Aim: Longer menstrual cycles have been associated with an increased risk of cardiovascular disease, supporting a contribution of abnormal ovarian function. Our objective was to characterize trajectories of menstrual cycle length during the menopause transition (MT) and test whether these trajectories are associated with postmenopausal markers of subclinical atherosclerosis. Methods: Women were included in the Nationwide Women’s Health Study Daily Hormone Study if they had an observed last menstrual period (FMP) date, recorded cycle length of ≥2 annual menstrual cycles (mean ± SD: 4.22 ± 1.91 cycles), and had measurements of postmenopausal carotid intima-media thickness (cIMT) and/or brachial-ankle pulse wave velocity (baPWV). Cycle length trajectories along the MT were identified using a group-based trajectory model and linked to cIMT and baPWV using linear regression. Results: We studied 428 women who had 1808 cycles on MT (45.1 ± 2.3 years at baseline visit), and of whom 263 had cIMT and 213 had baPWV measured postmenopausally (after 13.88 ± 0.42 and 15.25 ± 0.70 years from the initial visit, respectively). Three distinct cycle length trajectories were identified: stable (no change in cycle length over MT among 62.1% of women), late increase (a late increase 2 years before PMF among 21.8% ) and early increase (an early increase 5 years before the PMF between 16.2%). Women with the late rise pattern had significantly lower levels of postmenopausal cIMT (0.72 mm) and baPWV (1392 cm/s) than the stable group (0.77 mm and 1508 cm/s, respectively) adjusting for race , concurrent age, socioeconomic level, physical activity level and premenopausal cardiovascular risk profile. Conclusions: Patterns of cycle length over MT appear to be a marker of future vascular health that may help identify groups at higher or lower risk of atherosclerosis after menopause. |
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The length of a woman’s menstrual cycle as she approaches menopause could reflect her future risk of heart disease, researchers report.
Some women’s menstrual cycles lengthen as they approach menopause, while others’ cycles remain stable. This new study found that women whose cycle increased in length two years before menopause had better measures of vascular health than those who had stable cycles.
"Cardiovascular disease is the leading cause of death in women and the risk increases significantly after middle age, so we believe that menopause could contribute to this disease," said study author Samar El Khoudary, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.
"Menopause is not just the click of a button. It is a multi-stage transition in which women experience many changes that could put them at higher risk for cardiovascular disease," she said in a university news release. "The change in cycle length, which is related to hormone levels, is a simple metric that could tell us who is most at risk."
To examine this relationship, El Khoudary and her colleagues analyzed data from 428 older American women in an ongoing national study.
About 62% of women had relatively stable cycles before menopause, while about 16% had an early increase in cycle length (five years before menopause) and 22% had a late increase (two years before menopause).
Compared with women with stable cycles, those in the late-rising group had significantly better measures of artery hardness and thickness, indicating a lower risk of heart disease. Women in the early augmentation group had poorer artery health.
Changes in menstrual cycles during menopause may reflect hormone levels, which in turn contribute to heart health, the researchers suggested. They plan to test this theory in future research evaluating hormonal changes.
"These findings are important because they show that we cannot treat women as a single group: women have different menstrual cycle trajectories during the menopause transition, and this trajectory appears to be a marker of vascular health," El Khoudary said. . "This information adds to the set of tools we are developing for physicians caring for women in midlife to assess cardiovascular disease risk and brings us closer to personalizing prevention strategies."
