A new study measured arterial stiffness—an independent risk factor for development of cardiovascular disease (CVD) in women from a wide age range. Age was a strong determinant of arterial stiffness. Indicative of the role of hormones, menstrual cycle phase, contraceptive pill phase and menopausal state were also associated with arterial stiffness.

Arteries alternately dilate and contract, allowing blood to progress and the characteristic of flexibility (known as pulse wave), therefore, is critical. The walls of the arteries should be elastic enough, though not too much so, to allow the pulse wave to proceed without the walls of the arteries rupturing. As the blood vessels age, the arterial wall stiffens. Stiffening increases the risk of cardiovascular disease and the risk of cardiac mortality.

Female sex hormones have been shown to affect several factors that regulate vascular wall elasticity, so high estrogen levels are thought to be one of the mechanisms by which young adult women acquire a lower risk of cardiovascular disease than their male peers. Studies measuring both hormone levels and arterial stiffness in women differing due to their age or use of hormonal products are scarce.

“Our study combined two datasets including young adults and middle-aged women. It allowed for a comprehensive examination of the different hormonal statuses involved in women’s lives,” says Associate Professor Eija Laakkonen from the Gerontology Research Center and the Faculty of Sports and Health Science, University of Jyväskylä in Finland. “We were able to study the associations of the natural menstrual cycle and the use of birth control pills, as well as the natural menopause and the use of hormone therapy with the flexibility of the arteries.”

The study focused on women aged 19 to 58 years. The older the women were, the researchers found, the stiffer their arteries. Of the hormones measured, estradiol and follicle-stimulating hormone were associated with arterial stiffness, but age was a stronger determinant of stiffness than were hormone levels. Examination of the subsets showed hormonal state to be associated with arterial stiffness. The attenuation of the pulse wave was faster in the late follicular and ovulation phases than it was during menstrual bleeding. Combined oral contraceptive users have varying hormonal levels due to taking pills containing estrogen and progestogen for the first three weeks and then changing to hormone-free pills for a week during which withdrawal bleeding occurs. While taking the hormonal pills, the arteries were more elastic than they were during bleeding. Among menopausal women, postmenopausal women on hormone therapy had the stiffest arteries.

“Based on this study, we can conclude that age is a significant regulator of vascular functions, but hormones also play a role in regulating arterial elasticity at different stages of a woman’s life,” Laakkonen stated.

Laakkonen EK, “Associations of Sex Hormones and Hormonal Status with Arterial Stiffness in a Female Sample from Reproductive Years to Menopause.” Frontiers in Endocrinology, 2021

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