Cardiovascular disease, and particularly coronary heart disease (CHD), has a low incidence
in premenopausal women. Loss of ovarian hormones during the perimenopause and menopause leads to
a sharp increase in incidence. Although most CHD risk factors are common to both men and women,
the menopause is a unique additional risk factor for women. Sex steroids have profound effects on many
CHD risk factors. Their loss leads to adverse changes in lipids and lipoproteins, with increases being
seen in low density lipoprotein (LDL) cholesterol and triglycerides, and decreases in high density lipoprotein
(HDL) cholesterol. There is a reduction in insulin secretion and elimination, but increases in
insulin resistance eventually result in increasing circulating insulin levels. There are changes in body fat
distribution with accumulation in central and visceral fat which links to the other adverse metabolic
changes. There is an increase in the incidence of hypertension and of type 2 diabetes mellitus, both major
risk factors for CHD. Oestrogens have potent effects on blood vessels and their loss leads to dysfunction
of the vascular endothelium. All of these changes result from loss of ovarian function contributing
to the increased development of CHD. Risk factor assessment in perimenopausal women is recommended,
thereby permitting the timely introduction of lifestyle, hormonal and therapeutic interventions
to modify or reverse these adverse changes.
Non-alcoholic fatty liver disease as a risk factor for female sexual dysfunction in premenopausal women
