Uticaj ženskih polnih hormona na funkciju nosa u menstrualnom ciklusu i postmenopauzi

Abstract

Funkcija nosa povezana je sa različitim anatomskim, fiziološkim i emocionalnim faktorima. Postoji mnogo teorija koje su pokušale da objasne efekat ženskih polnih hormona (estrogena i progesterona) na fiziologiju nosa, ali sam mehanizam njihovog dejstva još uvek ostaje izazov za mnoge istraživače. Prethodno je opisano da ženski polni hormoni mogu da izazovu nazalnu opstrukciju, povećavajući ekspresiju histaminskih H1 receptora i menjajući koncentraciju neurotransmitera, što dovodi do edema nosne sluznice i modifikacije nazalnog otpora. Kada je reč o mirisnoj funkciji na malom broju ispitanika i u različito dizajniranim studijama je pokazano da je u fazi ovulacije mirisni prag značajno niži u odnosu na folikularnu i luteinsku fazu, međutim ne postoje podaci o identifikaciji i diskriminaciji mirisa u menstrualnom ciklusu. Nizak nivo estrogena prouzrokovan fiziološkom atrofijom jajnika u postmenopauzi može dovesti do hiposmije ili čak anosmije, što predstavlja još jedan dokaz o osetljivosti nazalne sluznice na estrogen. Cilj ovog istraživanja je bio da se ispita uticaj ženskih polnih hormona na respiratornu i mirisnu funkciju nosa u menstrualnom ciklusu i postmenopauzi. Istraživanje je u celosti prospektivno, sprovedeno je na Zavodu za fiziologiju, Medicinskog fakulteta, Univerziteta u Novom Sadu. Uključeno je 204 osoba ženskog pola koje su bile podeljene u dve grupe. Prvu grupu su činile 103 devojke uzrasta 23,126 ± 4,597 godina u reproduktivnom periodu sa regularnim menstrualnim ciklusom i 101 žena prosečnog uzrasta 60,069 ± 5,570 u postmenopauzi. Respiratorna i mirisna funkcija nosa procenjene su uz pomoć odgovarajućih standaradizovanih objektivnih i subjektivnih metoda. Funkcija donjih disajnih puteva ispitana je uz pomoć spirometrije. Kod žena u reproduktivnom periodu testiranje se vršilo u fazi ovulacije i lutealnoj fazi menstrualnog ciklusa, a kod ispitanica u postmenopauzi jednom. Nakon određivanja prvog plodnog dana ispitanice su uz pomoć standardizovanih urin - tračica za određivanje pika luteinizirajućeg hormona u urinu utvrđivale momenat ovulacije, dok se drugo testiranje u lutealnoj fazi vršilo sedam dana nakon prvog. Respiratorna funkcija nosa je značajno lošija u fazi ovulacije u odnosu na progesteronsku fazu menstrualnog ciklusa,ali se značajno ne razlikuje između žena u reproduktivnom periodu i žena u postmenopauzi. Subjektivni osećaj nazalne opstrukcije značajno se ne razlikuje u različitim fazama menstrualnog ciklusa, kao ni između testiranih populacija zdravih žena. Sposobnost identifikacije mirisa je statistički značajno slabija, a subjektivni osećaj intenziteta mirisa izraženiji u fazi ovulacije u odnosu na luteinsku fazu menstrualnog ciklusa. Međutim, sposobnost identifikacije mirisa značajno je lošija kod žena u postmenopauzi u odnosu na obe faze menstrualnog ciklusa. Reaktivnost nosne sluznice značajno je veća u fazi ovulacije u odnosu na lutealnu fazu menstrualnog ciklusa, ali se ista ne razlikuje između žena u reproduktivnom period i žena u postmenopauzi. Respiratorna i mirisna funkcije nosa u testiranim populacijama zdravih žena nisu značajno povezane.

The nasal function is associated with various anatomical, physiological and emotional factors. There are many theories that have tried to explain the effect of female sex hormones (estrogen and progesterone) on the nasal physiology, but the mechanism still remains unknown for many researchers. It has been previously described that female sex hormones can cause nasal obstruction by increasing the expression of histamine H1 receptors and altering the concentration of neurotransmitters, which leads to edema of the nasal mucosa and modification of nasal resistance. When it comes to olfaction on a small number of subjects and in differently designed studies, it was shown that in the ovulatory phase the olfactory threshold is significantly lower compared to the follicular and luteal phase, however there are no data on the identification and discrimination of odors in the menstrual cycle. Low estrogen levels caused by physiological atrophy of the ovaries in postmenopause can lead to hyposmia or even anosmia, which is another proof of the sensitivity of the nasal mucosa to estrogen. The aim of this study was to examine the effect of female sex hormones on respiratory and olfactory function of the nose in the menstrual cycle and postmenopause. The research is prospective and it was conducted at the Department of Physiology, Faculty of Medicine, University of Novi Sad. It included 204 females who were divided into two groups. The first group consisted of 103 women aged 23.126 ± 4.597 years in the reproductive period with a regular menstrual cycle and 101 women with an average age of 60.069 ± 5.570 in the postmenopausal period. The respiratory and olfactory function of the nose were assessed using appropriate standardized objective and subjective methods. The lower airway function was examined using spirometry. Young women in reproductive period were tested twice, in the ovulatory and luteal phase of the menstrual cycle, and the postmenopausal women were tested only once. After menstrual bleeding the participans used standardized urine strips consecutively day by day to determine ovulation (the peak of the luteinizing hormone (LH) in plasma which pointed out the estrogen plasma peak). The test was positive if two horizontal pink streaks appeared on the strip 5 to 10 minutes after the contact with the urine. One pink streak indicates a correctly performed test, while the second streak appears only if there is an LH peak. Within 24 hours of confirmed LH peak, the subjects were tested for the first time. The second measurement was performed in the luteal phase of the menstrual cycle (the progesterone plasma peak) seven days after the first one. The nasal respiratory function is significantly worse in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ significantly between women in the reproductive period and postmenopausal women. The subjective sense of the nasal obstruction does not differ significantly in different phases of the menstrual cycle, as well as between tested populations of healthy women. The odor identification ability is statistically significant weaker and the subjective sense of odor intensity is more pronounced in the ovulatory phase compared to the luteal phase of the menstrual cycle. However, the ability to identify odors is significantly worse in postmenopausal women compared to both phases of the menstrual cycle. The reactivity of the nasal mucosa is significantly higher in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ between women in the reproductive period and postmenopausal women. The respiratory and olfactory nasal functions in these tested populations are not significantly corelated.