Irregular, long menstrual cycles may be indicative of future CVD
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Irregular and long menstrual cycles were associated with elevated risk for incident CVD events, primarily CHD, according to research published in JAMA Network Open.
Among women who continued to report irregular and long menstrual cycles, their CVD risk increased as they aged, according to the study.
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The researchers wrote that polycystic ovary syndrome (PCOS) is likely a factor in many women with irregular or long menstrual cycles.
“In our prospective cohort study, irregular and long menstrual cycle lengths across the reproductive lifespan were associated with an increased risk of CVD later in life,” Yi-Xin Wang, MD, PhD, research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Furthermore, we found that only a small proportion of the relation between cycle characteristics and CVD risk was driven by hypercholesterolemia, chronic hypertension, and type 2 diabetes. Our results suggest that menstrual cycle dysfunction may be a useful marker for identifying women who are more likely to develop CVD events later in life.”
To better understand the relationship between menstrual cycle characteristics across reproductive lifespan and CVD risk, researchers used data from the Nurses’ Health Study II to identify 80,630 participants who reported menstrual cycle regularity and length for ages 14 to 17 years and 18 to 22 years at enrollment in 1989 and reported updated cycle information in 1993, at ages 29 to 46 years (mean age, 37.7 years).
The primary outcome was CVD events, defined as fatal and nonfatal CHD — MI or coronary revascularization — and stroke.
Irregular, long menstrual cycles and CVD risk
Women who reported having usually irregular, always irregular or no periods represented 9.1% of the overall cohort and those reporting long cycles represented 13.9%.
Women who reported irregular cycles had a higher mean BMI and were more likely to have hypercholesterolemia and chronic hypertension at baseline compared with women reporting regular cycles.
Over 24 years of follow-up, 2.3% of the cohort experienced a CVD event (1.5% CHD, 0.8% stroke).
Researchers observed greater risk for CVD among women who reported irregular cycles or no periods at ages 14 to 17 years (HR = 1.15; 95% CI, 0.99-1.34), 18 to 22 years (HR = 1.36; 95% CI, 1.06-1.75) or 29 to 46 years (HR = 1.4; 95% CI, 1.14-1.71) compared with women reporting regular cycles at the same age.
Similarly, women who reported longer cycle length ( 40 days) or a cycle length too irregular to estimate at ages 18 to 22 years (HR = 1.44; 95% CI, 1.13-1.84) or 29 to 46 years (HR = 1.3; 95% CI, 1.09-1.57) experienced greater risk for CVD compared with women who reported a cycle length of 26 to 31 days.
Researchers noted that although women who reported irregular cycles or no periods were more likely have certain CV risk factors, the subsequent development of hypercholesterolemia, chronic hypertension and diabetes only explained 5.4% to 13.5% of the associations between irregular or long cycles and incident CVD.
Underlying PCOS may be present
“PCOS, which is characterized by irregular cycles and ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology, is the most common cause of irregular menstrual cycles. Approximately 90% of women with cycle irregularities or oligomenorrhea have clinical, laboratory, or ultrasound evidence of PCOS,” the researchers wrote. “Meanwhile, CVD risk factors, including dyslipidemia, type 2 diabetes and abnormal vascular and endothelial function, are well described among women with PCOS. Therefore, the associations observed between cycle irregularity and long cycle length during early and mid-adulthood with CVD and the mediating role of hypercholesteremia, chronic hypertension, and type 2 diabetes are likely attributable to underlying PCOS.”
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