Effectiveness of Interventions to Improve Cardiovascular Perturbations in Women with Exercise-Associated Amenorrhea: A Systematic Review.

Abstract

Objectives: Women with exercise-associated amenorrhea demonstrate cardiovascular perturbations such as endothelial dysfunction and altered lipid profiles. The objective of this systematic review was to assess the effectiveness of pharmacological/nutraceutical and non-pharmacological interventions for improving these cardiovascular perturbations.

Design data sources and eligibility criteria: A literature search was performed in October 2023 and updated in July 2024 of CINAHL (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations and four sources of gray literature. Experimental and quasi-experimental pre-post studies of women with exercise-associated amenorrhea, using pharmacological/nutraceutical or non-pharmacological intervention, were included.

Results and summary: Three studies from three countries were included. Interventions included 9 months of low-dose oral contraceptives and 4 weeks of folic acid (10 mg/day). Both interventions improved endothelial function in women experiencing exercise-associated amenorrhea, from 1.42% to 4.88% and 3.0% to 7.7%, respectively. The impact of oral contraceptives on lipids was conflicting, and increases were seen in select inflammatory markers, including high-sensitivity C-reactive protein and tumor necrosis factor.

Conclusion: Oral contraceptives or folic acid may improve the endothelial dysfunction associated with exercise-associated amenorrhea. As cardiovascular disease remains a global cause of mortality for women, further investigation into the long-term cardiovascular consequences of impaired vascular and lipid profiles of exercise-associated amenorrhea is warranted.