Reproductive health as a sentinel of chronic disease in women

Abstract

In summary, the reproductive health of women provides glimpses into subclinical processes and their future risk of chronic disease. A smoothly functioning reproductive axis, marked by regular menstruation and uncomplicated pregnancy, may portend reduced risk of cardiovascular disease. However, reproductive features associated with inefficient reproduction - later age at menarche, irregular cycles, pre-eclampsia and restricted fetal growth - may indicate lower breast cancer risk. We need further work to elucidate the endocrine, metabolic, vascular, immune and inflammatory factors shared by reproductive disorders and chronic disease. Many of the reproductive disorders overlap in definition or etiology, as in the predominance of preterm infants among the low birthweight, or the insulin resistance common to menstrual irregularity, PCOS, subfertility and gestational diabetes. The extent to which reproductive factors are independent predictors of cardiovascular and cancer risk remains to be tested. Perhaps some combination of reproductive factors will prove useful additions to breast cancer and cardiovascular disease prediction algorithms for women. Eventually, information about reproductive health might be used as a form of 'personalized medicine' to tailor health advice to women, from early in their lives, in order to change disease trajectories before they emerge as chronic disease at menopause. © 2009 Future Medicine Ltd.