Investigation of flow-mediated vasodilation in female athletes with exercise-associated amenorrhea

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Background Exercise-associated amenorrhea (EAA) is frequently observed in highly trained female athletes associated with a hypoestrogenic state. Vascular endothelial function is modulated during the menstrual cycle. The purpose of the present study was to investigate vascular endothelial function in highly trained female athletes with EAA.Methods and Results The study subjects consisted of 26 female volleyball players, who had a regular menstrual cycle (regular group, n=15) and EAA (EAA group, n=11). Vasodilatory responses of the brachial artery were evaluated by measuring endothelium-dependent flow-mediated vasodilation (FMD) and glyceryltrinitrate (an endothelium-independent dilator)-induced vasodilation using high-resolution ultrasonography. Plasma levels of estradiol and progesterone were measured in all the subjects. In the regular group, all measurements were performed at 12 to 14 days after the first day of the last menstrual cycle. Plasma estradiol levels were significantly lower in the EAA group than in the regular group (p<0.05). Plasma progesterone levels did not differ between the two groups. The regular and EAA groups did not differ in terms of arterial diameter and blood flow at baseline, nor in blood flow during hyperemia. FMD was significantly smaller in the EAA group than in the regular group (p<0.05). Glyceryltrinitrate-induced vasodilation did not differ between the groups. FMD significantly correlated with plasma estradiol levels (r=0.41, p<0.05).Conclusions Endothelium-dependent vasodilation was impaired in highly trained female volleyball players with EAA associated with a hypoestrogenic state. Thus, the detrimental effects of vigorous exercise training on vascular endothelial function may have important clinical implications for the health of female athletes.