The role of endothelial dysfunction in the development of clinical manifestations of climacteric syndrome in premenopausal women

Authors

DOI:

https://doi.org/10.18370/2309-4117.2017.37.58-64

Keywords:

climacteric syndrome, endothelial dysfunction, treatment, L-arginine, Valargin

Abstract

The aim of the study was to determine the state of vascular microcirculation in women with clinical manifestations of climacteric syndrome (CS) and to study the efficacy of using oral forms of L-arginine in its treatment.

Materials and methods. 62 patients aged 40–50 years were examined: 30 patients with clinical manifestations of CS and 32 patients without signs of CS. The severity of CS was assessed using the menopausal rating scale (MRS). The study of hormonal homeostasis consisted in determining the levels of estradiol, FSH, LH, TSH and prolactin. The evaluation of the state of the vessels of the microcirculatory bed was carried out with the help of a test with «reactive hyperemia» and laser doppler fluorometry (LDF) with occlusion test. All patients with signs of endothelial dysfunction were prescribed an oral form of L-arginine –Valargin in a dose of 1 tablet per day during 1 month, after which a repeated examination of the state of the vascular endothelium was carried out.

Results. When comparing the hormonal status, a decrease in the average level of estradiol and an increase in the average FSH indices in the main group were found in comparison with the control group. Based on the results of the test with «reactive hyperemia», a significantly higher level of pathological response to occlusion was revealed in comparison with the control group.

In addition, a significant direct correlation was found between the level of estrogens and the index reflecting the activity of endotheliocytes. 1 month after Valargin application the degree of CS on the MRS scale decreased from 14.7 ± 1.5 to 8.6 ± 1.3 points.

Conclusion. In patients with clinical manifestations of CS endothelial dysfunction is more reliably detected. This requires additional testing and the use of preventive measures aimed at preventing cardiovascular pathology. The efficacy of oral forms of L-arginine in adequately high doses, in particular Valargin, in the treatment of endothelial dysfunction and the positive effect of this therapy in patients with CS is proved.

Author Biographies

О. В. Занько, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Postgraduate student at the Endocrine Gynecology Department

Л. В. Болгова, Medical Centre «Verum»

Doctor of functional diagnostics

Н. В. Коваленко, Kiev City Hospital No. 9

Doctor at gynecological department

Т. Ф. Татарчук, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, сhief of the Endocrine Gynecology Department

Н. В. Яроцька, State Institution “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Junior researcher at the Endocrine Gynecology Department

References

  1. “National consensus on the management of patients in menopause.” Reproductive endocrinology 1.27 (2016): 8–25.
  2. “Maintaining the quality of life and social activity of women in the postreproductive period.” Resolution of the Expert council on the implementation of the social-information project. Reproductive endocrinology 4.36 (2017): 9–12.
  3. Babushkina, A.V. “Efficacy of oral administration of L-arginine in patients with endothelial dysfunction.” Ukrainian medical journal 1.75 (2010): 24–30.
  4. Gromova, O.A., Torshin, I.Y., Limanova, O.A., Nikonov, A.A. “Pathophysiology of vegetative-vascular paroxysms (flushes) during menopause in women and mechanisms of b-alanine exposure. New clinic pharmacological concept.” Gynecology 2.12 (2010): 29–36.
  5. Krupatkin, A.I., Sidorov, V.V. Laser Doppler flowmetry of blood microcirculation. Moscow. Medicine (2005): 254 p.
  6. Mitchenko, O.I., Mamedov, M.N., Kolesnik, T.V., et al. “Features of the prevalence of cardiovascular risk factors in women, depending on the presence of menopause.” Ukrainian cardiology magazine 4 (2015): 96–102.
  7. Khudyakova, N.V., Shishkin, N.A., Pchelin, I.Y., Ivanov, N.V. “Mechanisms of the effect of estrogens on the cardiovascular system.” Bulletin of St. Petersburg University Issue 1, Series 11 (2015): 13–24.
  8. Shah, C.T., Palaskas, N., Ahmed, A. “An Update on Gender Disparities in Coronary Heart Disease Care.” Curr Atheroscler Rep 18.5 (2016): 28.
  9. Baber, R.J., Panay, N., Fenton, A., The IMS Writing Group. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 19.2 (2016): 109–50.
  10. Bonetti, P.O., Lerman, L.O., Lerman, A. ”Endothelial dysfunction: a marker of atherosclerotic risk.” Arterioscler Thromb Vasc Biol 23 (2003): 168–75.
  11. Celermajer, D.S., Sorensen, К.Е., Gooch, V.М., et al. ”Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis.” Lancet 340.8828 (1992): 1111–5.
  12. El Khoudary, S.R. , Chen, X., Brooks, M. “Cardioprotective Association Between High Density Lipoprotein Cholesterol and Endothelial Function Attenuated at Lower Levels of Estradiol in Women at Midlife. The SWAN Heart Study.” Circulation 135 (2017): AP118.
  13. Escalante, C.G., Mora, S.Q., Bolaños, L.N. ”Hormone replacement therapy reduces lipid oxidation directly at the arterial wall: A possible link to estrogens’ cardioprotective effect through atherosclerosis prevention.” J Midlife Health 8.1 (2017):11–6.
  14. Moreau, K.L., Hildreth, K.L., Meditz, A.L., et al. ”Endothelial Function Is Impaired across the Stages of the Menopause Transition in Healthy Women.” J Clin Endocrinol Metab 97.12 (2012): 4692–700.
  15. Melik, Z., Zaletel, P., Virtic, T., Cankar, K. ”L-arginine as dietary supplement for improving microvascular function.” Clinical Hemorheology and Microcirculation Preprint (2016): 1–13.
  16. Strehlow, K., Werner, N., Berweiler, J., et al. “Estrogen increases bone marrow-derived endothelial progenitor cell production and diminishes neointima formation.“ Circulation 107 (2003): 3059–65.
  17. Thurston, R.C., Sutton-Tyrrell, K., Everson-Rose, S.A. “Hot flashes and subclinical cardiovascular disease: Findings from the Study of Women’s Health Across the Nation Heart Study.” Circulation 118.12 (2008): 1234–40.

Downloads

Published

2017-10-30

How to Cite

Занько, О. В., Болгова, Л. В., Коваленко, Н. В., Татарчук, Т. Ф., & Яроцька, Н. В. (2017). The role of endothelial dysfunction in the development of clinical manifestations of climacteric syndrome in premenopausal women. REPRODUCTIVE ENDOCRINOLOGY, (37), 58–64. https://doi.org/10.18370/2309-4117.2017.37.58-64

Issue

No. 37 (2017)

Section

Management of menopause

License

Copyright (c) 2017 О. В. Занько, Л. В. Болгова, Н. В. Коваленко, Т. Ф. Татарчук, Н. В. Яроцька

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.