Menopause and vascular endothelial health: Is it all about the oestrogen?

Cardiovascular disease (CVD) is a leading cause of mortality in women, and CVD risk is accelerated during the menopause transition. This acceleration has traditionally been attributed to the hallmark decline in oestradiol with menopause. However, the menopause transition is also characterized by changes in other sex hormones that exert effects on the vascular endothelium including declines in progesterone and rising follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. The purpose of this review is to examine the relationships between sex hormones and vascular endothelial function in menopausal women. We emphasize data from clinical and translational studies investigating the effects of oestradiol, progesterone, FSH, LH, and testosterone on vascular endothelial function, and the putative underlying mechanisms including modulation of endothelin-1 signalling, oxidative stress and inflammatory pathways.