Menstrual cycle effects on sympathetic neural responses to upright tilt
Open accessAbstract
Young women are more susceptible to orthostatic intolerance than men, though the sex‐specific pathophysiology remains unknown. As blood pressure (BP) is regulated through the baroreflex mechanism, we tested the hypothesis that baroreflex control of muscle sympathetic nerve activity (MSNA) during orthostasis is impaired in women and can be affected by the menstrual cycle. MSNA and haemodynamics were measured supine and during a graded upright tilt (30 deg for 6 min, 60 deg for 45 min or till presyncope) in 11 young men and 11 women during the early follicular (EFP) and mid‐luteal phase (MLP) of the menstrual cycle. Sympathetic baroreflex sensitivity was quantified using the slope of the linear correlation between total activity and diastolic BP during spontaneous breathing. Baroreflex function was further assessed during a Valsalva manoeuvre (VM). Although MSNA burst frequency responses during tilting were similar between sexes and menstrual phases, increases in total activity were lower in women during EFP than MLP ( P = 0.030), while total peripheral resistance and plasma noradrenaline were not similarly lower; upright total activity tended to be lower in women during EFP than men ( P = 0.102). Sympathetic baroreflex sensitivity did not differ between sexes ( P = 0.676) supine (−281 ± 46 ( s.e.m. ) units beat −1 mmHg −1 in men vs −252 ± 52 in EFP and −272 ± 40 in MLP in women), at 30 deg tilt (−648 ± 129 vs −611 ± 79 and −487 ± 94), and at 60 deg tilt (−792 ± 135 vs −831 ± 92 and −814 ± 142); this sensitivity was not affected by the menstrual cycle ( P = 0.747). Similar sympathetic baroreflex sensitivity between sexes and phases was also observed during the VM. Cardiovagal baroreflex sensitivity assessed during decreasing BP (i.e. early phase II of the VM) was comparable between sexes, but it was greater in men than women during increasing BP (i.e. phase IV); the menstrual cycle had no influences on cardiovagal baroreflex sensitivity. We conclude that the menstrual cycle affects sympathetic neural responses but not sympathetic baroreflex sensitivity during orthostasis, though upright vasomotor sympathetic activity is not clearly different between men and women. Not only sympathetic but also cardiovagal baroreflex sensitivity is similar between sexes and menstrual phases during a hypotensive stimulus. However, cardiovagal baroreflex‐mediated bradycardia during a hypertensive stimulus is different between sexes but not affected by the menstrual cycle. Thus, other factors rather than sympathetic baroreflex control mechanisms contribute to sex differences in orthostatic tolerance in young humans.
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There is a tight relationship between stroke volume and HR in men, healthy women, and women with POTS.
“Figure 2B shows the tight relationship between stroke volume and HR in men, healthy women, and women with POTS (4,12).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [12]
The ‘Responses during upright tilt’ section reports that heart rate increased while stroke volume decreased in healthy men and women. It does not establish a tight stroke-volume–heart-rate relationship, and the ‘Study limitations’ section says all subjects were healthy, so the claim about women with POTS is not supported by this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measuredHealthy women have smaller stroke volumes and higher HRs compared with healthy men, whereas women with POTS have both an exaggerated fall in stroke volume and an apparent compensatory rise in HR.
“healthy women have smaller stroke volumes and higher HRs compared with healthy men, whereas women with POTS have both an exaggerated fall in stroke volume and an apparent compensatory rise in HR.”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [12]
The Responses during upright tilt section reports lower stroke volumes in healthy women than men, while heart rates only tended to be higher. The Study limitations section says all participants were healthy; the paper does not support the claim about an exaggerated stroke-volume fall or compensatory heart-rate rise in women with POTS. Page numbers were not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe order of testing was randomized or counterbalanced for each study.
“The order of testing was randomized5,8,12 or counterbalanced4,9 for each study.”
From Ovarian Cycle and Sympathoexcitation in Premenopausal Women (2013) · cites this paper as [9]
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Cardiac origins of the postural orthostatic tachycardia syndrome
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Self-citationOvarian Cycle and Sympathoexcitation in Premenopausal Women
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“Subjects Subjects were retrospectively analyzed from 5 previous studies.(4,5,8,9,12) Original inclusion and exclusion criteria were consistent across laboratories (see original articles), and all studies were approved by the corresponding institutional review boards.”
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- Authors
- Fu, Q., Okazaki, K., Shibata, S., Shook, R. P., VanGunday, T. B., Galbreath, M. M., Reelick, M. F., & Levine, B. D.
- Affiliations
- Texas Health Dallas (US)
- Corresponding author
- Fu, Qi
- Venue
- The Journal of Physiology
- Publisher
- Wiley
- Published
- 2009-04-29
- Volume
- 587
- Issue
- 9
- Pages
- 2019-2031
- ISSN
- 0022-3751 (ISSN-L)
- 1469-7793
- PMC
- PMC2689340
- OpenAlex
- W2108684279
- Semantic Scholar
- 91c3033422f1eaa0b197c89342fa19ae3958c95b
- Cited by
- 144
- References
- 52
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 9 · 2023: 3 · 2022: 7 · 2021: 12 · 2020: 12 · 2019: 8 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 12 · 2014: 4 · 2013: 9 · 2012: 13
- FWCI
- 13.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Physiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (K23HL075283)
- National Center for Research Resources (RR 00633, M01RR000633)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- menstrual cycle, orthostatic intolerance, muscle sympathetic nerve activity, baroreflex sensitivity, upright tilt, sex differences, Valsalva maneuver, hemodynamics, plasma norepinephrine, systemic vascular resistance, presyncope, young women, autonomic nervous system, blood pressure regulation, luteal phase, follicular phase, orthostatic hypotension
- MeSH terms
- Adult, Blood Pressure, Female, Humans, Menstrual Cycle, Posture, Sympathetic Nervous System, Baroreflex, Tilt-Table Test
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