Menopause – ABC CARDIOL

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Review Article

The Silent Shift of Menopause: The Intersection between Salivary Glands, Oral Cavity Status, and Cardiovascular Health

Silvia Vanessa Lourenço et al. Giovanna Piacenza Florezi Cibele Pelissari Flavio Carneiro Hojaij … José Pinhata Otoch José Antonio Franchini Ramires

Abstract

Background:

Menopause represents a major biological transition in a woman’s life, defined by the cessation of ovarian function and a marked decline in estrogen levels. Although its systemic consequences, including osteoporosis and increased cardiovascular risk, are well established, its impact on oral health remains insufficiently recognized by both medical and dental professionals.

Objective:

To examine the influence of menopause on women’s oral health, emphasizing key pathophysiological mechanisms, clinical manifestations, and interdisciplinary strategies for prevention and management.

Methods:

A narrative review was conducted using articles retrieved from the PubMed database published between 2000 and 2025. The following keywords were used: “menopause,” “oral health,” “hormonal changes,” “cardiovascular disease,” “xerostomia,” “salivary glands,” “periodontitis,” and “postmenopausal women.”

Results:

Hormonal changes during menopause are associated with a range of oral manifestations, including xerostomia, burning mouth syndrome, periodontal disease, and taste alterations. Estrogen deficiency appears to contribute to reduced salivary flow, mucosal atrophy, and an increased inflammatory response in periodontal tissues. Emerging evidence also suggests an association between oral health during menopause and cardiovascular disease, among other systemic conditions. However, important knowledge gaps persist regarding clinical management and interdisciplinary care for menopausal women.

Conclusion:

Oral health during menopause reflects a complex interplay of hormonal, systemic, and behavioral factors. Because of increasing life expectancy worldwide, oral health education and research programs should prioritize this topic. Strengthening awareness and fostering multidisciplinary collaboration are essential to improving health outcomes in midlife women.

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Editorial

Herbal Therapy in Post-Menopause

Rosana dos Santos e Silva Martin et al. Luis Cuadrado Martin

Traditional Chinese medicine and its modern products have shown potential in treating atherosclerosis. The possible mechanisms include regulation of blood lipids, anti-lipid peroxidation, anti-polymerization, anticoagulation, and pro-fibrinolysis, inhibition of smooth muscle cell proliferation, and protection of vascular endothelial function. Ginseng derivatives are being used in menopause treatment and andropause treatment.

The paper “Chronic Treatment with Panax ginseng and Angelica keiskei Decreases Blood Pressure and Improves Endothelial Function in Ovariectomized Rats”, published in this journal, obtained improvement in blood pressure in ovariectomized rats treated by Panax ginseng and Angelica keiskei This effect was associated with amelioration of endothelial function.

[…]

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Original Article

Chronic Treatment with Panax ginseng and Angelica keiskei Decreases Blood Pressure and Improves Endothelial Function in Ovariectomized Rats

Nayara Formenton da Silva et al. Luis Henrique Oliveira de Moraes Camila Pereira Sabadini Rita Cristina Cotta Alcântara … Patrícia Corrêa Dias Gerson Jhonatan Rodrigues

Abstract

Background

Menopause is a natural physiological process that can impact various systems and organs, often leading to increased blood pressure. The combination of Panax ginseng and Angelica keiskei (Pg + Ak) is a formulation known to improve vascular function.

Objective

This study aimed to evaluate the in vivo effects of these combined plants on cardiovascular parameters in female rats experiencing menopause induced by ovariectomy.

Methods

Twenty-four 70-day-old female Wistar rats were randomly assigned to three groups: sham-operated (Sham), ovariectomized (OVX), and ovariectomized with Pg + Ak treatment (OVX + Pg + Ak). The rats in the Pg + Ak treatment group received an intraperitoneal injection of 100 mg/kg/day for two weeks. Blood pressure was measured using tail plethysmography, and endothelial function was assessed through vascular reactivity tests.

Results

At the end of the treatment, mean blood pressure in the SH group was lower than in the control group (OVX), and the Pg + Ak treatment improved the endothelial dysfunction caused by ovariectomy. This was evident in the restored endothelium-dependent vasodilation in the aortic rings of the OVX rats treated with Pg + Ak compared to untreated OVX rats.

Conclusions

Our findings suggest that the Pg + Ak combination effectively reduces blood pressure and reverses endothelial dysfunction in ovariectomized rats.

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Editorial

Overcoming Women’s Lifelong Hormonal Rollercoaster: A Turning Point for Cardiovascular Prevention

M. Julia Machline-Carrion

Although cardiovascular diseases (CVD), especially coronary artery disease and stroke, are the leading cause of death and disability in Brazil, both in women and men,^, addressing cardiovascular (CV) prevention implies a comprehensive approach to the inherent differences related to sex. In this sense, understanding, for instance, the role of hypertension, a major risk factor for coronary artery disease and stroke in Brazilian women, in the context of this population’s specificities is key.

Hypertensive disorders, including pregnancy-induced hypertension (occurring in 6-7% of pregnancies) and preeclampsia/eclampsia (occurring in up to 10% of pregnancies), are important CV risk factors^, that should be accounted for when assessing women’s CV risk.

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Review Article

Crossroads between Estrogen Loss, Obesity, and Heart Failure with Preserved Ejection Fraction

Allan Kardec Nogueira de Alencar et al. Hao Wang Gláucia Maria Moraes de Oliveira Xuming Sun … Gisele Zapata-Sudo Leanne Groban

Abstract

The prevalence of obesity and heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women. Although obesity is a risk factor for left ventricular diastolic dysfunction (LVDD), the mechanisms that link the cessation of ovarian hormone production, and particularly estrogens, to the development of obesity, LVDD, and HFpEF in aging females are unclear. Clinical, and epidemiologic studies show that postmenopausal women with abdominal obesity (defined by waist circumference) are at greater risk for developing HFpEF than men or women without abdominal obesity. The study presents a review of clinical data that support a mechanistic link between estrogen loss plus obesity and left ventricular remodeling with LVDD. It also seeks to discuss potential cell and molecular mechanisms for estrogen-mediated protection against adverse adipocyte cell types, tissue depots, function, and metabolism that may contribute to LVDD and HFpEF.

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Original Article

DD Genotype and Atherosclerosis in Overweight Menopausal Women

José Ramón Lanz-Luces et al. Fernando Alves Costa Luis Fernando Escobar Guzman Antonio Ricardo de Toledo Gagliardi … José Antonio Lanz-Luces José Daniel Lanz-Souquett Leandro Menezes Alves da Costa

Abstract

Background

Sex-specific pathology of coronary artery disease (CAD) has not been recognized. Women with obstructive or nonobstructive CAD associated with traditional risk factors have similar events; no studies have explored both populations in association with genetic markers.

Objective

To evaluate the DD genotype in overweight menopausal women and its association with CAD and traditional risk factors.

Method

This cross-sectional study included 356 menopausal women who underwent coronary angiography as CAD assessment. The patients’ DNA was extracted and polymorphisms were detected with a single polymerase chain reaction assay. Two groups were formed based on luminal lesions (normal [n = 134] or pathological [n = 222]) with a cutoff value > 30%, considering overweight and age. The chi-square test, Student’s t-test, and multivariate logistic regression were performed as appropriate (p < 0.05) using the following variables: overweight, diabetes, hypertension, dyslipidemia, smoking status, sedentary lifestyle, and a family history of CAD.

Results

The mean age of the sample was 63 8 years, and the mean BMI was 28 5 kg/m². The DD genotype was slightly more prevalent in the pathological group (30.2% vs. 21.6%, p = 0.079), but this significantly changed when BMI > 25 was considered (33% vs. 18%, p = 0.012). In multivariate analysis with two threshold levels (> 50 and > 60 years), diabetes was significantly associated with CAD in both models (p = 0.021 vs. 0.009) but the genotype was only associated with younger age (p = 0.034).

Conclusion

These data support an association between atherosclerosis and the renin–angiotensin system in overweight menopausal women that is dependent on the age at which the ischemic event occurs.

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Editorial

The Impact Of Exercise On Inflammation, Oxidative Stress And Remodelling In Cardiac Muscle

Fernando Mendes et al. Diana Martins

Aging is naturally connected with a decline, in some if not all physiological functions, namely loss of bone mass density (BMD) and strength associated with the loss of muscle mass.^–

This muscle loss happens mainly due to an imbalance between muscle protein synthesis and muscle protein breakdown. The increase of catabolic factors such as oxidative stress and inflammation contribute significantly to the above process. Nevertheless, the weakening of strength and muscle loss is not linear, occurring differently in all sexes. Other factors such as a decline in hormonal levels due to menopause phenomenon are thought to be also implicated in this process. In fact, some authors proposed that, in females, an accelerated loss of muscle mass and strength arises at an earlier age than in males, around the time of menopause. A good body of evidence supports that the decline in muscle mass may be in line with the estrogen decrease that typifies menopausal years.

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Original Article

Effects of Physical Training on the Myocardium of Oxariectomized LDLr Knockout Mice: MMP 2/9, Collagen I/III, Inflammation and Oxidative Stress

Ledimar Brianezi et al. Elisabete Ornelas Flávia de Sousa Gehrke Fernando Luiz Affonso Fonseca … Beatriz da Costa Aguiar Alves Luiz Vinicius de Alcantara Sousa Jessica Souza Laura Beatriz Mesiano Maifrino

Abstract

Background:

The emergence of coronary heart disease is increased with menopause, physical inactivity and with dyslipidemia. Physical training is known to promote the improvement of cardiovascular functions.

Objective:

To investigate the effects of aerobic physical training on the left ventricle in ovariectomized LDL knockout mice.

Methods:

Thirty animals were divided into 6 groups (n = 5): Sedentary non-ovariectomized control; Sedentary ovariectomized control; Trained ovariectomized control; Sedentary non-ovariectomized LDL-knockout, sedentary ovariectomized LDL-knockout and trained ovariectomized LDL-knockout. We analyzed the average parameters of apparent density of collagen fibers types I and III, and metalloproteinase type 2 and type 9, were considered significant p < 0.05.

Results:

The results showed that the proposed exercise protocol altered the volume of type I collagen fibers, altered collagen remodeling parameters (MMP-2), and also reduced the 8-hydroxy-2’-deoxyguanosine (8OHdG) oxidative stress parameter.

Conclusion:

Moderate intensity aerobic training acts on collagen fiber volume, on collagen remodeling with the reduction of oxidative stress in the left ventricles of ovariectomized LDL-knockout mice.

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Original Article

Evaluation of Collagen Fibers, MMP2, MMP9, 8-OHdG and Apoptosis in the Aorta of Ovariectomized LDL Knockout Mice Submitted to Aerobic Exercise

Laura Beatriz M. Maifrino et al. Nathalia E. A. de Lima Mara R. Marques Clever G. Cardoso … Lidiane B. de Souza Tabata de Carvalho Tomé Hananiah Tardivo Quintana Flavia de Oliveira Beatriz da Costa Aguiar Alves Reis Fernando Luiz Affonso Fonseca

Abstract

Background:

In menopause, there is greater cellular exposure to oxidative stress, related to the decreased antioxidative effects of estrogen. These metabolic changes favor the progression of cardiovascular diseases, such as atherosclerosis. Abnormal function of the aorta – the most important artery – is associated with many cardiovascular diseases. Collagen, especially types I and III, is one of the most important aortic wall components and it can be affected by many factors, including menopause. The 8-OHdG is one of the main markers of DNA oxidative damage induced by reactive oxygen species (ROS).

Objective:

We aimed to investigate effects of moderate aerobic training on the ascending aorta of LDL-knockout (LDL-KO) and ovariectomized female mice.

Methods:

A total of 15 C57BL/6 mice and 15 LDL-KO mice were divided into experimental groups. The thickness and volume density of types I and III collagen fibers were performed by morphoquantitative analysis, whereas the MMP-2 and MMP-9 and 8-OHdG were detected by immunohistochemistry and apoptosis was detected by the TUNEL assay. The significance level for all tests was p < 0.05.

Results:

Exercise causes an increase in the thickness of the aorta in LDL-KO groups, particularly accentuated in the ovariectomized groups. The type I collagen fibers showed an increase in volume density influenced by training in both Control groups and in the LDL-KO group. Type III collagen density decreased in both groups. The MMP-2 showed moderade immunostaining in the tunica media in LDL-KO groups, which did not occur in the control groups and the MMP-9 stained irregularly in all tissues. The marker 8-OhdG was stronger in the exercise training groups. Additionally, the ovariectomy, the exercise training and the LDL-KO treatments increased apoptosis.

Conclusion:

These results suggest that moderate-intensity aerobic exercise in ovariectomized mice associated to an increase in LDL rate possibly increases oxidative stress and apoptosis induction.

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IJCS

Original Article

Metabolic Syndrome and Insulin Resistance by HOMA-IR in Menopause

Érika Joseth Nogueira da Cruz Fonseca et al. Tânia Pavão Oliveira Rocha Iara Antônia Lustosa Nogueira Jorgileia Braga de Melo … Bianca Lima e Silva Elenice Jardim Lopes Claudiana Batalha Serra Maria Vaneide Gomes Andrade Surama Maria Bandeira de Sousa José Albuquerque de Figueredo Neto

Abstract

Background:

Metabolic syndrome is an important cardiovascular risk factor, and its prevalence increases after menopause. However, it is still uncertain whether menopause is an independent risk factor for metabolic syndrome. One of the pathophysiological basis for metabolic syndrome is insulin resistance, which can be calculated by the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) method, and the association between insulin resistance and menopause is little known.

Objective:

To evaluate the association between metabolic syndrome and insulin resistance in menopausal women.

Method:

Descriptive study, which evaluated 150 women, aged 40 to 65, treated at a Gynecology Outpatient Clinic of a tertiary public hospital, from May to December of 2013. The sample was divided into two groups: Group I, comprising women in the premenopausal period and Group II, comprising women in the post-menopausal period. The presence of metabolic syndrome and its components were evaluated, as well as occurrence of insulin resistance in both groups. The association of menopausal status and the assessed variables was assessed using the Mann-Whitney, Chi-square and Fisher’s exact tests. The significance level was set at 5%. The statistical analysis was performed using STATA 12.0.

Results:

Metabolic syndrome and its components were more prevalent in postmenopausal women. Postmenopausal women also had a higher prevalence of insulin resistance, but no statistical association was observed between the findings.

Conclusion:

The menopausal status was not significantly associated with metabolic syndrome and insulin resistance. Insulin resistance was considered an independent risk factor for the development of metabolic syndrome only in the postmenopausal group.

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Artigo Original

Pulmonary artery pressure, gender, menopause, and pregnancy in schistosomiasis-associated pulmonary hypertension

Anderson C. Armstrong et al. Ângela M. P. Bandeira Luis C. L. Correia Humberto C. O. Melo … Carlos A. M. Silveira Eugênio Albuquerque Jeová C. Moraes Jr Antônio M. L. Silva João A. C. Lima Dário C. Sobral Filho

BACKGROUND: Schistosomiasis-associated pulmonary arterial hypertension (SPAH) is a major concern worldwide. However, the role of gender-specific contributing factors in SPAH is unknown. OBJECTIVE: We investigated how systolic pulmonary artery pressure (SPAP) values and the presence of severe SPAP relate to gender, menopausal status, and pregnancy history in SPAH patients. METHODS: Seventy-nine patients diagnosed with SPAH from 2000 to 2009 were assessed and 66 were enrolled in the study. Information about age, menopausal status, pregnancy, echocardiography-derived SPAP, and invasive mean pulmonary artery pressure (mPAP) was collected from medical records. The relation between values of SPAP and mPAP and their agreement for severe disease were assessed. Regression models assessed the association of gender, menopausal status, and pregnancy history with SPAP values and the presence of severe SPAP. RESULTS: Moderate correlation and good agreement for severe disease were found between mPAP and SPAP. Mean SPAP values were similar for men and women. A trend toward higher values of SPAP was found for non-menopausal women compared to men. Higher SPAP values were found for menopausal compared to non-menopausal women; the values were non-significant after adjustment for age. Pregnancy history had no association with SPAP. Menopause and positive pregnancy had no association with severe SPAP. CONCLUSION: In SPAH patients, neither gender, nor menopausal status, nor pregnancy history showed independent correlation with SPAP values assessed by echocardiography.

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Artigo Original

Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome

Aluísio Henrique Rodrigues de Andrade Lima et al. Henrique Eduardo Couto Glêbia Alexa Cardoso Lidiane Tavares Toscano … Alexandre Sérgio Silva Maria Paula Gonçalves Mota

BACKGROUND: Arterial Hypertension (AH) is an aggravating condition for Metabolic Syndrome (MS), as well as being aggravated by it. Menopause can make hypertension treatment more difficult, as it favors the worsening of MS components. Although there is evidence that exercise training reduces blood pressure, whether menopause and SM affect the exercise-induced benefits is yet to be elucidated. OBJECTIVE: To compare the effects of aerobic training on blood pressure in non-menopausal and menopausal women with MS METHODS: A total of 44 women were recruited and divided into four groups: non-menopausal control (NMC: 39.5 ± 3.6 years, n = 11); menopausal control (MC: 54.9 ± 5.9 years, n = 12), non-menopausal aerobics (NMA: 43.1 ± 6.8 years, n = 11) and menopausal aerobics (MA: 52.1 ± 5 years, n = 10). The exercise groups performed aerobic training for three months, five times a week, at an intensity between 60% and 70% of heart rate reserve. The resting blood pressure and blood pressure response after 60 minutes of exercise were measured before and after the training period. The two-way ANOVA test was used, considering a p value 0.05). CONCLUSION: Three months of aerobic training improved MS components, but did not alter resting blood pressure or the BP response after an acute exercise session in women with MS.

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Artigo Original

Metabolic syndrome and menopause: cross-sectional study in gynecology clinic

José Albuquerque de Figueiredo Neto et al. Eduardo Durans Figuerêdo José Bonifácio Barbosa Fabrício de Flores Barbosa … Geny Rose Cardoso Costa Vinícius José da Silva Nina Rachel Vilela de Abreu Haickel Nina

BACKGROUND: In Brazil, there are few studies of the metabolic syndrome in the general population, and even fewer studies that establish a correlation between metabolic syndrome and climacteric. OBJECTIVE: To determine the prevalence of metabolic syndrome and its components among climacteric women. METHODS: Cross-sectional study with 323 climacteric women, divided into two groups: pre and post-menopausal. They were examined for the presence of metabolic syndrome, according to the criteria of National Cholesterol Education Program’s (NCEP) and International Diabetes Federation (IDF). It was possible to notice the association between the variables under study and the metabolic syndrome by conducting a univariate analysis and a multivariate analysis. A p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of metabolic syndrome during the climacteric was 34.7% (NCEP) and 49.8% (IDF). The most frequent components of the metabolic syndrome were low HDL-cholesterol, hypertension, abdominal obesity, hypertriglyceridemia and diabetes in both criteria. The multivariate analysis showed that age was the most important risk factor for the development of metabolic syndrome (p < 0.001), which was present in 44.4% (NCEP) and 61.5% (IDF) of postmenopausal women compared to 24% (NCEP) and 37% (IDF) of premenopausal women. CONCLUSION: The prevalence of metabolic syndrome was higher in postmenopausal women than in premenopausal women. The main risk factor for the increase in this prevalence was age. Menopause, when it is analyzed alone, did not constitute a risk factor for metabolic syndrome.

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Artigo Original

Nutritional status and lipid profile of postmenopausal women with coronary heart disease

Aparecida de Oliveira et al. Jorge Mancini Filho

OBJECTIVE: To assess the nutritional status and lipid profile of postmenopausal women with coronary heart disease. METHODS: A retrospective cross-sectional study was conducted with information obtained from the medical records of 217 women on the occasion of their first visit to the InCor Nutrition Outpatient Care Clinic. The data referred to the patients’ nutritional status, body mass index, use of lipid-lowering medication, and serum lipid levels (cholesterol and fractions). RESULTS: The mean age was 60.98 ± 9.23 years, and obesity prevailed in 56% of the patients. The use of lipid-lowering drugs was observed in 73% of the population. In regard to lipid profile, 56% had adequate serum levels of HDL-C. The nutritional status was inadequate due to the prevalence of obesity, which results in the appearance of other chronic diseases, such as dyslipidemias. Although the dosages of the lipid-lowering drugs used were not assessed, their use by the population studied did not seem to be favorable, because high levels of total cholesterol and LDL-C were observed, and those high levels in that condition are strongly related to the occurrence of cardiovascular diseases. CONCLUSION: Multidisciplinary action in the form of programs to promote women’s health is required, comprising preventive aspects related to coronary heart disease, to improve the quality of life in that population.

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Original Article

Lipid peroxidation and nitric oxide inactivation in postmenopausal women

Isabela Rosier Olimpio Pereira et al. Marcelo Chiara Bertolami André Arpad Faludi Maria Fernanda Campos … Simone Ferderbar Emersom Silva Lima José Mendes Aldrighi Dulcineia Saes Parra Abdalla

OBJECTIVE: To assess the effect of endogenous estrogens on the bioavailability of nitric oxide (·NO) and in the formation of lipid peroxidation products in pre- and postmenopausal women. METHODS: NOx and S-nitrosothiols were determined by gaseous phase chemiluminescence, nitrotyrosine was determined by ELISA, COx (cholesterol oxides) by gas chromatography, and cholesteryl linoleate hydroperoxides (CE18:2-OOH), trilinolein (TG18:2-OOH), and phospholipids (PC-OOH) by HPLC in samples of plasma. RESULTS: The concentrations of NOx, nitrotyrosine, COx, CE18:2-OOH, and PC-OOH were higher in the postmenopausal period (33.8±22.3 mM; 230±130 nM; 55±19 ng/mL; 17±8.7 nM; 2775±460 nM, respectively) as compared with those in the premenopausal period (21.1±7.3 mM; 114±41 nM; 31±13 ng/mL; 6±1.4 nM; 1635±373 nM). In contrast, the concentration of S-nitrosothiols was lower in the postmenopausal period (91±55 nM) as compared with that in the premenopausal p in the premenopausal period (237±197 nM). CONCLUSION: In the postmenopausal period, an increase in nitrotyrosine and a reduction of S-nitrosothiol formation, as well as an increase of COx, CE18:2-OOH and PC-OOH formation occurs. Therefore, •NO inactivation and the increase in lipid peroxidation may contribute to endothelial dysfunction and to the greater risk for atherosclerosis in postmenopausal women.

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