Impact of endo- and exogenous estrogens on heart rate variability in women: a review

Abstract

Measurement of heart rate variability (HRV) is an established method to assess the activity of the autonomic nervous system. The aim of this review was to examine the link between HRV, reproductive life stages and menopausal hormone therapy. A literature review was performed using the Medline database. Based on title and abstract, 45 studies were extracted out of 261 citations screened. Due to different study designs and evaluation methods, HRV indices were not directly comparable. Qualitative comparisons in between the vast majority of studies, however, demonstrated a decrease of the vagal dominance on the heart from the follicular to the luteal cycle phase, although some studies asserted no change. The intake of oral contraceptives appeared not to alter the vagal modulation of the heart. All investigations agreed on a decline of HRV towards higher sympathetic control after menopause. Different menopausal hormone therapy approaches showed a supporting impact of estrogen on HRV in most studies. A combined therapy of estrogen and progestogens revoked this benefit. Further research is needed to demonstrate how this process might be attenuated by different menopausal hormone therapies.

Keywords:

• Estrogen
• menopause
• menopausal hormone therapy
• menstrual cycle phase
• oral contraception
• heart rate variability

Acknowledgements

The authors are grateful for the support of Ramona Guelpa, secretary at the Department of Obstetrics and Gynecology, Section on Gynecological Endocrinology and Reproductive Medicine, Inselspital Bern, Switzerland, for her help with ordering the identified publications.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Source of funding

The authors have received no funding for this article.