Sex hormones and stroke: Beyond estrogens

Area of Science:

• Reproductive endocrinology
• Neuroscience
• Cardiovascular science

Background:

• Stroke risk and poor outcomes in postmenopausal women are often linked to lower estrogen levels.
• However, evidence suggests estrogen may not be the only factor, as stroke risk increases before menopause and estrogen therapy is not universally effective.
• Other sex hormones might also contribute to elevated stroke risk.

Purpose of the Study:

• To review and synthesize evidence on the role of ovarian hormones in stroke risk and outcomes.
• To investigate the contribution of hormones beyond estrogen, such as Follicle Stimulating Hormone (FSH) and androgens, to postmenopausal stroke risk.
• To analyze data from various populations including natural/surgical menopause, chemotherapy patients, and preclinical models.

Main Methods:

• Literature review and synthesis of existing clinical and preclinical data.
• Analysis of hormonal changes associated with menopause, including estrogen, FSH, inhibin, and androgens.
• Examination of stroke risk and outcomes in diverse female populations and experimental models.

Main Results:

• Elevated Follicle Stimulating Hormone (FSH) and reduced inhibin levels indicate decreased ovarian reserve prior to menopause.
• Menopause leads to an increased ratio of androgens to estrogens, which may negatively impact cardiovascular health.
• Evidence suggests androgens could contribute to postmenopause-associated stroke risk.

Conclusions:

• Estrogen reduction is not the sole determinant of increased stroke risk in postmenopausal women.
• The elevated androgen-to-estrogen ratio may be a significant factor in postmenopausal stroke risk.
• A comprehensive understanding of multiple ovarian hormones is crucial for addressing stroke risk in women.