Key result
Menstruation linked to ~9-point higher ACS onset than expected in premenopausal women.
Why the study?
Pre-menopausal women have lower CVD incidence potentially due to atheroprotective sex hormones, prompting exploration of whether ACS occurs more often during menstruation when female sex hormone levels are low.
Does menstruation (days 1-4 of the menstrual cycle) increase the risk of acute coronary syndrome onset compared with the rest of the menstrual cycle in premenopausal women?
Observational (n=22)
No
Does menstruation (days 1-4 of the menstrual cycle) increase the risk of acute coronary syndrome onset compared with the rest of the menstrual cycle in premenopausal women?
This exploratory case series suggests premenopausal women may experience acute coronary syndrome more frequently during menstruation when endogenous estrogen levels are lowest, particularly among smokers, warranting routine documentation of menstrual cycle phase at hospital admission.
Background: The incidence of cardiovascular disease (CVD) among women is lower before the menopause, which may be due to the atheroprotective effects of female sex hormones, including estrogens. This study explored whether women experienced acute coronary syndrome (ACS) more often during menstruation, when the levels of female sex hormones are low. Methods: All premenopausal women referred to the local cardiac rehabilitation program after ACS between August 2010 and September 2018 were contacted by telephone to gather information about their menstrual cycle, contraceptive use and whether ACS occurred during menstruation. Information on cardiovascular risk factors was collected using the clinical electronic health record. Results: Of the 22 women fulfilling the inclusion criteria and having a regular menstrual cycle, 22.7% reported that they were diagnosed with ACS at the time of menstruation. Conclusions: The percentage of women who were menstruating whilst having their cardiovascular event is higher than the percentage expected if the event was unrelated to the menstrual cycle. To gain more insight into the effect of female sex hormones on ACS, it is suggested that information on the menstrual cycle is routinely collected from women admitted to hospital with the condition.
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Bijl et al. (2023) conducted an observational in Acute coronary syndrome in premenopausal women (n=22). Menstruation (days 1-4 of a 28-day menstrual cycle) vs. Other times in the menstrual cycle was evaluated on Occurrence of acute coronary syndrome during menstruation (days 1-4 of the menstrual cycle). Menstruation coincided with acute coronary syndrome onset in 22.7% of premenopausal women, exceeding the 14% expected rate if unrelated to the menstrual cycle.
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