A Vizag based physician tells all about how post-menopause affects health

This original article research is done in order to highlight the correlation between health issues post-menopause in women. Wishing everyone a very happy international women’s day and here is an article dedicated to all women.

Study of Comparison between Autonomic Dysfunction and Dyslipidemia in Healthy Postmenopausal Women by Dr.Kavyachand Yalamudi-consultant physician-Vizag

Introduction

Menopause is the permanent cessation of menstruation due to the loss of ovarian function which occurs at a mean age of 50 years.The transition from pre-menopause to post-menopause is associated with many features of metabolic syndrome.The hormonal changes associated with menopause, that is, low plasma levels of estrogen and marked increase in follicle‑stimulating hormone and luteinizing hormone exert a significant effect on plasma lipids and lipoproteins leading to increase in low‑density lipoprotein (LDL) cholesterol and decrease in high‑density lipoprotein (HDL) cholesterol, henceforth, leading to increased risk of cardiovascular disease in postmenopausal women. Decreased level of estrogen in postmenopausal women causes alteration in cardiac autonomic system leading to a decrease in vagal tonic modulation of the heart rate in the setting of preserved sympathetic tone and consequently, there is a predominance of sympathetic tone leading to decreased heart rate variability further predisposing to cardiovascular disease in the postmenopausal women. Various research evidence suggests that cardiovascular autonomic balances are related to baroreceptor sensitivity and heart rate variability. It has been observed that in women, oophorectomy suppresses baroreceptor sensitivity and heart rate variability. During the postmenopausal period, due to hormonal imbalance, a myriad of vague symptoms centered around vasomotor symptoms arise such as hot flushes and sweating, and emotional symptoms such as depression and anxiety may occur in symptomatic postmenopausal women.[6] Various studies have shown that in healthy postmenopausal women, dyslipidemia is associated with heart rate variability, as a result of decreased level of estrogen.

Materials and Methods:

This study was carried out on sixty healthy postmenopausal women before the age of 65 years, without any gross systemic disease. The following five autonomic functional tests were performed on the study group: heart rate response to deep breathing, heart rate response to Valsalva maneuver, heart rate response to standing up from supine position, blood pressure response to sustained handgrip, and blood pressure response to standing up from supine position. Fasting lipid profile of the study group was tested.

Inclusion criteria–

All healthy postmenopausal women who have attained menopause by natural means before the age of 65 years.

Exclusion criteria-Post-menopausal women with:

a. Diabetes mellitus

b. Hypertension

c. Obesity

d. Underwent hysterectomy/oophorectomy

e. On hormone replacement therapy

RESULTS

1. Of the total 60 female healthy postmenopausal women included in the study, the largest group was in the age range of 55-60 years(50%).In this study, the females of the age range of 50-55years is 20% and females of the age range of 60-65years are 30%.

2. Autonomic dysfunction wise distribution of cases in a study group of the 60 female healthy postmenopausal women included in the study group,67% had  Autonomic dysfunction and 33% did not have autonomic dysfunction.

3. Dyslipidemia wise distribution of cases in a study group of the 60 female healthy postmenopausal women included in the study,68% had Dyslipidemia and 33% did not have Dyslipidemia.

4. Association between Dyslipidemia and Autonomic dysfunction in a study group of 60 female healthy postmenopausal women,41 patients have dyslipidemia –out of which 40 patients have autonomic dysfunction. Value of P<0.0001 is statistically significant hence proving a strong correlation between dyslipidemia and autonomic dysfunction in healthy postmenopausal women. This distribution is seen in the bar diagram

Sensitivity = 100%               Specificity = 95%                  PPV = 97.56%               NPV = 100Chi-square = 55.61, P<0.0001 Accuracy = 98.33%

5. Comparison of Sr. Cholesterol according to autonomic dysfunction in the study group – In the study, The cut-off value for normal total cholesterol is taken as < 200 mg/dl and on comparison with autonomic dysfunction, p-value <0.0001 which is statistically significant.Hence the correlation of autonomic dysfunction and serum cholesterol level in healthy postmenopausal women is proved

6. Comparison of Sr. Triglyceride according to autonomic dysfunction in study group – In the study, The cut-off value for normal total cholesterol is taken as <150mg/dl and on comparison with autonomic dysfunction, p-value <0.0001 which is statistically significant.Hence the correlation of autonomic dysfunction and serum triglyceride level in healthy postmenopausal women is proved

7. Comparison of Sr. LDL according to autonomic dysfunction in study group – In the study, The cut-off value for normal total cholesterol is taken as <130mg/dl and on comparison with autonomic dysfunction, p-value <0.0001 which is statistically significant.Hence the correlation of autonomic dysfunction and serum LDL level in healthy postmenopausal women is proved)

8. Comparison of Sr. HDL according to autonomic dysfunction in study group – In the study, The cut-off value for normal total cholesterol is taken as <40mg/dl and on comparison with autonomic dysfunction, p-value which is >0.05 which is not statistically significant

Results and Conclusion

In the present study, autonomic dysfunction is found in 67% of healthy postmenopausal women. The sixty female healthy postmenopausal women included in the study, 68% has dyslipidemia. • In our study, there is statistically significant correlation between autonomic dysfunction and dyslipidemia in healthy postmenopausal women • In the healthy postmenopausal women with increased serum cholesterol, serum LDL, and serum TGLs, autonomic dysfunction is present which is statistically significant • There is no statistical significance is found on comparison of serum HDL cholesterol with the autonomic dysfunction in healthy postmenopausal women.