Is there a golden hour for exercise in aging females? A perspective on the female-specific effects of estradiol in regulating vascular endothelial function

Sex hormones are known for their roles in reproductive health; however, they pose auxiliary actions on non-reproductive tissues such as the vasculature, notably involving the mediation of endothelial vasodilation and vasoconstriction. Abrupt declines in oestrogen during the menopausal transition have been associated with endothelial dysfunction and a subsequent increase in cardiovascular events. It should come as no surprise that participation in physical activity and exercise are recommended as common strategies to enhance endothelial function, and the effectiveness of different exercise modalities on vascular health outcomes and risk modulation has been investigated extensively. However, despite the awareness of increased cardiovascular disease (CVD) risk during and after menopause, there is conflicting evidence surrounding the efficacy of exercise as a means to enhance endothelial function in females during this critical period. This perspective article intends to discuss the current evidence relating to the female-specific influence of oestradiol on endothelial function, and if there is potential to elicit greater vascular benefits of exercise in late reproductive age by intervening during perimenopause.