。然而，由于运动相关性继发性闭经是可逆的，CVD 的一级预防对公共健康很重要，因此治疗继发性闭经和恢复雌激素水平可能很重要。
