Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 132722

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1148 - 1150 Full Version

Evaluation of the Autonomic Functions in Perimenopausal and Menopausal Women

Published: November 1, 2011 | DOI:
G.V. Lathadevi, Warun Kumar M.R.

Department of Physiology PSG Institute of Medical Sciences and Research (PSGIMS & R), Coimbatore – 641 004, India. II MBBS student2, PSG Institute of Medical Sciences and Research (PSGIMS & R), Coimbatore – 641 004, India.

Correspondence Address :
G.V. Latha Devi
Associate professor, Department of Physiology,
PSG Institute of Medical Sciences and Research (PSGIMS & R),
Coimbatore – 641 004, India.
Bobile: 9344851415; Office: 0422 2570170 [ext.5809]
Telefax: 0422 2594400


Background and Objectives: The autonomic nervous system controls most of the visceral functions of the body through the sympathetic and the parasympathetic nerve fibers. In women, the withdrawal of the hormones in the perimenopausal and the menopausal period is gradual. This study was aimed to assess the physiological changes in the autonomic function tests in them.

Material and Methods: 60 normal women volunteers, perimenopausal and postmenopausal, were divided into 2 groups of 30 each, Group I (perimenopausal) and Group II (postmenopausal). The parasympathetic function tests included the standing to lying ratio (S/L ratio), the 30:15 ratio and the valsalva ratio. The sympathetic function tests like the blood pressure response to the isometric handgrip (IHG) and the blood pressure response to standing (BPS) were also done. The above 5 tests were recorded in the groups I and II subjects.

Results: By the independent sample ‘t’ test, we found the mean difference of the S/L ratio, the 30:15 ratio, the valsalva ratio, the IHG test and BPS between the perimenopausal and the menopausal women, with a ‘p’ value >0.5.

Conclusion: The comparison of the autonomic functions in the perimenopausal and menopausal women showed no significant changes. The parasympathetic activity was reduced because the values which were obtained in the parasympathetic function tests were reduced to below the normal values. The sympathetic activity was increased in both the groups, indicating an increased risk of cardiovascular disease in women even before menopause.


Autonomic functions, Menopausal women, Perimenopausal women

The autonomic nervous system controls most of the visceral functions of the body through the sympathetic and the parasympathetic nerve fibers. The peripheral nerves mediate the autonomic control of the heart rate and the blood pressure and their influence on the uterus depends on the oestrogen and progesterone secretions (1). The autonomic functions are altered, which is due to the gradual withdrawal of the hormones and a decline in the physical function due to aging (2).

A woman, in her reproductive period, gradually transcends into perimenopause and later after a couple of years, into menopause. Perimenopause is a hormonally distinct time in midlife. It is a transititional stage which is prior to menopause [which can range from 2 to 10 years, the average being 6 years] 30-50 years. It is only in this stage that the menstrual periods are irregular, with a 30% reduction in oestrogen and a decrease in progesterone and when the normal ovulation becomes inconsistent (3).

Menopause is the total cessation of menstruation and this occurs between the age group of 45 and 60. Menopause is defined as the absence of menstrual periods for 12 consecutive months and thereafter (4).

Earlier study reports document the autonomic changes in the reproductive period with respect to the menstrual cycle (5),(6),(7) and pregnancy (8), but there is no proper documentation regarding the autonomic function tests in perimenopausal and menopausal women. This study was done to demonstrate the physiological changes in the autonomic function tests in perimenopausal and menopausal women.

Material and Methods

This study was conducted in the Department of Physiology, PSG Institute of Medical Sciences and Research (PSGIMS and R), Coimbatore. Prior to the commencement of the study, the permission of the Institute Research Council and the Institute Ethics Committee were obtained.

This study was carried out on 60 normal human women volunteers who were aged from 40 to 60 years. Subjects having diabetes, hypertension and other cardiac problems and those who did not have the natural course of menopause (i.e,) in whom hysterectomy was done, were excluded from the study. The subjects were randomly divided into two groups.

Group I consisted of 30 perimenopausal women who had menstrual periods once in 2 months or 3 months. Group II consisted of 30m(2e)nopausal women who had com(p3l)ete cessation of menstruation for a period of one year and more.

The nature of the study was explained to all the subjects and a written informed consent was obtained from all of them. The various autonomic function tests which were performed were the standing to lying ratio (S/L ratio), the 30:15 ratio, the valsalva ratio, the blood pressure response to a sustained hand grip and the blood pressure response to standing. The first three tests detected the parasympathetic function and the next two detected the sympathetic function The following parameters were recorded by using BIOPAC systems, Inc, MANB5L3S, student version. The methodology which was adopted for the autonomic assessment was as under:

1. The Standing to Lying Ratio (S/L Ratio): Each subject was asked to stand quietly and to then lie down without any support, while a continuous ECG was recorded from 20 beats before to 60 beats after lying down. The point at which the subject started to lie down was marked. The S/L ratio was calculated as follows S/L Ratio = (longest R-R interval during 5 beats before lying down)/(shortest R-R interval during 10 beats after lying down). The maximum ratio of three trials was taken. An S/L ratio of >1.01 was taken as normal (9).

2. The 30:15 ratio: Each subject lay quietly for 3 minutes, then stood up and remained motionless. A continuous ECG was recorded and a point was marked to identify the point of standing. The 30:15 ratio was calculated by taking the ratio of the R-R interval at beat 30 and at beat 15 after standing (9). Values which were >1.04 were taken as normal.

3. The Valsalva ratio: Each subject performed the valsalva maneouver for 15 seconds by blowing against a closed glottis through a mouthpiece which was attached to an aneroid manometer and was maintained a pressure of 40 mm Hg for 15 sec. Three trials were performed at intervals of 5 minutes. A continuous ECG was recorded 1 min before the maneouver (resting period), during the maneouver (strain period, 15 sec.) and 60 seconds subsequent to the strain period. The Valsalva ratio was calculated as the ratio of the maximum R-R interval after the strain to that of the shortest R-R interval during the strain, with values >1.21 being taken as normal (9).

4. The Blood Pressure Response to a Sustained Isometric Hand Grip Test, (HGT): The subject was asked to apply pressure on a hand grip dynamometer for 1 minute at 30% of the maximal voluntary contraction and simultaneously, the blood pressure changes were observed. The difference between the diastolic blood pressure (DBP) just before the release of the contraction and that before the handgrip began was taken as a measure of the response. A rise in DBP to >10 mm Hg was considered as normal (9).

5. The Blood Pressure Response to Standing: In this test, the subject’s blood pressure was measured with a sphygmomanometer while lying supine and immediately after standing up. The recording was done three times and the mean was calculated. The postural fall in the blood pressure was taken as a difference between the systolic pressure in the lying and the systolic pressure in the standing posture. The normal systolic fall would be upto less than 20 mmHg (10).

The data which were collected from the 60 subjects were subjected to statistical analysis by using the independent sample ‘t’- test.‘P’ values of less than 0.05 were considered as significant (11).


The comparison of the autonomic function tests in perimenopausal and menopausal women showed no significant changes with p values which were > 0.05, or as shown in (Table/Fig 1).The values which were obtained in the parasympathetic function tests were reduced to below the normal values, thus denoting a reduction in the parasympathetic activity. The values which were obtained in the sympathetic function tests were increased to above the normal values, thus denoting an increase in the sympathetic activity.


Perimenopause is a critical period in life during which striking endocrinological, somatic and psychological alterations occur in the transition to menopause. The perimenopausal period encompasses the change from the ovulatory cycle to the anovulatory cycle upto the cessation of menses and is marked by an irregularity of menstrual bleeding. In perimenopausal women, the serum oestradiol levels do not decline until less than a year before menopause. The circulating oestradiol levels in the perimenopausal age group are higher as compared to those in the menopausal age group.

Menopause is the permanent cessation of menses as a result of the irreversible loss of a number of ovarian functions including ovulation and oestrogen production. The ovarian functions gradually become diminished and so, the oestrogen production from the granulosa cells of the ovary also reduces, but the follicle stimulating hormone levels are very highly raised. It has long been suggested that oestrogen protects against atherosclerosis, because the incidence of cardiovascular disease is lower in women than in men in the reproductive age group. In menopausal women, the risk of cardiovascular diseases gradually increases due to the lack of the oestrogenic protective effects and the incidence of cardiovascular disease is equal to that in men.It is not so in perimenopausal women because of the highly circulating oestradiol levels. The effect of the sympathetic stimulation on the uterus is highly variable, depending on the oestrogen and progesterone secretions (1).

The sympathetic function tests were the isometric hand grip strength test and the blood pressure response to standing. In our study, the blood pressure response to standing was below the normal mean values of 20mm of Hg systolic pressure, thus indicating an increase in the sympathetic activity, though it was not statistically significant. The increase in the sympathetic activity in the menopausal women was consistent with those in the previous studies which were done by Rosana et al (12) and Noha H Farag et al (13). Perimenopausal women also showed an increase in the sympathetic activity and this was consistent with the findings of Sudhir K. et al (14) , with an increase in the total body norepinephrine spill over. There was a decrease in the norepinephrine induced vasoconstriction after the oestrogen supplementation.

In the isometric hand grip strength test, the blood pressure increase was due to an increase in the sympathetic activity and oestradiol does not have any effect on the muscle strength or the mobility.

The mechanisms by which oestrogen affects the cathecholeamine levels are also uncertain. The bulk of the circulating epinephrine appears to originate from the adrenal medulla and that of the norepinephrine from the sympathetic neuron, although under the condition of stress, the adrenal secretion of norepinephrine increases predominantly under neuronal control (15). There is evidence that oestrogen modulates cathecholamine synthesis in the neural tissue (16) and that it also increases the urinary cathecholamine clearance in post-menopausal women.

The parasympathetic function tests like the standing to lying ratio, the 30:15 ratio and the valsalva ratio showed a decrease in the values which were statistically insignificant, thus indicating that the parasympathetic functions were diminished in both perimenopausal and menopausal women. The cause for the decrease in the parasympathetic activity was a reduction in the cardiac parasympathetic tone in the older women as compared to that in the younger women. The arterial baroreflex control of the parasympathetic nerve activity was impaired in postmenopausal women, which was consistent with the earlier study reports of Saeki Y et al (17). Our findings revealed that the sympathetic dominance and the decreased level of oestrogen in postmenopausal women produced the unfavourable alterations in the cardiac function.


From the present study, we conclude that the comparison of the autonomic functions in perimenopausal and menopausal women showed no significant changes .The parasympathetic activity was reduced because the values which were obtained in the parasympathetic function tests were reduced to below the normal values. The sympathetic activity was increased in both the groups, thus indicating an increased risk of cardiovascular disease in both the perimenopausal and menopausal women. This study highlights the importance of risk factor screening for cardiovascular diseases, even prior to menopause, in order to prevent it.

Limitations: This was a short duration study with a small sample size since it was a ICMR project.

Key Message

This study highlights the importance of risk factor screening for cardiovascular diseases, even prior to menopause in women, in order to prevent it.


The present study was conducted as a short term student research studentship project by Mr.Warun Kumar M.R.II, MBBS batch of 2004, under the guidance of Dr.G.V.LathaDevi, Associate Professorof Physiology, PSGIMS and R, Coimbatore. We acknowledge the financial grant from ICMR, New Delhi.


Chaudhuri . SK Concise Medical Physiology, 5th edition, 552
Kurina LM, Gulati M, Everson-Rose SA, Chung PJ, Karavolos K, Cohen NJ, et al. The effect of menopause on the grip and pinch strength: Results from Chicago, Illinois, site of the Study of Women’s Health Across the Nation. Am J Epidemiol 2004;160: 484-91.
Jerrilyn C. Prior CeMCOR: The centre for menstrual cycle and ovulation research June 2003;http:www.cem perimenopause http: /www.menopause –on line/ html pms or menopause
Gupta A, Bhattacharya S, Tiwari S Quantification of the sympathetic activity in different phases of the menstrual cycle. Ind. J.Physiol and Pharmac 2005; 49:5[supplement] 60
Rohtagi S, Bhattacharya S, Tiwari S. Effect of the menstrual cycle on parasympathetic function. Ind. J.Physiol and Pharmac, 2005; 49:5[supplement] 61
Samuel P J, Chandrasekhar M, Shyamala R Parasympathetic activity in various phases of the menstrual cycle in normal females. Ind. J.Physiol and Pharmac 2005;49:5[supplement] 75
Yang CCH, Chao TC, Kuo TBJ, Yin CS, Chen HI. Preclamptic pregnancy is associated with the increased sympathetic and decreased parasympathetic control of HR. Am. J. Physiol Heart Circ Physiol 2000Apr;278(4):1269-73.
Kubba S, Agarwal SK, Prakash A, Puri V, Babbar R, Anuradha S, et al. Effect of losartan on albuminuria,peripheral and autonomic neuropathy in normotensive microalbuminuric type 2 diabetes. Neurol. India 2003; 51/3: 355-8.
Jain A.K Manual of practical physiology,1st edition, 247-52.
Raveendran R Gitanjali B, A practical guide to post graduate dissertation. 1997; 48-50
Rosano GM, Patrizi R, Leonardo F. Effect of estrogen replacement therapy on heart rate variability and heart rate in healthy post menopausal women. Am. J. Cardiology 1997 Sept 15;80(6):815-17.
Farag N H,.Baedwell W A,. Nelesen R A et al; Autonomic responses to psychological stress; the influence of menopausal status. Annals of Beh Med. 2003; 26(2): 134-8.
Sudhir K, Esler MD, Jennings GL, Komesaroff PA. Estrogen supplementation decreases norepinephrine induced vasoconstriction and total body epinephrine spill over in perimenopausal women. Hypertension 1997; 30:1538-43.
Komesaroff PA, Funder JW. Glucocorticoid effects on catecholeamine responses to stress. Am. J.Physiol 1994;266: E118-E128.
Ma ZQ, Bondiolotti GP, Olasmaa M, Violani E, Patrone C, Picotti GB, Maggi A, et al. The estrogen modulation of catecholamine synthesis and monoamine oxidase A activity in the human neuroblastoma cell line SK-ER3. J Steroid Biochem Mol Biol 1993;47:207-11.
Saeki Y, Atogami F, Hiraishi M,Furuta N,and Yoshizawa T. Impairment of autonomic function which was induced by posture change in postmenopausal women. J Women’s Health 1998 June; 7(5):575- 82.

Tables and Figures
[Table / Fig - 1]
DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)