女性月经期间的所有激素变化及对人体的影响

Recent neuroimaging research suggests that female sex hormone fluctuations modulate brain activity. Nevertheless, how brain network dynamics change across the female menstrual cycle remains largely unknown. Here, we investigated the dynamical complexity underlying three menstrual cycle phases (i.e., early follicular, pre-ovulatory, and mid-luteal) in 60 healthy naturally-cycling women scanned using resting-state fMRI. Our results revealed that the pre-ovulatory phase exhibited the highest dynamical complexity (variability over time) across the whole-brain functional network compared to the early follicular and mid-luteal phases, while the early follicular showed the lowest. Furthermore, we found that large-scale resting-state networks reconfigure along menstrual cycle phases. Multilevel mixed-effects models revealed age-related changes in the whole-brain, control, and dorsal attention networks, while estradiol and progesterone influenced the whole-brain, DMN, limbic, dorsal attention, somatomotor, and subcortical networks. Overall, these findings evidence that age and ovarian hormones modulate brain network dynamics along the menstrual cycle.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder linked to impaired cognition and altered dopamine neurotransmission. Emerging evidence suggests that women with ADHD experience pronounced hormone-related difficulties, with menstrual cycle-related changes in mood and cognition interfering with daily functioning and diminishing treatment efficacy. This review examines the influence of hormonal fluctuations during the menstrual cycle on cognitive functioning and ADHD symptomatology in women. A comprehensive literature search of Ovid EmBase identified studies published between 2015 and 2025 examining cognitive performance, including attention, executive functioning, working memory, and inhibitory control, across menstrual cycle phases in women with or without ADHD. Twenty-nine studies met inclusion criteria. Neurobiological measurements included hormonal assays, neuroimaging, and neurotransmitter models. Seven studies in non-clinical populations suggested that attentional processing was enhanced during the mid-luteal phase, which may be linked to higher progesterone levels. By contrast, four studies in women with ADHD and six studies in women with mood-related disorders, such as PMS or PMDD, consistently observed impairments in attention, executive function, and impulsivity during the mid-luteal and pre-menstrual phases. These objective findings parallel subjective reports of worsened cognition, heightened mood symptoms, and diminished medication efficacy during the luteal phase. Current evidence indicates that ADHD-related cognitive functioning fluctuates with the menstrual cycle, with impairments particularly evident in women with ADHD and/or comorbid mood disorders. These changes may reflect increased sensitivity to allopregnanolone, peri-menstrual oestrogen withdrawal, and the absence of compensatory neural adaptations observed in non-clinical populations. However, findings remain preliminary and sometimes contradictory due to methodological heterogeneity and small sample sizes. Further research is needed to clarify these mechanisms and, importantly, to translate theoretical insights into clinical application through female-specific diagnostic procedures and treatment strategies.

Abstract Many studies have shown that the human endocrine system modulates brain function, reporting associations between fluctuations in hormone concentrations and brain connectivity. However, how hormonal fluctuations impact fast changes in brain network organization over short timescales remains unknown. Here, we leverage a recently proposed framework for modeling co-fluctuations between the activity of pairs of brain regions at a framewise timescale. In previous studies we showed that time points corresponding to high-amplitude co-fluctuations disproportionately contributed to the time-averaged functional connectivity pattern and that these co-fluctuation patterns could be clustered into a low-dimensional set of recurring “states.” Here, we assessed the relationship between these network states and quotidian variation in hormone concentrations. Specifically, we were interested in whether the frequency with which network states occurred was related to hormone concentration. We addressed this question using a dense-sampling dataset (N = 1 brain). In this dataset, a single individual was sampled over the course of two endocrine states: a natural menstrual cycle and while the subject underwent selective progesterone suppression via oral hormonal contraceptives. During each cycle, the subject underwent 30 daily resting-state fMRI scans and blood draws. Our analysis of the imaging data revealed two repeating network states. We found that the frequency with which state 1 occurred in scan sessions was significantly correlated with follicle-stimulating and luteinizing hormone concentrations. We also constructed representative networks for each scan session using only “event frames”—those time points when an event was determined to have occurred. We found that the weights of specific subsets of functional connections were robustly correlated with fluctuations in the concentration of not only luteinizing and follicle-stimulating hormones, but also progesterone and estradiol.

Although the fluctuations of hormones over the menstrual cycle are well recognized, this study investigated the variability in these patterns for individual women. This study examined a set of daily blood hormone results from an underlying data set of previous research. Hormones included follicle-stimulating hormone (FSH), luteinizing hormone, progesterone, and estradiol taken over one menstrual cycle in 20 women of reproductive age (age 20–36 years), with ultrasound-confirmed ovulation. Although every woman’s profile of hormone changes was consistent with the expected physiological sequence of events, there was notable variability in the timing and peak levels. Variability in the length of the follicular phase was greater than in the length of the luteal phase, with the greater part of the variability in the cycle length being explained by variability in the follicular phase. Lower levels of FSH at the beginning of the cycle were associated with a longer follicular phase. Variability in the timing of events around ovulation was relatively consistent across all women. Variability in the length of the luteal phase was associated with the duration of elevated levels of progesterone. Differences were seen in the extent to which FSH increased at the end of the cycle. This study suggests the variability of the first part of the follicular phase may be due to initial FSH changes. Understanding the variability of menstrual cycle hormones is relevant for all women. Identifying subclinical ovulatory disturbances and variability is important to understand female health, across different populations including menstruating women and female athletes.

Many studies have shown that the human endocrine system modulates brain function, reporting associations between fluctuations in hormone concentrations and both brain activity and connectivity. However, how hormonal fluctuations impact fast changes in brain network structure over short timescales remains unknown. Here, we leverage “edge time series” analysis to investigate the relationship between high-amplitude network states and quotidian variation in sex steroid and gonadotropic hormones in a single individual sampled over the course of two endocrine states, across a natural menstrual cycle and under a hormonal regimen. We find that the frequency of high-amplitude network states are associated with follicle-stimulating and luteinizing hormone, but not the sex hormones estradiol and progesterone. Nevertheless, we show that scan-to-scan variation in the co-fluctuation patterns expressed during network states are robustly linked with the concentration of all four hormones, positing a network-level target of hormonal control. We conclude by speculating on the role of hormones in shaping ongoing brain dynamics.

Cyclic fluctuations in hypothalamic-pituitary-gonadal axis (HPG-axis) hormones exert powerful behavioral, structural, and functional effects through actions on the mammalian central nervous system. Yet, very little is known about how these fluctuations alter the structural nodes and information highways of the human brain. In a study of 30 naturally cycling women, we employed multidimensional diffusion and T1-weighted imaging during three estimated menstrual cycle phases (menses, ovulation, mid-luteal) to investigate whether HPG-axis hormone concentrations co-fluctuate with alterations in white matter (WM) microstructure, cortical thickness (CT), and brain volume. Across the whole brain, 17β-estradiol and luteinizing hormone (LH) concentrations were directly proportional to diffusion anisotropy (μFA), while follicle-stimulating hormone (FSH) was directly proportional to cortical thickness. Within several individual regions, FSH and progesterone demonstrated opposing associations with mean diffusivity and cortical thickness. These regions mainly reside within the temporal and occipital lobes, with functional implications for the limbic and visual systems. Lastly, progesterone was associated with increased tissue and decreased CSF volumes, with total brain volume remaining unchanged. These results are the first to report simultaneous brain-wide changes in human WM microstructure and cortical thickness coinciding with menstrual cycle-driven hormone rhythms. Strong brain-hormone interaction effects may not be limited to classically known HPG-axis receptor-dense regions.

Abstract Diabetes mellitus is one of the most prevalent chronic diseases. Previous studies have shown differences in glucose metabolism between males and females. Moreover, difficulties in medication adherence have been reported in females with type 2 diabetes. These observations are believed to be caused by fluctuations in sex hormone concentrations during the menstrual cycle. Furthermore, gut microbiota is linked to female host metabolism and sex hormone production. Understanding the interactions between fluctuating hormone concentrations during the menstrual cycle, gut microbiota, and glucose metabolism in humans is significant because of the increasing prevalence of diabetes and the consequent need to expand preventive efforts. A literature search was performed to determine and summarize the existing evidence, deduce future research needs to maintain female health, and investigate the relationship between the physiological menstrual cycle and glucose metabolism. Studies from 1967 to 2020 have already examined the relationship between variations during the menstrual cycle and glucose metabolism in healthy female subjects using an oral-glucose tolerance test or intravenous glucose tolerance test. However, the overall number of studies is rather small and the results are contradictory, as some studies detected differences in glucose concentrations depending on the different cycle phases, whereas others did not. Some studies reported lower glucose levels in the follicular phase than in the luteal phase, whereas another study detected the opposite. Data on gut microbiota in relation to the menstrual cycle are limited. Conflicting results exist when examining the effect of hormonal contraceptives on the gut microbiota and changes in the course of the menstrual cycle. The results indicate that the menstrual cycle, especially fluctuating sex hormones, might impact the gut microbiota composition. The menstrual cycle may affect the gut microbiota composition and glucose metabolism. These results indicate that glucose tolerance may be the greatest in the follicular phase; however, further well-conducted studies are needed to support this assumption.

This review article summarizes the current literature investigating the effects of transient sex hormone fluctuations on large artery endothelial function, primarily concerning the menstrual cycle and the diurnal rhythm of testosterone secretion. Women and men experience acute fluctuations in circulating levels of sex hormones, and there is substantial variability in circulating levels of sex hormones in both sexes. These acute fluctuations in sex hormones generally coincide with alterations in endothelial cell function and in vivo endothelium-dependent vasodilation, and we see that the timing of these acute fluctuations match the timing of cardiovascular events in both women and men. It is important to improve our understanding of how acute fluctuations in sex hormones affect endothelial function in women and men, as clinical cardiovascular complications coincide with these changes. This would allow for the identification of novel therapeutic targets and aid in the prevention and treatment of cardiovascular disease.

BACKGROUND Female sex hormones may play a crucial role in the occurrence of cycle-related mood disorders. However, the literature is inconsistent and methodologically stringent observational studies on the relationship between sex hormones and negative affect are lacking. METHODS In this longitudinal multisite study from Hannover, Germany, and Zurich, Switzerland, we examined oestrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone serum levels in association with negative affect as measured with the Positive and Negative Affect Schedule (PANAS). Negative affect and hormone assays were collected at four consecutive time points comprising menstrual, pre-ovulatory, mid-luteal and premenstrual phase across two cycles (n=87 and n=67 for the first and second cycles). The Beck Depression Inventory (BDI) was assessed once prior to the first cycle and included as a secondary measure. RESULTS Mean negative affect scores did not significantly fluctuate across both cycles and there was in particular no symptom increase premenstrually. No sex hormone consistently related to repeated measures of negative affect across two consecutive cycles. The BDI sum-score assessed at baseline was not related to hormone levels across the first cycle. CONCLUSIONS This is the first multisite longitudinal study on the association between negative affect and sex hormone levels encompassing two consecutive menstrual cycles. Negative affect did not fluctuate across the cycle and there was no direct and uniform association between sex hormones and self-reported negative affect. These findings suggest that moderators such as personality traits and epigenetics should be considered in future research.

Gonadal hormone receptors are widely distributed across the brain, yet their influence on brain structure remains understudied. Here, using precision imaging, we examined four females, including one with endometriosis and one using oral contraceptives (OC), across a monthly period. Whole-brain analyses revealed spatiotemporal patterns of brain volume changes, with substantial variations across the monthly period. In typical cycles, spatiotemporal patterns were associated with serum progesterone levels, while in cycles with endometriosis and during OC intake, patterns were associated with serum estradiol levels. The volume changes were widely distributed rather than region-specific, suggesting a widespread but coordinated influence of hormonal fluctuations. These findings underscore the importance of considering diverse hormonal milieus beyond typical menstrual cycles in understanding structural brain dynamics and suggest that hormonal rhythms may drive widespread structural brain changes. Heller et al. showed dense longitudinal imaging in four females, including one with endometriosis and one using oral contraceptives, and the finding that different hormonal milieus influence widespread brain volume changes linked to progesterone or estradiol.

With the increasing participation of women in sports, research on women’s sports has gradually increased but remains less than that on men’s sports as a whole. The menstrual cycle is a unique physiological feature of women. Hormone fluctuations during this period can have a potential effect on exercise performance through various mechanisms, including substrate metabolism, cardiopulmonary function, body temperature regulation, and psychological factors. This narrative review analyzed the changes in aerobic performance, anaerobic performance, and strength during the menstrual cycle by analyzing domestic and international research on exercise performance at different phases of menstrual cycle and preliminarily discussed the influence of menstrual cycle-related factors on exercise performances. Results show that although a considerable proportion of female athletes believe that their exercise performance is affected by their menstrual cycle (poor exercise performance during the early follicular and midluteal phases), various exercise performance during different phases of the menstrual cycle are inconsistent. Such variability may be related to the inconsistency of current research methods, such as the method for identifying menstrual cycle phases. Current research focuses on aerobic, anaerobic, and strength indices, and only a few studies on speed, sensitivity, and flexibility exist. Studies that support the differences in transport performance during different menstrual cycle phases have the overall consensus that aerobic performance in the follicular phase is higher than that in the luteal phase and the effect of hormonal fluctuations on aerobic performance during the menstrual cycle can be reduced by ingesting glucose. Maximum strength is poorest during the luteal phase. However, strength training can be planned on the basis of the hormone fluctuation characteristics of the menstrual cycle. Most studies have shown that anaerobic performance is unaffected by the menstrual cycle. Further research is needed to quantify exercise performance during different phases of the menstrual cycle and determine the relevant factors affecting exercise performance to understand women’s exercise performance fully. It provides help to athletes in regulating their physiological cycle before games and ensuring their maximum performance during competition.

Simple Summary Hormonal fluctuations during the menstrual cycle can impact a woman’s performance on tasks that require memory, attention, and cognitive processing speed. These changes could also help explain cognitive differences between women and men. In this study, we tested 71 young adults on a series of cognitive tasks. Women were assessed twice: during the menstrual phase (low hormone levels) and the pre-ovulatory phase (when oestradiol is high). Men were tested once. We found that women performed better on memory and attention tasks just before ovulation. Differences in processing speed between men and women were observed only during women’s menstrual phase. These differences disappeared when oestradiol levels were higher (before ovulation). In men, better performance was also linked to higher oestradiol and progesterone. Our results suggest that oestradiol plays an important role in cognitive changes during the menstrual cycle. Recognising hormonal variation, especially in oestradiol, may be essential when studying sex differences in cognition.

The menstrual cycle affects the autonomic nervous system (ANS), cognition, and emotional valence in all biological women. There exists a complex relationship between hormonal fluctuations, ANS, cognition, and emotional valence during the different phases of the menstrual cycle, which includes menstruation, the follicular phase, ovulation, and the luteal phase. Hence, this narrative review is an attempt to comprehensively understand the effects of the menstrual cycle on the structural and functional integrity of the ANS. In order to provide a comprehensive understanding of the complex relationship between the menstrual cycle, hormonal fluctuations, and ANS function in biological women, this review examines key parameters, including heart rate variability (HRV), baroreflex sensitivity (BRS), muscle sympathetic nerve activity (MSNA), and pupillary light reflex (PLR), to investigate how these physiological systems are dynamically influenced by the cyclical changes in hormone levels and how these fluctuations impact various physiological and psychological outcomes, such as mood, cognition, and emotional regulation. There have been several studies previously performed to assess these parameters during different phases of the menstrual cycle. However, the results have been contradictory; therefore, this review explores possible reasons behind these inconsistent results, with likely reasons including irregularity in the menstrual cycles and differences in hormonal fluctuations between different women during similar phases of the menstrual cycle. Overall, there appears to be evidence to suggest that the menstrual cycle has both direct and indirect effects on ANS, cognition, and emotional valence, whilst measures of ANS may provide a means for assessing the effect of the menstrual cycle.

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Abstract This study explores how menstrual cycle phases influence cardiovascular performance and VO₂ max in women. Hormonal changes, particularly fluctuations in estrogen and progesterone, impact oxygen transport, cardiac output, and exercise tolerance. While some studies suggest reduced VO₂ max during the luteal phase, others report negligible differences, indicating a research gap in standardized assessment. This study investigates the influence of menstrual cycle phases on cardiovascular performance and maximal oxygen uptake (VO₂ max) in women. Hormonal fluctuations, particularly estrogen and progesterone, are hypothesized to affect oxygen transport, cardiac output, and endurance capacity. While some studies suggest reduced VO₂ max during the luteal phase, others report negligible differences, highlighting methodological inconsistencies. This paper aims to synthesize existing literature, identify research gaps, and propose a structured methodology to clarify the relationship between menstruation and aerobic performance.

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Sex hormones, particularly estrogen and progesterone, undergo continuous fluctuations throughout a woman's life, beginning at puberty and extending through the menstrual cycle, pregnancy, and menopause. These hormonal variations significantly influence gingival health, leading to various periodontal conditions. During puberty, elevated levels of estrogen and progesterone enhance blood circulation to the gingival tissues, increasing their sensitivity to plaque and resulting in puberty gingivitis. This condition is characterized by gingival enlargement, redness, and bleeding. Throughout the menstrual cycle, hormonal fluctuations can cause menstrual gingivitis, presenting as inflamed and bleeding gums, typically occurring prior to menstruation and subsiding thereafter. Pregnancy induces substantial hormonal changes, with heightened estrogen and progesterone levels exacerbating gingival inflammation. This often leads to pregnancy gingivitis, marked by swelling, bleeding, and tenderness of the gums. In some cases, a localized overgrowth known as a pyogenic granuloma or "pregnancy tumor" may develop on the gingiva. The use of oral contraceptives, which alter hormonal levels, has been associated with increased gingival inflammation and exudate, similar to the effects observed during pregnancy. Menopause brings a significant decline in estrogen levels, leading to various oral health issues such as dry mouth (xerostomia), a burning sensation in the mouth, and an increased risk of osteoporosis affecting the alveolar bone supporting the teeth. These changes contribute to a heightened susceptibility to periodontal diseases in post-menopausal women. The influence of estrogen and progesterone on the immune response, oral microbial composition, bone density, and enzymes like collagenase plays a crucial role in modulating gingival inflammation and the risk of periodontal diseases. Understanding these hormonal impacts is essential for developing effective prevention and treatment strategies for maintaining optimal gingival health in women across different life stages.

Hormonal changes are associated with healthy female in different stages of her life, such as menarche, pregnancy, and menopause. The main female hormones (i.e., Estrogen and progesterone) act as modulators and effectors during different phases of menstrual cycle. Additionally, these hormones were shown to affect the body inflammatory status. Few studies addressed gingivitis and female hormones. Although gingivitis main cause is dental biofilm, female hormones might modulate this inflammation. If no treatment provided, gingivitis might proceed to periodontitis and alveolar bone destruction may appear. was to assess the changes in gingival inflammation, and salivary pH in relation to changes in hormonal levels during different menstrual phases in young females. 25 healthy young females with regular menstrual cycles were included. The volunteers were invited to visit the clinic during their 2nd day of menstrual cycle (menses phase (MP)). During the visit, plaque index (PLI) and gingival index (GI) were scored. Additionally, salivary pH was calculated. Follow-up readings were taken on the 20th day of menstruation (pre-menstrual phase (PMP)). The difference in PLI, GI and salivary pH was analysed using t-test and chi-square test. The study showed that PLI and GI increased statistically significantly with increasing levels of female hormones during PMP and decreased during MP (P-value = 0.012 for PLI and 0.0003 for GI). Salivary pH decreases slightly during PMP and saliva becomes more alkaline during MP (P-value = 0.015). The study showed increased gingival inflammation and plaque accumulation during the premenstrual period. It is recommended to raise awareness of gingival inflammation among adult females to prevent progressive changes of periodontitis. However, due to the limited sample size of this study, a comprehensive population-based study is needed to support the findings.

The menstrual cycle is a complex physiological process regulated by hormonal fluctuations, preparing the female reproductive system for potential conception. This paper provides a comprehensive overview of the menstrual cycle, its phases, hormonal changes, and associated psychological, emotional, and physiological effects. The menstrual cycle consists of four primary phases: menstruation, follicular, ovulation, and luteal, each governed by the interplay of estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Various factors, including genetics, stress, and nutrition, influence cycle regularity and health. Abnormal menstrual patterns such as amenorrhea, menorrhagia, and dysmenorrhea are discussed, along with their underlying causes and health implications. The paper also explores the emotional and psychological changes experienced during different phases, including mood swings, cognitive variations, and their impact on mental health. Additionally, the study highlights menstrual hygiene practices and their role in maintaining reproductive health. Understanding the menstrual cycle’s dynamics is essential for early detection of menstrual irregularities and ensuring overall well-being. Future research should focus on improving menstrual health awareness, addressing associated disorders

The menstrual cycle induces a wide range of physiological changes in the skin and its appendages, often overlooked in dermatologic practice. Catamenial dermatoses, influenced by hormonal fluctuations, present with cyclical skin manifestations. This review explores the underrecognized intersection between menstruation and dermatology, highlighting changes across menstrual phases such as variations in hydration, lipid levels, pigmentation, hair and nail growth, and sweat gland activity. Autoimmune progesterone dermatitis and estrogen dermatitis are key examples of hormone-induced skin responses. These conditions have complex pathogenesis, variable clinical features, and present diagnostic challenges. Treatment options include hormonal suppression and newer therapies such as omalizumab. The review also examines the link between menstruation and increased susceptibility to infections, as well as the flare of preexisting dermatoses. Conditions such as acne, psoriasis, and atopic dermatitis may worsen in relation to hormonal shifts. Understanding the cyclical responses of skin to endogenous hormones can help clinicians better identify and manage hormone-responsive dermatoses, ultimately improving diagnosis and patient care.

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Understanding the global prevalence and phenotypic features of polycystic ovary syndrome (PCOS) is important as geographic factors and ethnic variations can significantly alter the clinical syndrome. The aim of this study was to determine and evaluate the luteinizing hormone/follicle-stimulating hormone ratio (LH/FSH) in women with PCOS during therapy on selected endocrine and biochemical parameters. Women with PCOS were included in the study and were classified into two groups: women without therapy (de novo) and women with therapy for PCOS. ESHERE/ASRM criteria that require the presence of two out of three criteria: ovulatory dysfunction, hyperandrogenism, and morphological PCOS detected by ultrasound diagnostics. Electrochemiluminescence immunoassay (ECLIA) was used for FSH and insulin analysis. The enzymatic method was used to analyze the biochemical profile. There was a significant difference between the two groups in terms of the LH/FSH ratio (2.56 vs. 2.41, P=0.043), glucose (6.23 vs. 5.12, P=0.003), insulin (19.21 vs. 7.35, P=0.000), IR (3.22 vs. 1.42, P=0.000), cholesterol (5.97 vs. 4.92, P=0.002), and LDL (3.56 vs. 2.56, P=0.001). The data suggest that patients with PCOS therapy have reduced hyperinsulinemia and insulin resistance. There was a significant correlation between the LH and FSH in the de novo group, as well as the correlation between hormone levels and LH/FSH ratio in both groups. Patients with PCOS therapy have a tendency for normal body weight and reduction of severe obesity compared to patients without therapy. Clinical features such as regular menstrual cycle and the prevalence of acne and hirsutism are not significantly different between groups. PCOS cause irregularities of the menstrual cycle, the appearance of clinical manifestations, especially changes of LH/FSH ratio. Therapy for PCOS contributes to better regulation of endocrine and biochemical parameters, especially in the reduction of hyperinsulinemia, insulin resistance, and reduced LH/FSH ratio.

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Background and Objectives: The Quantum Menstrual Health Monitoring Study will measure four key reproductive hormones in the urine (follicle-stimulating hormone, FSH; estrone-3-glucuronide, E13G; luteinizing hormone, LH; and pregnanediol glucuronide, PDG) to characterize patterns that predict and confirm ovulation, referenced to serum hormones and the gold standard of the ultrasound day of ovulation in participants with regular cycles. These normal cycles will provide a reference for comparison to irregular cycles in subjects with polycystic ovarian syndrome (PCOS) and athletes. Materials and Methods: Participants will track their menstrual cycles for 3 months and be provided with an at-home urine hormone monitor (Mira monitor) to predict ovulation. The day of ovulation will be confirmed with serial ultrasounds completed in a community clinic. Urine results will be compared to serum hormone values. Other markers of menstrual health, such as bleeding patterns and temperature changes, will be determined using a customized app. Three groups will be recruited. Group 1 will include those with consistent regular cycle lengths (between 24–38 days), and will be compared to two groups with irregular cycle lengths (with increased cycle length variability and longer cycles). Group 2 will include those with polycystic ovarian syndrome (PCOS) with irregular cycles and Group 3 will include individuals participating in high levels of exercise with irregular cycles. Hypothesis: The Mira monitor quantitative urine hormone pattern will accurately correlate with serum hormonal levels and will predict (with LH) and confirm (with PDG) the ultrasound day of ovulation in those with regular cycles as well as those with irregular cycles. Rationale: Once the ultrasound validation is complete, tools like the Mira monitor with a customized app may become a new standard for at-home and remote clinical monitoring of the menstrual cycle without having to use labor-intensive follicular-tracking ultrasound or follow serum hormone changes. Conclusions: Precision monitoring of the menstrual cycle is expected to impact individuals who want to increase their menstrual health literacy and guide decisions about fertility.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disease among women of childbearing age. Women with PCOS frequently experience reproductive complications, which are closely associated with the concentration of vitamin D. This systemic review and meta‐analysis were conducted to elucidate the possible effect of vitamin D supplementation in PCOS women on hormones, including Luteinizing hormone (LH), follicle‐stimulating hormone (FSH), the ratio of LH and FSH (LH/FSH), and the menstrual cycle regularization.

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Researchers have observed potential confounding factors, such as stress, physical activity, and diet, that may influence the relationship between screen time and menstrual health. Excessive screen use can disrupt physiological functions, including the regulation of menstrual cycles. Emerging evidence suggests that lifestyle factors associated with prolonged screen exposure—such as increased stress, sedentary behavior, and disrupted sleep—can negatively impact hormonal regulation, potentially leading to menstrual irregularities. Early health intervention can be the implication of the same. In order to promote improved physical and mental health, create a balanced lifestyle, and improve general well-being, the public can be educated on screen time management, sleep hygiene, and healthier digital habits.

Introduction: The menstrual cycle is a well known physiological model to study the ovarian steroid hormones, influencing cognitive functions like Working Memory (WM). Hormonal fluctuation during the menstrual cycle also affects menstrual distress-related symptoms, which indecently could the cognitive functions. However, the data were inconclusive regarding the change in WM functions during different phases of the menstrual cycle and the correlation of various WM functions with menstrual distress-related symptoms. Aim: To examine the verbal and visuospatial WM functions during the proliferative (day 10-14) and secretory phase (day 21-25) of the menstrual cycle and to correlate various WM functions with menstrual distress symptoms scores. Materials and Methods: A cross-sectional, observational study was carried out in the Department of Physiology at VMMC and Safdarjung Hospital, New Delhi, India, over a period of 18 months, from November 2020 to May 2022. A total of 40 young adult females with a history of regular menstrual cycles were selected for the study. Computerised software-based dual-task n-back WM tasks were given twice in the same menstrual cycle: first, the proliferative (day 10-14) and second, the secretory phase (day 21-25). In addition, a standardised Menstrual Distress Questionnaire (MDQ) based on various menstrual distress symptoms was also administered to each subject after completion of the WM task, first in the proliferative (day 10-14) and second, in the secretory phase (day 21-25). Based on MDQ, a score was calculated, a Menstrual Distress Score (MDS). Descriptive statistics such as mean, median, standard deviation, and mode were calculated and Pearson’s coefficient/ Spearman’s rank correlation coefficient was used to assess the correlation WM parameters with MDS. Data was compiled and analysed using the statistical software Graph PadPrism. Results: The mean age of the study population was 23.4 years with an average menstrual cycle length of 30 days. In the WM task, the ‘overall proportion of correct’ responses across all the tasks were significantly better in the secretory phase of the menstrual cycle than in the proliferative phase (p-value=0.040). Similarly, significantly improved performance in WM tasks during the secretory phase was also seen in the overall ‘hit rate’ of the visual target (p-value=0.020) and auditory targets (p-value=0.044). On the other hand, the correlation of WM parameters with MDS did not show any statistical significance except a significant negative correlation (r-value -0.369; p-value=0.019) between the ‘parametric sensitivity’ (subject’s ability to correctly distinguishing a target from a non target) of auditory WM of secretory phase and MDS of the proliferative phase. Conclusion: The visual and auditory WM skills were significantly improved during the secretory phase compared to the menstrual cycle’s proliferative phases in terms of the target ‘hit rate’. However, increased MDS had no significant detrimental effect on the performance of WM tasks during the normal menstrual cycle.

Sleep and menstrual cycle both are normal physiological processes in women’s life but they are regulated by different centers. Sleep is a daily rhythm whereas the menstrual cycle lasts for 28 days. During this period the estrogen peaks twice. We have shown earlier that there is an inverse relationship between estrogen and the hormone melatonin which aids sleep. Because of this menstruating women will have sleep disorders.

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Estrogen and progesterone have distinct concentrations across the menstrual cycle, each one promoting several physiological alterations other than preparing the uterus for pregnancy. Whether these physiological alterations can influence motor output during a fatiguing contraction is the goal of this review, with an emphasis on the obtained effect sizes. Studies on this topic frequently attempt to report if there is a statistically significant difference in fatigability between the follicular and luteal phases of the menstrual cycle. Although the significant difference (the P-value) can inform the probability of the event, it does not indicate the magnitude of it. We also investigated whether the type of task performed (e.g., isometric vs. dynamic) can further influence the magnitude by which exercise-induced fatigue changes with fluctuations in the concentration of ovarian hormones. We retrieved experimental studies in eumenorrheic women published between 1975 and 2019. The initial search yielded 921 studies, and after manual refinement, 46 experimental studies that reported metrics of motor output in both the follicular and luteal phases of the menstrual cycle were included. From these retrieved studies, 15 showed a statistical difference between the luteal and follicular phases (seven showing less fatigability during the luteal phase and eight during the follicular phase). The effect size was not consistent across studies and with a large range (-6.77; 1.61, favoring the luteal and follicular phase, respectively). The inconsistencies across studies may be a consequence of the differences in the limb used during the fatiguing contraction (upper vs. lower extremity), the type of contraction (isometric vs. dynamic), the muscle mass engaged (single limb vs. full body), and the techniques used to define the menstrual cycle phase (e.g., serum concentration vs. reported day of menses). Further studies are required to determine the effects of a regular menstrual cycle phase on the exercise-induced fatigability.

The cyclical nature of female sex hormones - primarily estradiol and progesterone - exerts a multidimensional influence on physiological processes relevant to sports performance. This narrative review summarizes the current understanding of how different phases of the menstrual cycle affect energy metabolism, cardiovascular dynamics, neuromuscular function, thermoregulation, and psychological responses in physically active women. Estrogen-dominant phases, especially the late follicular stage, are generally associated with enhanced aerobic capacity, improved vasodilation, mood stabilization, and more efficient motor control. Conversely, progesterone-dominant phases - most notably the mid-to-late luteal stage - are characterized by increased core temperature, fluid retention, fatigue, and greater reliance on carbohydrate metabolism. The review also evaluates the effects of hormonal contraceptives, particularly oral contraceptives, on athletic performance and training adaptations. While individual responses vary, hormonal fluctuations create predictable patterns of performance variability that can be leveraged through phase-aware training. Based on the reviewed literature, the paper suggests practical training strategies, including phase-specific adaptations, nutritional support, and attention to menstrual symptoms. The review further highlights methodological limitations in the literature, including small sample sizes, inconsistent hormone validation, and underrepresentation of elite athletes. A personalized understanding of menstrual physiology enables more effective planning of training loads and recovery strategies, benefiting both professional and recreationally active women.

 Introduction The menstrual cycle influences various physiological systems, including energy metabolism, neuromuscular function, and psychological states, which collectively impact athletic performance. Despite increased research in this area, findings remain inconsistent due to individual variability and methodological differences. This review synthesizes current evidence on the effects of menstrual cycle phases on athletic performance to identify actionable strategies for female athletes. Materials and Methods A systematic review of 35 studies published between 2019 and 2025 was conducted using PubMed and PMC databases. Inclusion criteria focused on studies examining the physiological, psychological, or performance-related effects of menstrual cycle phases. Each study was evaluated for its methodology, population, and outcomes to ensure a comprehensive analysis. Analysis of the Literature This review explores the influence of hormonal fluctuations during the menstrual cycle on energy metabolism, neuromuscular function, endurance, strength, and psychological aspects. It highlights individualized recovery strategies and long-term adaptations to phase-specific training. Conclusions Menstrual cycle phases exert significant, though variable, effects on athletic performance. While the follicular phase favors carbohydrate metabolism and high-intensity activities, the luteal phase supports fatigue resistance and fat utilization. Personalized training protocols informed by hormonal profiling can optimize outcomes, though further research is needed to standardize methodologies and evaluate long-term adaptations.

Women's increased risk for depression during reproductive transitions suggests an involvement of the hypothalamic-pituitary-ovarian (HPO) axis. This is the first systematic review and meta-analysis of HPO functioning in female mood disorders. Inclusionary criteria were: i) women suffering from premenstrual dysphoric disorder (PMDD) or a depressive disorder, ii) assessment of HPO-axis related biomarkers, iii) a case-control design. Sixty-three studies (N=5,129) were included. There was evidence for PMDD to be paralleled by lower luteal oestradiol levels. Women with depression unrelated to reproductive transition showed lower testosterone levels than healthy controls and there was some evidence for lower dehydroepiandrosterone sulfate levels. There were no differences in HPO-related parameters between women with pregnancy, postpartum, and perimenopausal depression and controls. Women with PMDD and depression unrelated to reproductive transitions exhibit specific changes in the HPO axis, which potentially contribute to their symptoms. Further research into reproductive mood disorders characterised by extreme endocrine changes is warranted.

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Objectives of the study: to investigate the peculiarities of the steroid hormone status in girls with menstrual function disorders, depending on comorbid psychopathology.Materials and methods. A total of 174 girls with menstrual function disorders (78 with abnormal uterine bleedings (AUB) and 96 with oligomenorrhea (OM)) were examined. The diagnosis of psychopathology was determined based on the clinical presentation at the time of examination. The comparison group consisted of 35 girls with a normal menstrual cycle.The laboratory examination included the assessment of estradiol, testosterone, cortisol (C), and dehydroepiandrosterone sulfate (DHEA-S) levels. The C/DHEA-S ratio was calculated using the unprocessed raw values. Results. Menstrual function disorders are often associated with hypoestrogenemia, a prevalent phenomenon. It was observed in almost a third of patients with AUB, whereas in girls with OM this number was significantly higher. Significant reduced values are found in girls with accompanying depressive states, especially in cases of AUB and OM. In instances of AUB and OM, the number of individuals with elevated levels of testosterone increased by 1.97–2.2 times in the presence of psychopathology. DHEA-S in patients with AUB was reduced in more than half of the girls, while in patients with OM it varies evenly in both directions, regardless of the presence or absence of psychopathology. A C level were more often reduced than increased, and achieves statistical significance when OM combined with neurotic disorders and AUB combined with depressive states. The C/DHEA-S ratio, as a stress indicator, was statistically significantly elevated in patients with AUB. This may suggest more pronounced manifestations of stress in patients with AUB than in girls with OM and a higher adaptability of the girls’ bodies with OM.Conclusions. Thus, the understanding of the role of reproductive steroids in the development of menstrual function disorders during adolescence has been deepened. Distinctive features of their interrelations in the presence of psychopathology have been identified. The impact of cortisol and DHEA-S, as well as C/DHEA-S ratio, on mental well-being in endocrine-related gynecological disorders in girls has been established

Abstract Studies have compared HPA and HPG stress reactivity across the follicular and luteal phases to assess the menstrual impact of estradiol and progesterone fluctuations. Ovulatory shifts in baseline and stressor-induced testosterone among athletic women offer a new framework to explore these responses. Here we investigated menstrual variation in baseline testosterone as a predictor of the acute testosterone and cortisol response to laboratory stressors in female athletes. Using a semi-randomized crossover design, thirty athletic women completed a physical (4 × 6-s bike sprints) and psychological (5 × 2-min cognitive tests with social evaluation) stressor on day seven (D7), 14 (D14), and 21 (D21) of a menstrual cycle. Baseline fluctuations and acute changes in salivary testosterone and cortisol were measured. The D14 testosterone response to both stressors (13.7%) exceeded D7 (7.3%) and D21 (7.0%), whereas cortisol was less responsive on D14 (9.8%) than D7 (13.0%) and D21 (12.0%); all moderate to large effect size differences (p < 0.01). Baseline testosterone, which presented large individual and menstrual variation with a D14 peak, was significantly related (moderate correlations) to testosterone and cortisol stress reactivity on a between-person level. Both outcomes were related (weak correlations) to within-person fluctuations in baseline testosterone, but these effects were mediated by testing day. In conclusion, menstrual variation in baseline testosterone concentration correlated with testosterone and cortisol reactivity to a physical and psychological stressor. Thus, gradients of stressor-induced hormonal change showed some dependency to endogenous testosterone, both individual differences and fluctuations over time, among naturally cycling athletic women. Lay summary The female menstrual cycle is accompanied by dramatic shifts in estradiol and progesterone concentration, but less is known about testosterone variability and its role in stress regulation. In this study, menstrual fluctuations in baseline testosterone concentration correlated with acute testosterone and cortisol reactivity to laboratory stressors.

The human tendency to share goods with others at personal costs declines across the perceived social distance to them, an observation termed social discounting. Cumulating evidence suggests that social preferences are influenced by the agent's neurohormonal state. Here we tested whether endogenous fluctuations in steroid hormone compositions across the menstrual cycle were associated with differences in generosity in a social discounting task. Adult healthy, normally-cycling, women made incentivized decisions between high selfish rewards for themselves and lower generous rewards for themselves but also for other individuals at variable social distances from their social environment. We determined participants' current levels of menstrual-cycle-dependent steroid hormones via salivary sampling. Results revealed that the increase in progesterone levels as well as the decrease in estradiol levels, but not changes in testosterone or cortisol, across the menstrual cycle, accounted for increased generosity specifically toward socially close others, but not toward remote strangers.

Hormonal functioning against the background of stress is almost the most discussed problem in Ukraine today. The menstrual cycle as a vital indicator of life activity reacts sharply to changes in the environment. Russian military aggression in Ukraine forced the majority of the population to experience the hardships of war. Research of hormonal support of menstrual cycle disorders in the emergency situations will expand the understanding of the interaction of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes.The objective: to compare the hormonal determinants of stress-related menstrual disorders in adolescent girls in the pre-war period and against the background of war.Materials and methods. 331 adolescent girls with menstrual disorders (in 2018–2021 – 184 girls and in 2022–2024 – 147 girls) aged 11–17 years were examined. 149 girls were diagnosed with abnormal uterine bleeding (AUB) (84 girls before the war and 65 – after the war), and 182 patients with oligomenorrhea (OM) (100 adolescents before the war and 82 – after the war). All patients lived in the territory of the city of Kharkiv and the Kharkiv region, which are subject to constant military attacks during the war. The hormonal examination complex included determination of blood serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone, cortisol, estradiol (E2), dehydroepiandrosterone sulfate (DHEA-S), and their ratios were calculated (LH/FSH, cortisol/DHEA-S, prolactin/cortisol, testosterone/cortisol, testosterone/E2).Results. In adolescents with menstrual disorders of the AUB and OM type, who were in the epicenter of constant bombardment, hormonal determinants changed. The level of stress-dependent hormones probably increased. These are the DHEA-S and prolactin concentrations. Accordingly, the ratio prolactin/cortisol increased and ratio cortisol/DHEA-S decreased, which indicates an increased resistance to a stressful situation. Being in a zone of armed conflict leads to the classic relationship between cortisol and DHEA-S, their correlation appears. Sex hormones also participate in the reaction to a stressful situation, and in AUB – testosterone, and in OM – E2. In girls in a zone of constant air raids and bombardments, against the background of a strong positive relationship between cortisol and DHEA-S, a rather weak correlation between cortisol and testosterone is found, which may indicate a less sensitive relationship between stress and sex hormones.Conclusions. Menstrual disorders are accompanied by impaired regulation of the pituitary-adrenal and pituitary-gonadal axes. Being in a zone of armed conflict increases the tension of stress-dependent and sex hormones in this contingent of patients, which can provoke a complicated course of AUB and OM.

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Background The luteinizing hormone receptor (LHR) plays a pivotal role in regulating human follicular development and steroidogenesis through temporal and cell-specific expression on theca (TCs) and granulosa cells (GCs). Although LH-like activity (i.e., LH and/or human chorionic gonadotropin (hCG)) has long been incorporated into ovarian stimulation (OS) regimens, its precise physiological role in human folliculogenesis remains poorly defined. Recent large randomised clinical trials (RCT) have failed to demonstrate a consistent benefit of exogenous LH-like activity during OS, suggesting incomplete understanding of LHR-mediated actions in normo-gonadotropic women. Objective To provide a new mechanistic interpretation of the published data from the Rainbow RCT (Fernández Sánchez et al., 2022 (9)), which evaluated the effect of increasing doses of recombinant hCG (rhCG) as LH-like activity co-administration during OS, and to formulate a hypothesis that explains its divergent hormonal responses and reproductive outcomes. Outcome of the Rainbow trial In the Rainbow RCT, increasing doses of (rhCG) added to recombinant FSH (rFSH, i.e., rFSH-Δ) resulted in a dose-dependent reduction in the number of good-quality blastocysts and ongoing pregnancy rates, as well as paradoxical endocrine patterns. Androstenedione, 17-OH-progesterone (17OH-P4), testosterone, and oestradiol (E2) increased dose-dependently, whereas progesterone (P4), inhibin-A, and inhibin-B declined. Hypothesis These findings suggest attenuation of GC function exerted by rhCG despite preserved or enhanced TC activity. The divergent hormonal responses observed reflect fundamental differences in LHR expression, density, and downstream signalling between GCs and TCs. During OS, FSH induces LHR expression in GCs, potentially leading to distinct receptor clustering and susceptibility to biased agonism by different LH or hCG isoforms. Constant exposure to rhCG—as opposed to the physiological pulsatile LH pattern—may further alter receptor dynamics, contributing to selective attenuation of GC-function whilst maintaining TC responsiveness. Conclusion The Rainbow RCT may offer the first in vivo evidence supporting a temporal and cell type–specific difference in LHR function in human TCs and GCs. These data call for renewed investigation into LHR regulation, glycosylation, and receptor density in human immature GC and TC under both natural and stimulated conditions. Clarifying these mechanisms will be essential to optimizing gonadotropin combinations for OS and to advancing understanding of ovarian physiology. Clinical Trial Registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-003810-13/results, identifier 2017-003810-13.

Background Hormonal fluctuations during the menstrual cycle (and their suppression) are accompanied by altered mood, cognition, and sleep, yet their relationship to subjective sleep quality and glymphatic function - a sleep- dependent brain waste-clearance pathway that involves perivascular spaces (PVS) - is unclear. Methods We examined daily oestradiol, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), subjective sleep quality, and MRI-derived PVS volume (PVSV) in a single healthy woman across two 30-day periods: during her physiological menstrual cycle and, one year later, under oral contraceptive pill (OCP) use. We employed linear regression models to examine whether hormones are associated with sleep quality and PVSV, and whether they moderate the sleep quality–PVSV association during the physiological menstrual cycle. Subsequently, we conducted permutation-based Spearman rank correlations to assess whether day-to-day changes in sleep quality were associated with corresponding changes in PVSV across the physiological menstrual cycle and OCP use. False discovery rate (FDR) correction was used to control for multiple comparisons. Findings Higher LH levels were associated with poorer sleep quality during the physiological cycle (b=2·15, 95% CI 0·64 to 3·67, pFDR=0·028), while FSH moderated the sleep quality–PVSV association (b=−92·98, 95% CI −160·15 to −25·81, pFDR=0·034), suggesting that lower FSH was associated with lower PVSV, whereas this association reversed at elevated FSH levels characteristic of the periovulatory window. During the physiological menstrual cycle, day-to-day decreases in sleep quality were associated with synchronous increases in PVSV, driven by centrum semiovale PVSV (ρ=0·55, 95% CI 0·30 to 0·67, pperm=0·0095). This association was absent during OCP use and differed between hormonal milieus (Δρ=0·72, p=0·040). Interpretation Ovulation is characterized by poor sleep quality and reduced PVSV, potentially reflecting noradrenergic modulation. The association between sleep quality and PVSV day-to-day changes is shaped by the hormonal milieu, being absent under OCP. PVSV increase associated with poor sleep may reflect elevated sleep pressure promoting vasomotor-mediated cerebrospinal fluid inflow. Funding None

Introduction: The gonadal hormone output of females fluctuates monthly, and the endometrium, ovaries, and other genital organs undergo physical changes. It is known that women experience fluctuations in mood, energy, and cognitive abilities during different phases of their Menstrual Cycle (MC). Reaction Time (RT) is utilised to measure the ability of brain processing. The present study analysed the effect of various phases occurring in the MC on choice RT. Aim: To determine whether hormonal changes that occur throughout the MC and its phases may have any effect on cognition. Materials and Methods: An observational analytical crosssectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. The study duration was six months, from August 2021 to April 2022. A total of 50 apparently healthy females aged 18-25 years were included in the study. The subjects with a history of normal and regular MC for the last six months were included. The Choice Reaction Time (CRT) with visual and auditory stimuli was analysed using an RT apparatus developed by Anand Agencies, Pune, India. In CRT, random auditory and visual stimuli were given to the subjects, and they had to react accordingly. The RT apparatus timer started when the stimuli were given, and it automatically stopped when the subject reacted, providing the RT. RT was noted in the subjects on four occasions: two days prior to menstrual bleeding (premenstrual), the 2nd day during menstruation, the 8th day (follicular phase), and the 18th day after menstrual bleeding (luteal phase). The average value of each type of Visual Reaction Time (VRT) and Auditory Reaction Time (ART) in the various menstrual phases was noted and analysed. The level of significance in the various menstrual phases was analysed with inferential statistical study using one-way Analysis of Variance (ANOVA) and multiple comparison Tukey’s post-hoc test. Results: In the present study, prolongation of visual and ART was seen in the luteal phase. There was prolongation of VRT when the luteal phase was compared to the menstrual and follicular phase, but the difference was not statistically significant (p<0.05). While in ART, there was prolongation when the luteal phase was compared with the premenstrual, menstrual, and follicular phase, but the difference was not statistically significant (p<0.05). Conclusion: The current study reveals that there was a non significant prolongation of visual and ART in the luteal phase of MC when CRT was analysed. Thus, it was observed that there was no influence of fluctuating levels of ovarian hormones on ART and VRT in various phases of the MC while conducting CRT.

To study the dynamic changes in cognition across the human menstrual cycle, twenty, healthy, naturally-cycling women undertook a lateralized spatial figural comparison task on twelve occasions at approximately 3–4 day intervals. Each session was conducted in laboratory conditions with response times, accuracy rates, eye movements, salivary estrogen and progesterone concentrations and Profile of Mood states questionnaire data collected on each occasion. The first two sessions of twelve for the response variables were discarded to avoid early effects of learning thereby providing 10 sessions spread across each participant's complete menstrual cycle. Salivary progesterone data for each participant was utilized to normalize each participant's data to a standard 28 day cycle. Data was analysed categorically by comparing peak progesterone (luteal phase) to low progesterone (follicular phase) to emulate two-session repeated measures typical studies. Neither a significant difference in reaction times or accuracy rates was found. Moreover no significant effect of lateral presentation was observed upon reaction times or accuracy rates although inter and intra individual variance was sizeable. We demonstrate that hormone concentrations alone cannot be used to predict the response times or accuracy rates. In contrast, we constructed a standard linear model using salivary estrogen, salivary progesterone and their respective derivative values and found these inputs to be very accurate for predicting variance observed in the reaction times for all stimuli and accuracy rates for right visual field stimuli but not left visual field stimuli. The identification of sex-hormone derivatives as predictors of cognitive behaviours is of importance. The finding suggests that there is a fundamental difference between the up-surge and decline of hormonal concentrations where previous studies typically assume all points near the peak of a hormonal surge are the same. How contradictory findings in sex-hormone research may have come about are discussed.

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There is growing interest in understanding if, and how, the menstrual cycle may affect physical and cognitive performance, particularly in the context of sport and physical activity. While hormonal fluctuations are often assumed to impact cognition, especially during menstruation, empirical evidence remains inconclusive. This study aimed to investigate whether cognitive performance, mood, and symptomology vary across menstrual cycle phases and whether these effects are influenced by athletic participation level. Fifty-four females (18–40 years) categorised by athletic participation level (i.e., inactive, active, competing, elite) took part. At each key menstrual phase (menstruation / early follicular, late follicular, ovulation and mid-luteal), they completed a cognitive battery (attention, inhibition and spatial anticipation), and reported their mood and symptoms. Faster reaction times and fewer errors were committed during ovulation (p < .01), suggesting better overall performance. In contrast, reaction times were slower during the luteal phase (p < .01), but more errors were committed in the follicular phase (p = .01). Importantly, participants’ athletic level had a stronger effect on cognitive performance than phase, where inactive participants scored worse across tasks than their more active counterparts, and elite participants exhibited more significant fluctuations in cognition across phases. Mood and symptoms were worse during menstruation regardless of athletic level. However, while mood varied across phases it did not correlate with cognitive performance. Of note, participants perceived that their symptoms negatively impacted their cognitive performance during menstruation, but there was no evidence of any objective detriment to cognitive performance during this phase neither on reaction times nor errors on any task. These findings suggest the existence of mild cognitive fluctuations throughout the menstrual cycle, albeit with high individual variability, and which are incongruent with symptomology. Opposing results between perceived and measured performance challenge common assumptions about menstruation-related performance, and highlight the importance of addressing societal biases in female sport and health. The stronger effects of athletic engagement on cognitive performance, rather than phase, reinforce the cognitive benefits of an active lifestyle. This study aimed to investigate cognitive fluctuations in eumenorrheic females recruited from a range of activity levels. We demonstrate mild cognitive fluctuations throughout the menstrual cycle, which are incongruent with symptomology. And reinforce the importance of physical activity for supporting cognitive performance.

Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted. Methods The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health. Results Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause. Discussion Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.

Progesterone is a highly lipophilic gonadal hormone that can influence behavior and mental health through its receptors in the brain. Fluctuations in progesterone levels across critical periods of a femalés life are associated with increased susceptibility to mental conditions. This review highlights the effects of progestagens, including progesterone and synthetic progestins, on the brain, mood, stress, and cognition in females. The primary focus is on experimental pharmacological research that teases out the distinct effects of progestagens from those of estrogens. Additionally, the key literature on puberty, the menstrual cycle, pregnancy, perimenopause, hormonal contraceptives, and menopausal hormone therapy is reviewed, although conclusions are limited by the nested effects of progestagens and estrogens. Single study-findings suggest an influence of progesterone on amygdala reactivity related to processing of emotional stimuli and memory. In patients with premenstrual dysphoric disorder, progesterone receptor modulation improves premenstrual mood symptoms and potentially enhances fronto-cingulate control over emotion processing. The interaction between progestagens and the systems involved in the regulation of stress seems to influence subjective experiences of mood and stress. Sparse studies investigating the effects of progestin-only contraceptives suggest effects of progestagens on the brain, mood, and stress. Progesterone and progestins used for contraception can influence neural processes as myelination and neuroprotection, exerting protective effects against stroke. Concerning menopausal hormonal therapy, the effect of progestins are largely unknown. Levels of progesterone as well as type, administration route, timing, dose regimen, metabolism, and intracellular activity of progestins in hormonal contraceptives and menopausal hormonal therapy are factors whose effects remain to be elucidated. Altogether, current knowledge highlights the potential role of progestagens in femalés health but also calls for well-designed pharmaco-behavioral studies disentangling the effects of progestagens from those of estrogens.

The menstrual cycle is an important feature of female reproductive physiology, and its association with psychological factors is increasingly understood. Studies have found that fluctuations in estrogen and progesterone during the menstrual cycle can affect mood, cognition, and emotion regulation. Subsequent studies have had some success in attributing hormonal changes to neurotransmitter systems and brain regions that regulate emotional function. However, these findings still leave some unanswered questions, especially why some women experience severe symptoms such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This article explores the various hormonal phases of the menstrual cycle and their effects on mood through neurobiological mechanisms, including the effects of estrogen on serotonin and dopamine, and the effects of progesterone on GABA-A receptors. It then explores the role of brain structures such as the amygdala and prefrontal cortex, as well as treatment strategies such as selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle interventions. This article explores the effects of hormones on mood through an integrated perspective, which helps to deepen the understanding of mental health during menstruation and demonstrates the need for supportive public health policies. Future research could explore genetic susceptibility, long-term effects of birth control, and culturally sensitive approaches to better address and normalize hormone-related mood disorders.

Objective: Females represent a growing proportion of adults with ADHD yet remain understudied in the literature compared to males. An important aspect of the experience of females with ADHD is the impact of the menstrual cycle and ovarian hormones on both the symptoms of ADHD and effects of stimulant medications on treating these symptoms. Method: In the present pilot study, female participants being treated with amphetamine salts for ADHD (n = 30) were recruited to complete 35 daily online surveys to track ADHD symptoms, mood, and medication use through the menstrual cycle. Results: Results indicated that the degree of ADHD symptoms was significantly associated with menstrual cycle phase with ADHD symptoms being most severe in the menstruation phase and comparatively milder ADHD symptoms in the mid-follicular phase. This difference was positively correlated with subjective changes in negative mood. Conclusion: These results indicate that ADHD symptoms vary across the menstrual cycle among females being treated with amphetamine salts for their ADHD, a finding that could inform clinical and prescribing practices for physicians caring for females with ADHD.

Core body temperature (CBT) varies across the menstrual cycle, with lower CBT in the follicular phase and higher CBT in the luteal phase. Evidence suggests women have poorer sleep and mood outcomes in the luteal phase, yet it is unclear whether this is influenced by temperature changes occurring during sleep onset. The present study assessed CBT across sleep onset and its influence on next-morning sleepiness and mood in young adult women. Nine healthy young women (mean age = 19.78 = 1.86 years) participated in both follicular and luteal phases. Participants ingested a telemetric pill to continuously measure CBT. Polysomnography was recorded. CBT was averaged 3 hours before and after sleep onset in each phase. Upon awakening, participants completed the Stanford Sleepiness Scale and Positive and Negative Affect Schedule. Paired samples t-tests were performed to compare temperature, sleepiness and affect between phases. A linear mixed-effects model tested whether the difference in CBT from wake to sleep predicts sleepiness and mood upon awakening by phase. There was a significant difference in CBT after sleep onset between the follicular and luteal phase (t(8)=-3.12; p=0.01); CBT in the luteal was higher. There was no significant difference between CBT before sleep onset (t(8)=0.017; p=0.98), sleepiness (t(8)=0.814; p=0.44), or affect (t(8)=-0.077; p=0.94) between phases. However, there was a significant interaction between menstrual phase and wake/sleep CBT difference in predicting next-morning positive affect (p=0.001). In the follicular phase, greater wake/sleep CBT difference was associated with increased positive affect. In the luteal phase, greater wake/sleep CBT difference was associated with decreased positive affect. There was no significant interaction for sleepiness (p=0.29). The differences in CBT during sleep in the luteal and follicular phases are consistent with prior work. Interestingly, the impact of CBT fluctuations on mood differed by menstrual phase. In the follicular phase, a larger difference in CBT might indicate better thermoregulation aligned with a stronger circadian rhythm, improving mood, while in the luteal phase, the same change in temperature may suggest less optimal thermoregulation resulting in poorer mood. Future analyses will incorporate sleep physiology and ovarian hormones that may clarify how phase-related temperature differences influence mood.  

BACKGROUND Premenstrual Dysphoric Disorder (PMDD) is a cyclical mood disorder whereby symptoms are triggered by normal hormonal changes during the menstrual cycle. A better understanding of psychological changes that occur with PMDD can inform non-pharmacological and non-invasive treatment interventions. METHODS A systematic review was conducted of quantitative studies that measured any aspect of cognition or behaviour at a minimum of two time points in the menstrual cycle in those with and without PMDD. A narrative synthesis is reported. RESULTS 94 outcome measures were extracted from 21 papers and a total participant sample of 1222. Risk of bias was noted in relation to lack of power analysis and inappropriate statistical methods. Cognitive performance was most often tested but evidence of change with PMDD was limited and inconsistent. Findings of studies exploring cognitive processes and content suggest that a negative attentional bias is central to the psychological experience of PMDD. LIMITATIONS A quantitative synthesis could not be conducted due to limited reporting of key data. CONCLUSIONS Cognitive process, content, and behaviour are likely to be more informative in understanding PMDD than absolute cognitive abilities. Future studies should aim to investigate such in real-time and within the context of daily living.

Hormone sensitivity is a heterogeneous phenomenon involving multiple dimensions of sensitivity to estrogen and progesterone fluctuations across the menstrual cycle. While the majority of menstruating individuals do not experience any significant impact from these hormone changes on mood or behavior, rates of hormone sensitivity in clinical populations, particularly affective disorders, are substantially elevated, suggesting potential shared psychosocial or physiological mechanisms or moderators of risk. In this review, we provide an overview of menstrually related mood disorders and dimensions of hormone sensitivity across the cycle contributing to these presentations. We discuss how hormone sensitivity during the menstrual cycle corresponds with affective problems during other reproductive life events (puberty, perimenopause, pregnancy/postpartum) and review the evidence for environmental, neurobiological, and cognitive/affective factors associated with hormone sensitivity. Methodological considerations and directions for further research are highlighted throughout.

The objective of this study was to investigate the association of menstrual cycle phases on sexual function, well-being, and mood in young healthy women. Previous research has shown inconclusive results likely due to using non-validated methods for classification of menstrual cycle phases and/or small sample sizes. In this study, secondary analyses were performed on data from an earlier double-blind, randomized controlled trial with the main object to study the effects of oral contraceptives on young healthy women. The regularly cycling women randomized to placebo (n = 171) were examined at baseline (early follicular phase) and after three cycles of placebo treatment. At the follow-up visit, individuals were in different randomly distributed menstrual cycle phases: early follicular phase (n = 92), ovulation (n = 32), and luteal phase (n = 29), as confirmed by hormone measurements. The outcomes of this study were scores on the validated questionnaires Profile of Female Sexual Function, Sexual Activity Log, Personal Distress Scale, Psychological General Well-Being Index and Beck Depression Inventory. The intra-individual change in scores from baseline to follow-up for the three groups was analyzed using ordinary least squares regression adjusted for age, relationship, and education. There were small, non-significant variations in sexual function, well-being and mood between the different phases of the menstrual cycle (p > 0.05). However, participants who were in a stable relationship had an overall significantly better sexuality than those who were single (p < 0.001). This is the largest longitudinal study to date with a pre-registered protocol and hormonally verified cycle phases, showing no systematic variation in sexual function, mood, or well-being across the menstrual cycle in young healthy women. The results can be used to improve counseling about normal menstrual cycle variations in mood and behavior in young women with concerns.

Key cycle changes occur as women transition from reproductive life to menopause, and they can be roughly linked to menopausal staging. It is important to understand the types of studies that inform the current knowledge. Patterns of symptoms within menstrual cycles (sleep, headache) generally favor worsening in association with the perimenstrual phase of the cycle, and patterns of chronic symptoms, such as hot flashes and adverse mood, appear to be worse when hormones are more variable.

High altitude may alter redox balance and promote inflammation. It remains unclear if ovarian hormone fluctuations influence redox status. We sought to investigate the impact of menstrual cycle (MC) phases on oxidative stress, nitric oxide metabolism, inflammation, iron biomarkers and acute mountain sickness (AMS) during high-altitude sojourns in eumenorrheic women. Venous blood samples were collected at low altitude (1224 m) and after one night at 3375 m (Rifugio Torino, inspired O2 pressure: 96 ± 1 mmHg) during both the early follicular (EF) and mid-luteal (ML) phases. At high altitude, xanthine oxidase (XO: 0.140 ± 0.077 vs. 0.165 ± 0.084 μmol·L-1·min -1; p = 1.00), total nitrites and nitrates (NOx: 38.9 ± 10.8 vs. 32.8 ± 6.1 μmol·L-1; p = 1.00), interleukin-6 (IL-6: 17.3 ± 13.6 vs. 14.5 ± 13.2 ng·mL-1; p = 1.00) and serum iron concentration (19.7 ± 6.8 vs. 22.1 ± 4.6 μmol·L-1; p = 1.00) were not significantly different between EF and ML. However, total protein concentrations were significantly lower in EF compared to ML (75.5 ± 2.0 vs. 80.0 ± 5.1 g·L-1; p = 0.010). No significant differences were observed in Lake Louise scores (AMS) between EF and ML (2.17 ± 1.64 vs. 1.50 ± 1.83; p = 0.180). High-altitude exposure increased XO, IL-6 and erythropoietin levels and decreased NOx, when compared to low altitude. These findings suggest that redox balance, nitric oxide bioavailability, inflammation and iron homeostasis are not influenced by the MC at high altitude. Overall, susceptibility to AMS was similar across MC phases.

Background Menstruation is a daily opportunity for iron loss in women. Hepcidin (Hepc), a key regulator of iron metabolism, is known to respond to both iron status and inflammation. Menstruation is also accompanied by local and systemic production of reactive oxygen species and inflammatory responses. However, fluctuations in Hepc and oxidative stress during the menstrual cycle and their relationship are unclear. The purpose of this study was to clarify of the fluctuations Hepc and oxidative stress and relationships. Methods Sixteen women were recruited, of whom twelve with normal menstrual cycles were included in the final analysis. Blood samples were collected at four time points — The menstrual phase (MP), follicular phase (FP), early luteal phase (ELP), and late luteal phase (LLP) — while the participants were at rest. Serum Hepc, serum ferritin (FER), and oxidative stress levels were evaluated. In addition, differences between the iron-deficient (ID, <12 ng/ml) and non–iron-deficient (NID, ≥12 ng/ml) groups, classified according to FER levels during the ELP, were examined. Results Oxidative stress showed significant fluctuations across the menstrual cycle (p < 0.01), with higher values during the MP and FP compared with the LLP. This trend was particularly pronounced in the ID group. Hepc did not exhibit significant cyclical fluctuations. Nevertheless, its mean level was highest in the MP and lowest in the FP. No significant correlation was observed between oxidative stress and Hepc. FER was positively correlated with Hepc only in the LP (r = 0.769, p = 0.043), and significant differences in Hepc levels between the ID and NID groups were observed exclusively in the ELP (p = 0.003) and LLP (p = 0.010). Conclusion Oxidative stress fluctuated across the menstrual cycle, with increases observed during the MP and FP. These fluctuations appeared to be more pronounced in the presence of ID. In contrast, Hepc did not exhibit consistent cyclical changes. Although oxidative stress was considered to influence Hepc elevation through inflammatory responses, no direct relationship was detected at the blood marker level.

The purpose of this study was to examine the effects of menstrual cycle phase on myofiber injury, regenerative events and inflammation after electrical-stimulation (ES) induced myofiber damage. 28 premenopausal women (21.3 ± 2 yrs) were randomized into an early follicular (EF; N=14) or late follicular (LF; N = 14) group. After menstrual cycle tracking and phase confirmation, subjects underwent 200 electrically stimulated eccentric muscle contractions one week after providing a muscle biopsy. 7 days post-ES, subjects provided a final biopsy. Primary outcomes included: serum estradiol, indirect markers of muscle damage, direct indicators of myofiber necrosis and regeneration, satellite cell number, and macrophage infiltration. Women in the LF group had higher serum estradiol (122.1 ± 23.4 vs. 81.7 ± 30.8 pg/ml; P<0.001)compared to the EF group on the day of ES. Whereas the EF group recovered baseline maximal isometric strength by 4 days post-ES, the LF group did not. Only women in the LF group showed significant and consistent evidence of myofiber necrosis and regeneration pre- to post-ES. Despite showing more evidence of myofiber damage, women in the LF group also experienced reduced total and CD206+ macrophage infiltration relative to the EF group. Satellite cell quantity increased significantly post-ES in both groups, with no differences between groups. Collectively, the data suggest that the high estrogen LF phase may be associated with increased susceptibility to myofiber injury while also limiting the subsequent intramuscular inflammatory response.

The reproductive phase in women is characterized by fluctuations in sex hormones, as observed during the menstrual cycle. With aging, hormonal transitions occur, leading to a decline in sex hormones and the onset of menopause. These hormonal fluctuations throughout a woman's life significantly impact immune cell activity and metabolism. This literature review elucidates the effects of female sex hormones, particularly estradiol, on immunometabolic modulation in adult and elderly women. Additionally, the review explores the impact of physical activity and exercise as strategies for modulating inflammation, metabolic changes, and preventing chronic non-communicable diseases (CNCDs). The findings indicate that during the menstrual cycle, sex hormones are significantly associated with inflammatory and lipid proteins, particularly pro-inflammatory markers (such as TNF-α, IL-1β, IL-6), LDL-c and non-HDL in the luteal phase, and influence the distribution of specific immune cells (such as monocytes and neutrophils). With the decline in sex hormone concentrations, evidence suggests that women experience a pronounced inflammatory profile, marked by significant secretion of pro-inflammatory cytokines due to a shift in immune cell phenotype, reinforcing the relationship between sex hormones and the inflammatory response. However, the literature is beginning to demonstrate more consistently the beneficial effects of exercise training, as it promotes the release of anti-inflammatory and protective markers (such as IL-10, IL-6, HDL-c, HDL/LDL ratio) through improvements in the cellular profile, directly contributing to an enhancement of the immunometabolic profile and the prevention of chronic diseases.

BACKGROUND Low-grade chronic inflammation is commonly seen in polycystic ovary syndrome (PCOS) patients with elevated levels of inflammatory cytokines in the endometrium. However, our understanding of the mechanisms underlying cytokine synthesis and increased endometrial inflammation in PCOS patients remains limited. METHODS Endometrial biopsy samples were collected from non-PCOS (n = 17) and PCOS (n = 22) patients either during the proliferative phase of the menstrual cycle or with hyperplasia. Endometrial explants were prepared from PCOS patients and subjected to pharmacological manipulation in vitro. The expression and localization of TLR2/4, key elements of innate immune signal transduction and NFκB signaling pathways, and multiple cytokines were comprehensively evaluated by Western blotting, immunohistochemistry, and immunofluorescence in endometrial tissues. RESULTS We demonstrated the distribution of protein expression and localization associated with the significantly increased androgen receptor, TLR2, and TLR4-mediated activation of IRF-7 and NFkB signaling, cytokine production, and endometrial inflammation in PCOS patients compared to non-PCOS patients with and without endometrial hyperplasia. In vitro experiments showed that 5α-dihydrotestosterone (DHT) enhanced androgen receptor, TLR4, IRF-7, and p-NFκB p65 protein expression along with increased IFNα and IFNɣ abundance. The effects of DHT on IRF-7, p-NFκB p65, and IFN abundance were abolished by flutamide, an anti-androgen. Although 17β-estradiol (E2) decreased p-IRF-7 expression with little effect on TLR-mediated IRF7 and NFκB signaling or on cytokine protein levels, exposure to metformin alone or in combination with E2 suppressed IRAK4, p-IRF-7, IRF-7, IKKα, p-NFκB p65, IFNɣ, and TNFα protein expression. CONCLUSION Cytokine synthesis and increased endometrial inflammation in PCOS patients is coupled to androgen-induced TLR4/IRF-7/NFkB signaling, which is be inhibited by metformin treatment.

The immune system plays an important role in mediating exercise responses and adaptations. However, whether fluctuating hormone concentrations across the menstrual cycle may impact these processes remains unknown. The aim of this systematic review with meta‐analysis was to compare baseline concentrations as well as exercise‐induced changes in immune and inflammatory parameters between menstrual cycle phases. A systematic literature search was conducted according to the PRISMA guidelines using Pubmed/MEDLINE, ISI Web of Science, and SPORTDiscus. Of the 159 studies included in the qualitative synthesis, 110 studies were used for meta‐analysis. Due to the designs of the included studies, only the follicular and luteal phase could be compared. The estimated standardized mean differences based on the random‐effects model revealed higher numbers of leukocytes (−0.48 [−0.73; −0.23], p < 0.001), monocytes (−0.73 [−1.37; −0.10], p = 0.023), granulocytes (−0.85 [−0.1.48; −0.21], p = 0.009), neutrophils (−0.32 [−0.52; −0.12], p = 0.001), and leptin concentrations (−0.37 [−0.5; −0.23], p = 0.003) in the luteal compared to the follicular phase at rest. Other parameters (adaptive immune cells, cytokines, chemokines, and cell adhesion molecules) showed no systematic baseline differences. Seventeen studies investigated the exercise‐induced response of these parameters, providing some indications for a higher pro‐inflammatory response in the luteal phase. In conclusion, parameters of innate immunity showed cycle‐dependent regulation at rest, while little is known on the exercise responses. Due to a large heterogeneity and a lack of cycle phase standardization among the included studies, future research should focus on comparing at least three distinct hormonal profiles to derive more specific recommendations for exercise prescription.