Beyond Reproduction: The Systemic Role of Female Hormones in Cardiometabolic Health
DOI:
https://doi.org/10.64784/210Palabras clave:
Female hormonal regulation, cardiovascular health, metabolic syndrome, menopause, polycystic ovary syndrome, endothelial dysfunction, insulin resistance, cardiometabolic risk, hormone therapy, women’s health, endocrine physiology, hypertension, dyslipidemia, vascular health, reproductive endocrinologyResumen
Hormonal regulation in women plays a fundamental role not only in reproductive physiology, but also in metabolic and cardiovascular homeostasis throughout life. Recent scientific evidence demonstrates that endocrine transitions and hormonal disorders influence endothelial function, lipid metabolism, insulin sensitivity, inflammatory pathways, adipose tissue distribution, and long-term cardiovascular risk. This review aimed to analyze the systemic effects of female hormonal regulation beyond reproduction, emphasizing its relationship with metabolic and cardiovascular health through an interdisciplinary perspective integrating gynecology, endocrinology, cardiology, and public health. A narrative and integrative literature review methodology was employed using peer-reviewed scientific publications indexed in internationally recognized databases, including PubMed, Scopus, ScienceDirect, and Google Scholar. Contemporary evidence related to menopause, polycystic ovary syndrome, hypertensive disorders of pregnancy, hormonal therapies, endothelial dysfunction, insulin resistance, and cardiometabolic disease was analyzed and synthesized. The reviewed evidence demonstrated that menopause is strongly associated with endothelial dysfunction, visceral adiposity, dyslipidemia, insulin resistance, and increased cardiovascular risk. Polycystic ovary syndrome was identified as a multisystemic endocrine-metabolic disorder closely linked to obesity, chronic inflammation, hyperandrogenism, and future risk of type 2 diabetes mellitus. Additionally, pregnancy-related hypertensive disorders such as preeclampsia and gestational hypertension were associated with elevated long-term risk of chronic hypertension, ischemic heart disease, and cerebrovascular disease. Hormonal therapies and contraceptive methods demonstrated both beneficial vascular effects and potential thrombotic risks depending on patient characteristics and individualized cardiovascular profiles.
Referencias
• Barrett, P. M., McCarthy, F. P., Kublickiene, K., Cormican, S., Judge, C., Evans, M., Kublickas, M., Perry, I. J., Stenvinkel, P., & Khashan, A. S. (2020). Adverse pregnancy outcomes and long-term maternal kidney disease: A systematic review and meta-analysis. JAMA Network Open, 3(2), e1920964. https://doi.org/10.1001/jamanetworkopen.2019.20964
• Cignarella, A., Bolego, C., & Pinna, C. (2024). Sex and sex steroids as determinants of cardiovascular risk. Pharmacological Research, 201, 107092. https://doi.org/10.1016/j.phrs.2024.107092
• Cooney, L. G., Dokras, A., & Sammel, M. D. (2021). Cardiometabolic risk in polycystic ovary syndrome. Current Opinion in Endocrinology, Diabetes and Obesity, 28(6), 591–597. https://doi.org/10.1097/MED.0000000000000674
• D’Costa, Z., & Manson, J. E. (2025). Cardiovascular risk associated with menopause and menopausal hormone therapy. Current Atherosclerosis Reports, 27, 1–12.
• Douxfils, J., Raskin, L., Didembourg, M., Donis, N., Dogné, J. M., Morimont, L., & Beaudart, C. (2024). Are natural estrogens used in contraception at lower risk of venous thromboembolism than synthetic estrogens? A systematic review and meta-analysis. Frontiers in Endocrinology, 15, 1398871. https://doi.org/10.3389/fendo.2024.1398871
• El Khoudary, S. R., Aggarwal, B., Beckie, T. M., Hodis, H. N., Johnson, A. E., Langer, R. D., Limacher, M. C., Manson, J. E., Stefanick, M. L., Allison, M. A., & American Heart Association. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention. Circulation, 142(25), e506–e532. https://doi.org/10.1161/CIR.0000000000000912
• Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., McMurtry Baird, S., Magee, L. A., Rana, S., Vermunt, J. V., & August, P. (2022). Hypertension in pregnancy: Diagnosis, blood pressure goals, and pharmacotherapy. Hypertension, 79(2), e21–e41. https://doi.org/10.1161/HYP.0000000000000208
• González-Escudero, E., Gómez-Viquez, N. L., & García-Rubí, E. (2018). Asociación del estado hormonal con el riesgo cardiovascular en mujeres mexicanas. Ginecología y Obstetricia de México, 86(12), 791–798.
• Hidalgo, L. A., Chedraui, P. A., Morocho, N., Alvarado, M., & Chavez, D. (2006). The metabolic syndrome among postmenopausal women in Ecuador. Gynecological Endocrinology, 22(8), 447–454. https://doi.org/10.1080/09513590600890263
• Khialani, D., Rosendaal, F. R., & van Hylckama Vlieg, A. (2020). Hormonal contraceptives and the risk of venous thrombosis. Seminars in Thrombosis and Hemostasis, 46(8), 865–871. https://doi.org/10.1055/s-0040-1715450
• Ko, S. H., & Kim, H. S. (2021). Energy metabolism changes and dysregulated lipid metabolism in postmenopausal women. Nutrients, 13(12), 4556. https://doi.org/10.3390/nu13124556
• Manson, J. E., Aragaki, A. K., Bassuk, S. S., Chlebowski, R. T., Anderson, G. L., Rossouw, J. E., & WHI Investigators. (2024). The Women’s Health Initiative randomized trials and clinical practice: A review. JAMA, 331(20), 1748–1760. https://doi.org/10.1001/jama.2024.6542
• Palmisano, B. T., Zhu, L., Stafford, J. M., & Elam, M. B. (2017). Role of estrogens in the regulation of liver lipid metabolism. Advances in Experimental Medicine and Biology, 1043, 227–256. https://doi.org/10.1007/978-3-319-70178-3_12
• Pililis, S., Rizzo, M., Goulis, D. G., & Anagnostis, P. (2024). The cardiometabolic risk in women with polycystic ovarian syndrome. Metabolites, 14(9), 500. https://doi.org/10.3390/metabo14090500
• Rebolledo-Cobos, R. C., Hernández-Pérez, J. M., & Carbonell-Baeza, A. (2021). Correlation between physical activity and cardiovascular risk factors in postmenopausal women from Colombia. International Journal of Environmental Research and Public Health, 18(3), 1080. https://doi.org/10.3390/ijerph18031080
• Shufelt, C. L., Manson, J. E., & Taylor, H. S. (2021). Menopausal hormone therapy and cardiovascular disease. Journal of the American College of Cardiology, 77(10), 1369–1383. https://doi.org/10.1016/j.jacc.2021.01.020
• Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., & International PCOS Network. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction, 38(9), 1655–1679. https://doi.org/10.1093/humrep/dead156
• The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028
• Williams, J. S., Dunford, E. C., MacDonald, M. J., & Paquette, M. (2021). Influence of hormonal contraceptives on peripheral vascular function and structure in premenopausal females: A review. *American Journal of Physiology-Heart and Circulatory Physiology, 320*(1), H77–H89. https://doi.org/10.1152/ajpheart.00614.2020
• Wu, P., Green, M., & Myers, J. E. (2023). Hypertensive disorders of pregnancy. BMJ, 381, e071653. https://doi.org/10.1136/bmj-2022-071653
