Menopause and its effects on autonomic regulation of blood pressure: Insights and perspectives

Cardiovascular disease (CVD) risk increases substantially around the typical age of menopause (∼51 yrs). While the mechanisms underlying this phenomenon remain to be precisely elucidated, menopause-related autonomic (dys)function likely plays a key role in CVD development in postmenopausal females. Sympathetic activity is known to increase with age and may rise more steeply in older females, resulting in autonomic imbalance and chronic disease. The menopausal loss of estradiol, a major female sex hormone, contributes to changes in autonomic and vascular physiology and is implicated in prominent menopause symptoms such as sleep difficulty and vasomotor symptoms (hot flushes/night sweats). Estrogen replacement can mitigate some of these negative health effects, but hormone therapy may not be able to reverse all menopause-linked autonomic dysfunction. Thus, this review explores the vast and complex web connecting menopause physiology and symptomatology, including how sex-hormone loss and menopause symptoms may impact autonomic function– in particular, through altered sympathetic regulation of blood pressure and impaired vagal tone– as a gateway to adverse cardiovascular health and greater CVD risk.