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Oral contraceptive use and menstrual cycle influence acute cerebrovascular response to standing

  • Author Footnotes
    1 Indicates shared first authorship.
    C. Barranca
    Footnotes
    1 Indicates shared first authorship.
    Affiliations
    School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada
    Search for articles by this author
  • Author Footnotes
    1 Indicates shared first authorship.
    T.J. Pereira
    Footnotes
    1 Indicates shared first authorship.
    Affiliations
    School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada
    Search for articles by this author
  • H. Edgell
    Correspondence
    Corresponding author at: 355 Norman Bethune College, Toronto, Ontario, Canada.
    Affiliations
    School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada

    Muscle Health Research Centre, York University, Toronto, ON, Canada
    Search for articles by this author
  • Author Footnotes
    1 Indicates shared first authorship.
Published:December 07, 2022DOI:https://doi.org/10.1016/j.autneu.2022.103054

      Abstract

      Purpose

      To determine if the menstrual cycle and oral contraceptives (OC) influence responses to acute orthostatic stress and if these factors are clinically relevant to the diagnosis of initial orthostatic hypotension (iOH).

      Methods

      Young, healthy women were recruited, including OC users (n = 12) and non-users (NOC; n = 9). Women were tested during the low hormone (LH; placebo pills; days 2–5 natural cycle) and high hormone (HH; active dose; days 18–24 natural cycle) menstrual phases. Changes in mean arterial pressure, cardiac output, heart rate, the 30:15 heart rate ratio and cerebrovascular resistance indices within 30 s of standing were examined.

      Results

      There were no effects of OC or menstrual cycle on hemodynamic responses during standing (all p>0.05). In the LH phase, OC users had a greater fall in mean middle cerebral artery blood velocity (MCAV) compared to NOC (p<0.05). However, this was reversed in the HH phase, where OC users had a reduced fall in mean MCAV (p<0.05). Interestingly, 8 women (OC and NOC) had drops in systolic/diastolic blood pressure meeting the criteria for iOH, and 7 of those 8 women displayed this drop in a single phase of the menstrual cycle.

      Conclusion

      Our results indicate that chronic versus acute OC use (i.e., long-term use observed via LH phase versus short-term use observed via HH phase) have opposing effects on cerebral blood velocity during standing. Further, our results highlight that multiple assessments across the cycle may be necessary to accurately diagnose iOH, as most women met the diagnostic criteria during a single menstrual phase.

      Keywords

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