# Effectiveness of Interventions to Improve Cardiovascular Perturbations in Women with Exercise-Associated Amenorrhea: A Systematic Review

## TL;DR

This review examines how interventions like oral contraceptives and folic acid affect cardiovascular issues in women with exercise-associated amenorrhea.

## Contribution

The study evaluates specific interventions for cardiovascular improvements in a rare and understudied condition.

## Key findings

- Low-dose oral contraceptives improved endothelial function from 1.42% to 4.88%.
- Folic acid improved endothelial function from 3.0% to 7.7%.
- Oral contraceptives had conflicting effects on lipid profiles and increased some inflammatory markers.

## Abstract

Women with exercise-associated amenorrhea demonstrate cardiovascular perturbations such as endothelial dysfunction and altered lipid profiles. The objective of this systematic review was to assess the effectiveness of pharmacological/nutraceutical and non-pharmacological interventions for improving these cardiovascular perturbations.

A literature search was performed in October 2023 and updated in July 2024 of CINAHL (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), SPORTDiscus (EBSCOhost), and Scopus from inception to present with no date or language limitations and four sources of gray literature. Experimental and quasi-experimental pre–post studies of women with exercise-associated amenorrhea, using pharmacological/nutraceutical or non-pharmacological intervention, were included.

Three studies from three countries were included. Interventions included 9 months of low-dose oral contraceptives and 4 weeks of folic acid (10 mg/day). Both interventions improved endothelial function in women experiencing exercise-associated amenorrhea, from 1.42% to 4.88% and 3.0% to 7.7%, respectively. The impact of oral contraceptives on lipids was conflicting, and increases were seen in select inflammatory markers, including high-sensitivity C-reactive protein and tumor necrosis factor.

Oral contraceptives or folic acid may improve the endothelial dysfunction associated with exercise-associated amenorrhea. As cardiovascular disease remains a global cause of mortality for women, further investigation into the long-term cardiovascular consequences of impaired vascular and lipid profiles of exercise-associated amenorrhea is warranted.