Introduction: Epidemiological studies suggest that postmenopausal estrogen deficiency is responsible for the increased risk of aneurysmal subarachnoid hemorrhage, while menopausal hormone therapy is protective against cerebral aneurysms. These findings indicate the critical role of estrogen in the pathophysiology of cerebral aneurysm.
Areas covered: Here, we provide a narrative review for understanding the roles of estrogen and estrogen receptors in the pathogenesis of cerebral aneurysms. A specific selective estrogen receptor modulator is a potential drug for cerebral aneurysms, since it may favorably interact with estrogen receptors while avoiding unwanted side effects related to estrogen therapy. Expert Commentary: Future investigations into the role of estrogen on cerebral aneurysm pathophysiology may lead to the development of a novel drug, which interacts with estrogen receptors to modify the pathological mechanism of cerebral aneurysm formation on postmenopausal women.
Keywords: Cerebral aneurysm; endothelial cell; estrogen; estrogen receptor; extracellular matrix; inflammation; selective estrogen receptor modulator; subarachnoid hemorrhage; vascular remodeling; vascular smooth muscle cell.