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A prospective UK Biobank study concludes that irregular menstrual cycle throughout reproductive life is associated with cardiovascular disease (CVD). Researchers have seen that both long (starting at 35 days) and short (less than 21 days) menstrual cycles are associated with atrial fibrillation, while short menstrual cycles would be associated with increased risk of coronary heart disease and myocardial infarction.

However, menstrual cycle length was not associated with an increased risk of stroke or heart failure.

All are data obtained by a research group from the Department of Endocrinology and Metabolism of Nanfang Hospital / Southern Guangdong Medical University (China), led by Professor Huijie Zhang, which are published today in the Journal of the American Heart Association.

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Bless you.

"The period doesn't have to hurt. If there is pain, there is a hidden pathology."

  • Editor: P. PÉREZ Madrid

"The period doesn't have to hurt. If there is pain, there is a hidden pathology."

New evidence suggests that alterations in the menstrual cycle could have negative health consequences and that it would be important to monitor these women throughout their reproductive lives to prevent CVD and atrial fibrillation.

The authors of the study start from the idea that regular menstrual cycles throughout reproductive life reflect the normal functioning of the hypothalamus-pituitary-ovarian axis and are a vital sign of women's overall health, and that irregular and prolonged menstrual cycles are common endocrine disorders that occur in 20% of those of childbearing age. precisely because of the functional alteration of the aforementioned axis.

In this sense, they explain that cardiovascular disease (CVD), the leading cause of morbidity and mortality among women in the world, affects 45% of women in the West and accounts for a third of all deaths from this cause.

In addition, they state that some risk factors for CVD and cardiovascular mortality related to women were already known, such as polycystic ovary syndrome and early menopause, but they believe it is important that new risk factors be explored, precisely because of the increasing prevalence of CVD in women.

What causes menstrual irregularities?

Irregular and prolonged menstrual cycles have previously been reported to be closely linked to insulin resistance, metabolic disorders, hyperandrogenism, and chronic inflammation, which is linked to increased risk of coronary heart disease and mortality, obesity, and type 2 diabetes. Or that short menstrual cycles would double the risk of myocardial infarction in women younger than 55.

Other studies point to the relationship of irregular menstrual cycles with multiple heart disease risk factors, such as insulin resistance, high cholesterol, high blood pressure, chronic inflammation, and polycystic ovary syndrome; Or they also point out that women are at higher risk of arrhythmias or irregular heartbeat, precisely due to the hormonal fluctuations of the menstrual cycle.

"However, evidence linking menstrual cycle characteristics throughout reproductive life with CVD and cardiovascular mortality remains limited and large prospective studies are needed," according to these researchers, who have developed a large-scale survey with average follow-up of 11.8 years of 58,056 women from the UK Biobank registries, between 40 and 69 years of age.

"Our data indicated that menstrual cycle length of 21 days or 35 days was significantly associated with increased risk of CVD episodes," they stress, cautioning that the relationship between menstrual cycle regularity/length and specific CVD subtypes (atrial fibrillation, coronary heart disease, and myocardial infarction) is relatively limited.

The article includes the statistics of more than 1,600 cardiovascular events reflected in the epidemiological data of the women participating in the study. Always compared to women who had a regular cycle, a 40% higher risk of atrial fibrillation and 19% more heart disease has been seen in women with menstrual cycles of less than 21 days or more than 35; both shorter and longer courses were associated with increased CVD risk (29% and 11% respectively); As for atrial fibrillation, shorter menstrual cycles were associated with a 38% higher risk and longer ones with 30% more. Finally, menstrual cycle length was not associated with an increased risk of stroke or heart failure.

"To our knowledge, this is the first study to examine the relationships between menstrual cycle characteristics and atrial fibrillation risk," the paper's authors say. In short, the researchers believe that their findings could be transferred to clinical practice to open avenues for the prevention of atrial fibrillation, myocardial infarction and coronary heart disease in women.

"In addition, we found that the association between menstrual cycle characteristics and cardiovascular disease episodes was modified by smoking, and that the relationship between short menstrual cycle and onset of cardiovascular disease was significantly stronger in women with baseline high-density lipoprotein (HDL-C) cholesterol levels <1.3 mmol/L."

These data reinforce the importance of monitoring the menstrual cycle of these women during their reproductive lives, insisting that "those who have irregular menstrual cycle patterns may be more likely to develop heart disease," according to Zhang.

Why is there this link between menstruation and heart disease?

Several potential mechanisms could explain the relationships between menstrual cycle regularity and CVD incidence. On the one hand, irregular menstrual cycles are closely related to the multiple CVD risk factors already mentioned; and on the other, abnormal cycle length can have reproductive health consequences.

Monthly cycle length is thought to be an indicator of cumulative ovarian steroid exposure and reflects underlying hormonal patterns. Therefore, long and irregular cycles are associated with less exposure to estrogens, which may have a vasodilatory function by increasing adrenergic receptors and reducing oxidative stress. That would explain its association with CVD risk.

And even more. Irregular or long menstrual cycles are associated with higher testosterone levels and lower levels of sex hormone binding globulin (SHBG), a relationship that has already been strongly evidenced in CVD.

"In this study we saw that women with long or irregular menstrual cycles had higher incidence rates of diabetes and hypertension, and had higher BMI, higher total cholesterol levels and lower HDL-C levels, which are strong predictors of CVD episodes, and which together may contribute to increased risk." the researchers argue.

On the other hand, they add that oral contraceptives could also be apotential modifying actor of the relationship between menstrual cycle characteristics and CVD risk, since they have been widely used for the treatment of irregular menstrual cycles or polycystic ovary syndrome in women. But none of that was observed in the current study.

  • Gynaecology
  • Cardiology

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