Key result
HRT reduces pulsatility index by ~0.05 compared to post-menopausal controls.
Why the study?
Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function, prompting a synthesis to address knowledge gaps.
Does changing ovarian sex steroid hormone levels (e.g., via hormone replacement therapy) improve cerebrovascular function in healthy adult women?
Systematic Review (n=45)
Does changing ovarian sex steroid hormone levels (e.g., via hormone replacement therapy) improve cerebrovascular function in healthy adult women?
Effect estimate: MD -0.05 (95% CI (-0.10, -0.01))
Absolute Event Rate: 1.1% vs 1.15%
p-value: p=0.01
Hormone replacement therapy improves the pulsatility index in post-menopausal women, suggesting a potential beneficial effect on cerebrovascular resistance, though evidence for other hormonal phases remains insufficient.
HRT may lower post-menopausal cerebrovascular resistance; leaves open effects on other function measures and clinical outcomes.
Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function. To synthesise and identify knowledge gaps, a systematic review and meta-analysis was conducted to assess how ovarian sex steroid hormone changes across the lifespan affect cerebrovascular function in women. Three databases (EMBASE, MEDLINE and Web of Science) were systematically searched for studies on adult cerebrovascular function and ovarian sex steroid hormones. Forty-five studies met pre-defined inclusion criteria. Studied hormone groups included hormone replacement therapy (HRT; n = 17), pregnancy ( n = 12), menstrual cycle ( n = 7), menopause ( n = 5), oral contraception ( n = 2), and ovarian hyperstimulation ( n = 2). Outcome measures included pulsatility index (PI), cerebral blood flow/velocity (CBF), resistance index (RI), cerebral autoregulation, and cerebrovascular reactivity. Meta-analysis was carried out on HRT studies. PI significantly decreased [−0.05, 95% CI: (−0.10, −0.01); p = 0.01] in post-menopausal women undergoing HRT compared to post-menopausal women who were not, though there was considerable heterogeneity ( I 2 = 96.8%). No effects of HRT were seen in CBF ( p = 0.24) or RI ( p = 0.77). This review indicates that HRT improves PI in post-menopausal women. However, there remains insufficient evidence to determine how changing ovarian sex steroid hormone levels affects cerebrovascular function in women during other hormonal phases (e.g., pregnancy, oral contraception).
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Skinner et al. (2021) conducted a systematic review in Cerebrovascular function (n=45). Hormone replacement therapy (HRT) vs. Post-menopausal women not using HRT was evaluated on Pulsatility Index (PI) (MD -0.05, 95% CI (-0.10, -0.01), p=0.01). Hormone replacement therapy (HRT) significantly reduced pulsatility index (PI) by 0.05 compared to post-menopausal women who were not receiving HRT, with a p-value of 0.01.
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