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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Article info
Publication history
Published online: December 07, 2022
Accepted:
December 2,
2022
Received in revised form:
October 25,
2022
Received:
June 20,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
