Skip to main content
Log in

Phase of the menstrual cycle does not affect orthostatic tolerance in healthy women

  • RESEARCH ARTICLE
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Women of child-bearing age have a lower orthostatic tolerance (OT) than older women or men, and women suffering from frequent syncopal episodes often comment that their symptoms occur at certain times of the menstrual cycle. However, it is not known whether, in asymptomatic women, OT varies at different phases of the menstrual cycle. We studied 8 healthy asymptomatic women aged 26.8±3.4 years. We determined OT using a test of combined head-up tilting and lower body suction. We continuously monitored beat-to-beat blood pressure (Finapres), heart rate (ECG), and cerebral and forearm blood flow velocities (Doppler ultrasound). On each test day we assessed carotid baroreceptor sensitivity from suction/pressure applied to a neck chamber. We also determined estradiol and progesterone levels from a venous blood sample. Tests were performed in early follicular and late luteal phases, and during ovulation. Serum concentrations of estradiol (pmol • l–1) and progesterone (nmol • l–1) were in follicular phase 464.1 ± 63 and 6.3 ± 2.8; ovulation 941.6 ± 298 and 5.8 ± 1.2; luteal phase 698±188 and 32.3 ± 9.6. Progesterone levels were significantly higher in the luteal phase (p < 0.001). OT was not different on any test day: follicular 31.9 ± 1.6 min, ovulation 31.3 ± 0.7 min; luteal 31.1 ± 2.2 min. Supine and tilted heart rates and blood pressures, the maximum heart rate, and the cerebral autoregulatory and forearm vascular resistance responses to the orthostatic stress were similar during all studies. Both cardiac and vascular resistance carotid baroreceptor sensitivities were also similar on all test days. These results suggest that there is no difference in either OT or cardiovascular control at the tested phases of the menstrual cycle in healthy women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ali YS, Daamen N, Jacob G, Jordan J, Shannon JR, Biaggioni I, Robertson D (2000) Orthostatic intolerance: a disorder of young women. Obstet Gynecol Surv 55:251–259

    Article  CAS  PubMed  Google Scholar 

  2. Bowyer L, Brown MA, Jones M (2001) Vascular reactivity in men and women of reproductive age. Am J Obstet Gynecol 185:88–96

    Article  CAS  PubMed  Google Scholar 

  3. Brown CM, Hainsworth R (2000) Forearm vascular responses during orthostatic stress in control subjects and patients with posturally related syncope. Clin Auton Res 10:57–61

    Article  CAS  PubMed  Google Scholar 

  4. Bush VE, Cooper VL, Brown CM, Hainsworth R (2000) Vascular responses to orthostatic stress in patients with postural tachycardia syndrome (POTS), in patients with low orthostatic tolerance, and in asymptomatic controls. Clin Auton Res 10:279–281

    Article  CAS  PubMed  Google Scholar 

  5. Cankar K, Finderle Z (2003) Gender differences in cutaneous vascular and autonomic nervous response to local cooling. Clin Auton Res 13:214–220

    PubMed  Google Scholar 

  6. Chan NN, MacAllister RJ, Colhoun HM, Vallance P, Hingorani AD (2001) Changes in endothelium-dependent vasodilatation and alpha-adrenergic responses in resistance vessels during the menstrual cycle in healthy women. J Clin Endocrinol Metab 86:2499–2504

    Article  CAS  PubMed  Google Scholar 

  7. Charkoudian N (2003) How do female reproductive hormones influence vascular control in the hand? Clin Auton Res 13:178–179

    PubMed  Google Scholar 

  8. Chidambaram M, Duncan JA, Lai VS, Cattran DC, Floras JS, Scholey JW, Miller JA (2002) Variation in the renin angiotensin system throughout the normal menstrual cycle. J Am Soc Nephrol 13:446–452

    CAS  PubMed  Google Scholar 

  9. Claybaugh JR, Sato AK, Crosswhite LK, Hassell LH (2000) Effects of time of day, gender, and menstrual cycle phase on the human response to a water load. Am J Physiol 279:R966–R973

    CAS  Google Scholar 

  10. Claydon VE, Hainsworth R (2003) Cerebral autoregulation during orthostatic stress in healthy controls and patients with posturally related syncope. Clin Auton Res 13:321–329

    Article  PubMed  Google Scholar 

  11. Claydon VE, Hainsworth R (2004) Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension 43:1–5

    Article  CAS  Google Scholar 

  12. Cooper VL, Hainsworth R (2001) Carotid baroreceptor reflexes in humans during orthostatic stress. Exp Physiol 86:677–681

    Article  CAS  PubMed  Google Scholar 

  13. Cooper VL, Hainsworth R (2002) Effects of head-up tilting on baroreceptor control in subjects with different tolerances to orthostatic stress. Clin Sci 103:221–226

    CAS  PubMed  Google Scholar 

  14. Cooper VL, Hainsworth R (2002) Effects of dietary salt on orthostatic tolerance, blood pressure and baroreceptor sensitivity in patients with syncope. Clin Auton Res 12:236–241

    Article  PubMed  Google Scholar 

  15. Eckberg DL, Cavanaugh MS, Mark AL, Abboud FM (1975) A simplified neck suction device for activation of carotid baroreceptors. J Lab Clin Med 85:167–173

    CAS  PubMed  Google Scholar 

  16. El-Bedawi KM, Hainsworth R (1994) Combined head-up tilt and lower body suction: a test of orthostatic tolerance. Clin Auton Res 4:41–47

    Article  CAS  PubMed  Google Scholar 

  17. El-Sayed H, Hainsworth R (1995) Relationship between plasma volume, carotid baroreceptor sensitivity and orthostatic tolerance. Clin Sci 4:463–470

    Google Scholar 

  18. El-Sayed H, Hainsworth R (1995) Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75:134–140

    Google Scholar 

  19. Farhat MY, Abi-Younes S, Ramwell PW (1996) Non-genomic effects of estrogen and the vessel wall. Biochem Pharmacol 51:571–576

    Article  CAS  PubMed  Google Scholar 

  20. Freedman RR, Girgis R (2000) Effects of menstrual cycle and race on peripheral vascular alpha-adrenergic responsiveness. Hypertension 35:795–799

    CAS  PubMed  Google Scholar 

  21. Frey MA, Mathes KL, Hoffler GW (1986) Cardiovascular responses of women to lower body negative pressure. Aviat Space Environ Med 57:531–538

    CAS  PubMed  Google Scholar 

  22. Gilligan DM, Badar DM, Panza JA, Quyyumi AA, Cannon RO (1994) Acute vascular effects of estrogen in postmenopausal women. Circulation 90:786–791

    CAS  PubMed  Google Scholar 

  23. Gulli G, Cooper VL, Claydon VE, Hainsworth R (2003) Cross-spectral analysis of cardiovascular parameters whilst supine may identify subjects with poor orthostatic tolerance. Clin Sci 105:119–126

    Article  PubMed  Google Scholar 

  24. Hirshoren N, Tzoran I, Makrienko I, Edoute Y, Plawner MM, Itskovitz-Eldor J, Jacob G (2003) Menstrual cycle effects on the neurohumoral and autonomic nervous systems regulating the cardiovascular system. J Clin Endocrinol Metab 87:1569–1575

    Article  Google Scholar 

  25. Kolka MA, Stephenson LA (1997) Effect of luteal phase elevation in core temperature on forearm blood flow during exercise. J Appl Physiol 82:1079–1083

    CAS  PubMed  Google Scholar 

  26. Lieberman EH, Gerhard MD, Uehata A, Walsh BW, Selwyn AP, Ganz P, Yeung AC, Creager MA (1994) Estrogen improves endothelium-dependent, flow-mediated vasodilatation in postmenopausal women. Ann Intern Med 121:936–941

    CAS  PubMed  Google Scholar 

  27. Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, Suarez GA, Rummans TA (1995) Postural tachycardia syndrome (POTS). Neurology 45:S19–S25

    CAS  PubMed  Google Scholar 

  28. Meendering JR, Torgrimson BN, Houghton BL, Halliwill JR, Minson CT (2005) Menstrual cycle and sex affect hemodynamic responses to combined orthostatic and heat stress. Am J Physiol 289:H631–H642

    CAS  Google Scholar 

  29. Miller VM, Vanhoutte PM (1991) Progesterone and modulation of endothelium-dependent responses in canine coronary arteries. Am J Physiol 261:R1022–R1027

    CAS  PubMed  Google Scholar 

  30. Minson CT, Halliwell JR, Young TM, Joyner MJ (2002) Influence of phase of the menstrual cycle on sympathetic activity, baroreflex sensitivity, and vascular transduction in young women. Circulation 101:862–868

    Google Scholar 

  31. O’Brien PM, Selby C, Symonds EM (1980) Progesterone, fluid, and electrolytes in premenstrual syndrome. Br Med J 10:1161–1163

    Article  Google Scholar 

  32. Oelkers WKH (1996) Effects of estrogens and progestogens on the reninaldosterone system and blood pressure. Steroids 61:166–171

    Article  CAS  PubMed  Google Scholar 

  33. Olson BR, Forman MR, Lanza E, McAdam PA, Beecher G, Kimzey LM, Campbell WS, Raymond EG, Brentzel SL, Guttsches-Ebeling B (1996) Relationship between sodium balance and menstrual cycle symptoms in normal women. Ann Intern Med 125:564–567

    CAS  PubMed  Google Scholar 

  34. Ozisik HI, Kamisli O, Karlidag R, Kizkin, Ozcan C (2005) Sympathetic skin response in premenstrual syndrome. Clin Auton Res 15:233–237

    Article  PubMed  Google Scholar 

  35. Pechere-Bertschi A, Nussberger J, Biollaz J, Fahti M, Grouzmann E, Morgan T, Brunner HR, Burnier M (1998) Circadian variations of renal sodium handling in patients with orthostatic hypotension. Kidney Int 54:1276–1282

    Article  CAS  PubMed  Google Scholar 

  36. Pechere-Bertschi A, Maillard M, Stalder H, Brunner HR, Burnier M (2002) Renal segmental tubular response to salt during the normal menstrual cycle. Kidney Int 61:425–431

    Article  PubMed  Google Scholar 

  37. Pechere-Bertschi A, Burnier M (2004) Female sex hormones, salt, and blood pressure regulation. Am J Hypertens 17:994–1001

    Article  CAS  PubMed  Google Scholar 

  38. Rahman MA, Goodhead K, Medcalf JF, O’Connor M, Bennett T (1991) haemodynamic responses to nonhypotensive central hypovolaemia induced by lower body negative pressure in men and women. Eur J Appl Physiol Occup Physiol 63:151–155

    Article  CAS  PubMed  Google Scholar 

  39. Sheldrake P, Cormack M (1976) Variations in menstrual cycle symptom reporting. J Psychosom Res 20:169–177

    Article  CAS  PubMed  Google Scholar 

  40. Spruce BA, Baylis PH, Burd J, Watson MJ (1985) Variation in osmoregulation of arginine vasopressin during the human menstrual cycle. Clin Endocrinol 22:37–42

    CAS  Google Scholar 

  41. Stachenfeld NS, Taylor HS, Leone CA, Keefe DL (2003) Oestrogen effects on urine concentrating response in young women. J Physiol 552:869–880

    Article  CAS  PubMed  Google Scholar 

  42. Sudhir K, Jennings GL, Funder JW, Komesaroff PA (1996) Estrogen enhances basal nitric oxide release in the forearm vasculature in perimenopausal women. Hypertension 28:330–334

    CAS  PubMed  Google Scholar 

  43. Vokes TJ, Weiss NM, Schreiber J, Gaskill MB, Robertson GL (1988) Osmoregulation of thirst and vasopressin during normal menstrual cycle. Am J Physiol 254:R641–R647

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Victoria Elizabeth Claydon PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Claydon, V.E., Younis, N.R. & Hainsworth, R. Phase of the menstrual cycle does not affect orthostatic tolerance in healthy women. Clin Auton Res 16, 98–104 (2006). https://doi.org/10.1007/s10286-006-0330-y

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-006-0330-y

Key words

Navigation