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Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

INTRODUCTION: 
One of the significant demographic changes noticed both in the developed and developing countries is the gradual increase in the ageing population. The average lifespan of a women in India is 65 years while in developed countries it is 80 years, so women of our country deserve special attention. A women, gradually transcends into perimenopause and after a couple of years into menopause in her reproductive period. 
Perimenopause includes the period beginning with the first clinical, biological and endocrinological features of the approaching menopause such as vasomotor symptoms, menstrual irregularities and ends 12 months after the final menstrual period. It refers to the time period in the late reproductive years usually late forty’s to early fifty’s. 
Menopause, consists of gradual transition from reproductive to the non-reproductive phase of life, which is a normal ageing phenomenon in women.The term menopause refers to a point in time that follows one year after the cessation of menstruation. The postmenopause describes those years following this point and this occurs between the age group of 45 and 60. 
Menopause is an example of endocrinal senescence. It is a normal biological event and it signifies the depletion of functional ovarian follicles that are responsible for estradiol production. Metabolic and physiological functions within the women’s body are affected due to hormonal deficiency including the cardiovascular system. 
Thus, this study was done to compare the autonomic functions in perimenopausal and postmenopausal women to assess any significant deviations in sympathetic and parasympathetic activity and also to test the estrogen role in the modulation of autonomic functions. 
AIMS AND OBJECTIVES: 
1. The study is to compare the autonomic functions in perimenopausal women with the postmenopausal women. 
2. To test the hypothesis that estrogen exerts regulatory influence on autonomic nervous system in postmenopausal women. 
MATERIALS AND METHODS: 
This study was undertaken to compare the Autonomic functions in the perimenopausal women with postmenopausal women. Prospective non-interventional type of study was done. The study period extended from may 2011-2012. The subjects were selected from Thanjavur Medical College Hospital and Raja Mirasudar Hospital, Thanjavur. This study was performed on healthy women of age 45-55 yrs of perimenopausal and postmenopausal women. 
Perimenopausal period refers to a period, in which there would be declining of ovarian functions with menstrual irregularities, vasomotor symptoms that ends 12 months after the final menstrual period. 
Menopause: The permanent cessation of menstrual cycle for a period of one year or more. 
The nature of study was explained to all the subjects. Informed written consent was obtained from all the participants. The experimental protocol was approved by the Ethical committee. 
Inclusion Criteria: 
Healthy women of 45-55 yrs of age with 
1. irregular menstrual cycle, 
2. cessation of menstrual cycle, 
3. Symptoms of menopause which includes flushing, sweating. 
Exclusion Criteria: 
1. Diabetics, 
2. Hypertension, 
3. Cardiovascular disorders, 
4. Renal disorder, 
5. Liver disorder, 
6. Smoking, 
7. Alcohol, 
8. Oral pills, 
9. Hormone replacement therapy. 
MATERIALS FOR THE STUDY: 
1. Proforma to record the subject details and clinical examination findings, 
2. Electrocardiograph, 
3. ECG-paper, 
4. ECG-jelly, 
5. Sphygmomanometer, 
6. Cotton, 
7. Ice cold water, 
8. Stethoscope. 
RESULTS: 
A prospective, non-interventional study was conducted in 80 subjects. Their age varied from 45-55 yrs. 
Subjects who self reported with the H/O menstrual irregularities, irritability, sleep disturbances were included in perimenopausal group and are considered as Group A. 
Subjects who self reported with H/O amenorrhea more than a year associated with vasomotor symptoms like hot flushes, night sweats were included in postmenopausal group and are considered as Group B. 
The parameters evaluated in this study are sympathetic function tests which includes Pulse rate, Blood pressure, Orthostasis, Mean arithmetic mean, Cold pressor test, QTc. Parasympathetic function tests that includes Valsalva ratio, Expiration: Inspiration ratio, Standing: Lying ratio,30:15 ratio. Serum estrogen was done for both the groups. 
The mean and standard deviation values of all the parameters tested in postmenopausal women were compared with the perimenopausal women. The results were analyzed by the student’s t-test. The statistical significance was considered at P< 0.05. 
These parameters were correlated with serum estrogen level by using Pearson’s correlation coefficient test. 
CONCLUSION: 
The present study shows significant alteration in the Autonomic functions of postmenopausal women when compared with perimenopausal women. 
In this study, the result shows increased sympathetic and reduced parasympathetic activity in postmenopausal women. 
Parameters reflecting parasympathetic activity like valsalva ratio, 30:15 ratio, E:I ratio shows positive correlation with serum estrogen level in postmenopausal women. 
Estrogen levels are reduced in the postmenopausal women, when compared with perimenopausal women that exert a regulatory influence on autonomic functions. 
Cold pressor test reflecting sympathetic activity does not show significant increase in perimenopausal women. 
Standing / lying ratio reflecting parasympathetic activity does not show significant decrease in perimenopausal women. 
Assessment of sympathetic and parasympathetic functions, could therefore aid in early diagnosis of Autonomic dysfunction in postmenopausal women. Hence, estrogen may be administered early in them, which would prevent the cardiovascular complications.