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 nonreproductive tissues such as the vasculature, notably involving the mediation of endothelial vasodilation and vasoconstriction (1). Abrupt declines in estrogen during the menopausal transition have been associated with endothelial dysfunction and a subsequent increase in cardiovascular events (2). It should come as no surprise that participation in physical activity and exercise is recommended as a common strategy to enhance endothelial function, and the effectiveness of different exercise modalities on vascular health outcomes and risk modulation has been investigated (3–7). 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 throughout this critical period.