Physiological changes in platelet aggregation and nitric oxide levels during menstrual cycle in healthy women

Hormonal levels, mainly those of estrogens, protect women from the appearance of cardiovascular diseases by an increasing nitric oxide (NO) activity. NO is an endogenous vasodilator and antiaggregating substance. We decided to investigate platelet function and plasma levels of nitric oxide during preovulatory and midluteal phases in young and healthy women with normal menstrual cycles (MCs). Nine young, healthy female subjects had recorded three consecutive MCs before entering this program. Platelet-rich plasma (PRP) was used for the determination of platelet aggregation and NO measurements. Moreover, platelet sensitivity to the inhibitory effect of exogenous NO was tested. The EC₅₀ of collagen showed no differences between the preovulatory (1.36 ± 0.16 μg/mL) and the midluteal (1.31 ± 0.08 μg/mL; P, NS) phases. However, the EC₉₀ during the preovulatory phase was higher (2.05 ± 0.2 μg/mL) than during the midluteal phase (1.8 ± 0.6 μg/mL). Plasma levels of NO were lower during the preovulatory phase (19.1 ± 2 μM) in comparison to the midluteal phase (20.9 ± 2.3 μM). Interestingly, the exogenous amount of NO to produce at least half of the inhibition of an EC₉₀ collagen-induced aggregation was higher at the preovulatory phase (323.3 ± 60.9 nM) than during the midluteal phase (240.0 ± 37.5 nM; P, NS). We propose that during the follicular phase platelets rather use NO produced by the endothelium; therefore, it is necessary to add more agonist to activate those, but it results in higher consumption of circulating NO, whereas during luteal-phase platelets are not able to use NO, requiring lower amounts of agonist and thus resulting in higher plasma levels of NO. This is an interesting fact in research on cardiovascular diseases of women.