TMSS Medical College Journal

Background: Variation in autonomic nervous system functions is seen in postmenopausal women. Autonomic nervous system control is a major determinant in various cardiovascular diseases. In premenopausal and postmenopausal women the risk of cardiovascular diseases gradually increases and alteration in autonomic nervous functions. Objectives: To assess the cardiovascular response to cold pressor test in postmenopausal women. Materials and Methods: This cross sectional analytical study was conducted from July 2019 to June 2020 in the Department of Physiology, Rangpur Medical College, Rangpur. After obtaining permission, a total 120 subjects who meet the inclusion and exclusion criteria were enrolled in the study after briefing them objectives of the study. Among them 40 were reproductive women (Group-A), 40 were premenopausal women (Group-B) and 40 were postmenopausal women (Group-C). The blood pressure responses could be used as a tool for cold pressor test which is indicator of sympathetic activation and thus of cardiac status. The subjects were selected from different areas of Rangpur district. For statistical analysis one-way ANOVA (post-Hoc) test was performed by computer based software SPSS-23.0 version for windows. Results: Resting systolic blood pressure and resting diastolic pressure were significantly higher in group C (p<0.001). Systolic blood pressure in response to cold pressor test was significantly higher in group C (p< 0.001). Diastolic blood pressure in response to cold pressor test was significantly higher in group C (p< 0.001). Conclusion: The study concluded that the changes in systolic and diastolic blood pressure after cold pressor test increased in Postmenopausal women and thus indicating increased sympathetic activity.

The normal reproductive years of the female are characterized by monthly rhythmical changes in the rates of secretion of the female hormones and corresponding physical changes in the ovaries and other sexual organs. The age of reproductive period is about 13 to 46 years'. Menopause is defined as the permanent cessation of menses for 1 year and physiologically correlated with the decline in estrogen secretion resulting from the loss of follicular function. It is a normal aging phenomenon, involves gradual transition of woman from reproductive to non-reproductive phase of life’ The menopause usually occurs between the ages of 45 and 52 years. Joshi PK et al studied upon 60 premenopausal women of age 25 to 45 years and 60 postmenopausal women of age 46 to 60 years. They demonstrated systolic and diastolic pressure change in cold pressor test in postmenopausal women was significantly higher compared to premenopausal women.* Postmenopausal women have higher risk of cardiovascular disease, anxiety and depression. Hence health management is important for postmenopausal women.® Hormonal changes are associated with menopause. Changes in the hormone levels is responsible for autonomic system variations seen in pre- and post-menopausal women.” According to the survey conducted by the Korean Society of Menopause, of 707 women who underwent natural menopause, 89% answered that experienced  menopausal symptoms or have symptoms currently.’ The effect of menopause on cardiovascular disease (CVD) in women has been studied by kannel et al. It has been found that autonomic dysfunction is an important factor for the evaluation of risk of cardiovascular events in CVD patients.” Data from the Framingham study shows a two-fold age-adjusted increase in risk for coronary heart diseases in post- menopausal compared with pre-menopausal women.'® The high incidence of ischemic heart disease after menopause suggested a close association between ovarian hormone levels and cardiovascular system.'' In women, both pre and postmenopausal hormonal changes contribute to modifications of the autonomic control of the heart." Vongpatanasin W. has studied the increase of sympathetic tone and blood pressure in menopause. Lee et al. have found a relationship between postmenopausal symptoms and changes in cardiovascular autonomic functions in women. For example, hot flashes and sleep disorders are strongly associated with increased sympathetic tone.”