Effect of menstrual cycle on resting metabolism: A systematic review and meta-analysis

Abstract BACKGROUND Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population. OBJECTIVE AND RATIONALE The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21–35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes. SEARCH METHODS An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle–Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis. OUTCOMES Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21–27 days) was associated with lower ORT values as compared to normal (28–31 days), long (32–35 days) and all other (28–35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was −1.3 ng/mL (95% CI: −1.75 to −0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was −5.17 (95% CI: −5.96 to −4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72–0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of −1.8 oocytes (95% CI: −2.5 to −1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures. WIDER IMPLICATIONS MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.

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Effect of menstrual cycle phase, menstrual irregularities and hormonal contraceptive use on anterior knee laxity and non-contact anterior cruciate ligament injury occurrence in women: a protocol for a systematic review and meta-analysis

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2021-001170 ◽

2021 ◽

Vol 7 (4) ◽

pp. e001170

Author(s):

Elisa Nédélec ◽

Elvis Foli ◽

Sandra J Shultz ◽

Paul A Swinton ◽

Eimear Dolan ◽

...

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Cruciate Ligament ◽

Meta Analysis ◽

Ligament Injury ◽

Secondary Outcome ◽

Hormonal Contraceptives ◽

Cycle Phase ◽

Acl Injuries ◽

Anterior Knee

Exercising women report three to six times more ACL tears than men, which happen, in the majority of cases, with a non-contact mechanism. This sex disparity has, in part, been attributed to the differences in reproductive hormone profiles between men and women. Many studies have shown that anterior knee (AK) laxity and the rate of non-contact ACL injuries vary across the menstrual cycle, but these data are inconsistent. Similarly, several studies have investigated the potential protective effect of hormonal contraceptives on non-contact ACL injuries, but their conclusions are also variable. The purpose of this systematic review and meta-analysis is to, identify, evaluate and summarise the effects of endogenous and exogenous ovarian hormones on AK laxity (primary outcome) and the occurrence of non-contact ACL injuries (secondary outcome) in women. We will perform a systematic search for all observational studies conducted on this topic. Studies will be retrieved by searching electronic databases, clinical trial registers, author’s personal files and cross-referencing selected studies. Risk of bias will be assessed using the Newcastle Ottawa Quality Assessment Scale for Cohort and Case–Control Studies. Certainty in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The meta-analyses will use a Bayesian approach to address specific research questions in a more intuitive and probabilistic manner. This review is registered on the international database of prospectively registered systematic reviews (PROSPERO; CRD42021252365).

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Comment on: “The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis” and “The Effects of Oral Contraceptives on Exercise Performance in Women: A Systematic Review and Meta-analysis”

Sports Medicine ◽

10.1007/s40279-020-01384-8 ◽

2020 ◽

Cited By ~ 1

Author(s):

Tze-Huan Lei ◽

Huixin Zheng ◽

Claire E. Badenhorst ◽

Toby Mündel

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Oral Contraceptives ◽

Exercise Performance ◽

Meta Analysis ◽

Cycle Phase ◽

Menstrual Cycle Phase

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Exacerbation of Psychosis During the Perimenstrual Phase of the Menstrual Cycle: Systematic Review and Meta-analysis

Schizophrenia Bulletin ◽

10.1093/schbul/sbz030 ◽

2019 ◽

Vol 46 (1) ◽

pp. 78-90 ◽

Cited By ~ 3

Author(s):

Thomas J Reilly ◽

Vanessa C Sagnay de la Bastida ◽

Dan W Joyce ◽

Alexis E Cullen ◽

Philip McGuire

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Random Effects ◽

Psychotic Disorders ◽

Meta Analysis ◽

Psychotic Symptoms ◽

Cycle Phase ◽

Menstrual Cycle Phase ◽

Psychiatric Admission ◽

Admission Rates

Abstract Psychotic disorders can be exacerbated by the hormonal changes associated with childbirth, but the extent to which exacerbations occur with the menstrual cycle is unclear. We addressed this issue by conducting a systematic review. Embase, Medline, and PsychINFO databases were searched for studies that measured exacerbations of psychotic disorders in relation to the menstrual cycle. We extracted exacerbation measure, definition of menstrual cycle phase, and measurement of menstrual cycle phase. Standard incidence ratios were calculated for the perimenstrual phase based on the observed admissions during this phase divided by the expected number of admissions if the menstrual cycle had no effect. Random effects models were used to examine pooled rates of psychiatric admission in the perimenstrual phase. Nineteen studies, comprising 1193 participants were eligible for inclusion. Eleven studies examined psychiatric admission rates, 5 examined symptoms scores, 2 examined self-reported exacerbation, and 1 examined both admission rates and symptom scores. A random effects model demonstrated the rate of admissions during the perimenstrual phase was 1.48 times higher than expected (95% CI: 1.31–1.67), with no significant heterogeneity detected. Four of six symptom score studies reported perimenstrual worsening, but lack of consistency in timepoints precluded meta-analysis. Two studies examining self-reported menstrual exacerbations reported prevalences ranging from 20% to 32.4%. Psychiatric admission rates are significantly higher than expected during the perimenstrual phase. There is some evidence that a worsening of psychotic symptoms also occurs during this phase, but further research with more precise measurement of the menstrual cycle and symptomatology is required.

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Psychosocial Factors at Work and Menstrual Disorders: a Protocol for a Systematic Review and Meta-analysis

10.21203/rs.3.rs-179301/v1 ◽

2021 ◽

Author(s):

Natsu Sasaki ◽

Kotaro Imamura ◽

Kazuhiro Watanabe ◽

Yui Hidaka ◽

Emiko Ando ◽

...

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Psychosocial Factors ◽

Meta Analysis ◽

Scientific Evidence ◽

Work Capacity ◽

Female Workers ◽

Registration Number ◽

Cycle Disorders

Abstract Introduction: Menstrual abnormalities, such as menstrual cycle disorders or related symptoms (e.g., pelvic pain, premenstrual syndrome [PMS], menopausal symptoms), affect female workers’ quality of life and work capacity. The fertility of female workers is also a worldwide concern. However, the association between psychosocial factors at work and menstrual abnormalities or fertility is not well understood. To address this relationship, we will conduct a systematic review and a meta-analysis of the literature that has utilized a longitudinal or prospective cohort design.Methods and analysis: The inclusion criteria for this systematic review and meta-analysis are defined as follows: (P) Adult female workers (over 18 years old), (E) Presence of adverse psychosocial factors at work, (C) Absence of adverse psychosocial factors at work, and (O) Any menstrual cycle disorders, menstrual-related symptoms, or fertility. MEDLINE, EMBASE, PsycINFO, PsycARTICLES, and Japan Medical Abstracts Society electronic databases will be used to search for published studies. The statistical synthesis of the studies included in the meta-analysis will be conducted to estimate pooled coefficients and 95% CIs. We will use the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) to determine the quality of selected studies. To assess meta-bias, Egger’s test, along with a funnel plot, will be used to check for publication bias. Lastly, we will examine heterogeneity using the χ² test with Cochran’s Q statistic and I2.Ethics and dissemination: The results and findings will be submitted and published in a scientific peer-reviewed journal and will be disseminated broadly to researchers and policymakers interested in the translatability of scientific evidence into good practices.Trial registration: The study protocol was registered at the UMIN registry (registration number: UMIN000039488). The registration date is 14th Feb 2020.URL: https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000044704

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Impact of the menstrual cycle on peripheral vascular function in premenopausal women: systematic review and meta-analysis

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00341.2020 ◽

2020 ◽

Vol 319 (6) ◽

pp. H1327-H1337

Author(s):

Jennifer S. Williams ◽

Emily C. Dunford ◽

Maureen J. MacDonald

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Endothelial Function ◽

Vascular Function ◽

Meta Analysis ◽

Premenopausal Women ◽

Cycle Phase ◽

Peripheral Vascular ◽

The Impact

Fluctuations in endogenous hormones estrogen and progesterone during the menstrual cycle may offer vasoprotection for endothelial and smooth muscle (VSM) function. While numerous studies have been published, the results are conflicting, leaving our understanding of the impact of the menstrual cycle on vascular function unclear. The purpose of this systematic review and meta-analysis was to consolidate available research exploring the role of the menstrual cycle on peripheral vascular function. A systematic search of MEDLINE, Web of Science, and EMBASE was performed for articles evaluating peripheral endothelial and VSM function across the natural menstrual cycle: early follicular (EF) phase versus late follicular (LF), early luteal, mid luteal, or late luteal. A meta-analysis examined the effect of the menstrual cycle on the standardized mean difference (SMD) of the outcome measures. Analysis from 30 studies ( n = 1,363 women) observed a “very low” certainty of evidence that endothelial function increased in the LF phase (SMD: 0.45, P = 0.0001), with differences observed in the macrovasculature but not in the microvasculature (SMD: 0.57, P = 0.0003, I2 = 84%; SMD: 0.21, P = 0.17, I2 = 34%, respectively). However, these results are partially explained by differences in flow-mediated dilation [e.g., discrete (SMD: 0.86, P = 0.001) vs. continuous peak diameter assessment (SMD: 0.25, P = 0.30)] and/or menstrual cycle phase methodologies. There was a “very low” certainty that endothelial function was largely unchanged in the luteal phases, and VSM was unchanged across the cycle. The menstrual cycle appears to have a small effect on macrovascular endothelial function but not on microvascular or VSM function; however, these results can be partially attributed to methodological differences.

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A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies

Journal of Clinical Medicine ◽

10.3390/jcm8111946 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1946 ◽

Cited By ~ 12

Author(s):

Katja M. Schmalenberger ◽

Tory A. Eisenlohr-Moul ◽

Lena Würth ◽

Ekaterina Schneider ◽

Julian F. Thayer ◽

...

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Repeated Measures ◽

Meta Analysis ◽

Cycle Phase ◽

Extensive Literature ◽

Vagal Activity ◽

Physical And Mental Health ◽

Future Studies ◽

Meta Analyses

Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased exponentially in recent years. However, the understanding of sources of within-person change (i.e., intra-individual variance) in CVA is lagging behind. This systematic review and meta-analysis summarizes and quantifies current empirical evidence of within-person changes in measures of CVA across the menstrual cycle in naturally-cycling premenopausal females. We conducted an extensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in five databases to identify observational studies with repeated measures of CVA in at least two menstrual cycle phases. A broad meta-analysis (nstudies = 37; nindividuals = 1,004) revealed a significant CVA decrease from the follicular to luteal phase (d = −0.39, 95% CI (−0.67, −0.11)). Furthermore, 21 studies allowed for finer-grained comparisons between each of two cycle phases (menstrual, mid-to-late follicular, ovulatory, early-to-mid luteal, and premenstrual). Significant decreases in CVA were observed from the menstrual to premenstrual (nstudies = 5; nindividuals = 200; d = −1.17, 95% CI (−2.18, −0.17)) and from the mid-to-late follicular to premenstrual phases (nstudies = 8; nindividuals = 280; d = −1.32, 95% CI (−2.35, −0.29)). In conclusion, meta-analyses indicate the presence of CVA fluctuations across the menstrual cycle. Future studies involving CVA should control for cycle phase. Recommendations for covarying or selecting cycle phase are provided.

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The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis

Sports Medicine ◽

10.1007/s40279-020-01319-3 ◽

2020 ◽

Vol 50 (10) ◽

pp. 1813-1827 ◽

Cited By ~ 15

Author(s):

Kelly Lee McNulty ◽

Kirsty Jayne Elliott-Sale ◽

Eimear Dolan ◽

Paul Alan Swinton ◽

Paul Ansdell ◽

...

Keyword(s):

Systematic Review ◽

Menstrual Cycle ◽

Effect Size ◽

Exercise Performance ◽

Meta Analysis ◽

Experimental Studies ◽

Follicular Phase ◽

Effect Sizes ◽

Cycle Phase ◽

Early Follicular Phase

Abstract Background Concentrations of endogenous sex hormones fluctuate across the menstrual cycle (MC), which could have implications for exercise performance in women. At present, data are conflicting, with no consensus on whether exercise performance is affected by MC phase. Objective To determine the effects of the MC on exercise performance and provide evidence-based, practical, performance recommendations to eumenorrheic women. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for published experimental studies that investigated the effects of the MC on exercise performance, which included at least one outcome measure taken in two or more defined MC phases. All data were meta-analysed using multilevel models grounded in Bayesian principles. The initial meta-analysis pooled pairwise effect sizes comparing exercise performance during the early follicular phase with all other phases (late follicular, ovulation, early luteal, mid-luteal and late luteal) amalgamated. A more comprehensive analysis was then conducted, comparing exercise performance between all phases with direct and indirect pairwise effect sizes through a network meta-analysis. Results from the network meta-analysis were summarised by calculating the Surface Under the Cumulative Ranking curve (SUCRA). Study quality was assessed using a modified Downs and Black checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group. Results Of the 78 included studies, data from 51 studies were eligible for inclusion in the initial pairwise meta-analysis. The three-level hierarchical model indicated a trivial effect for both endurance- and strength-based outcomes, with reduced exercise performance observed in the early follicular phase of the MC, based on the median pooled effect size (ES0.5 = − 0.06 [95% credible interval (CrI): − 0.16 to 0.04]). Seventy-three studies had enough data to be included in the network meta-analysis. The largest effect was identified between the early follicular and the late follicular phases of the MC (ES0.5 = − 0.14 [95% CrI: − 0.26 to − 0.03]). The lowest SUCRA value, which represents the likelihood that exercise performance is poor, or among the poorest, relative to other MC phases, was obtained for the early follicular phase (30%), with values for all other phases ranging between 53 and 55%. The quality of evidence for this review was classified as “low” (42%). Conclusion The results from this systematic review and meta-analysis indicate that exercise performance might be trivially reduced during the early follicular phase of the MC, compared to all other phases. Due to the trivial effect size, the large between-study variation and the number of poor-quality studies included in this review, general guidelines on exercise performance across the MC cannot be formed; rather, it is recommended that a personalised approach should be taken based on each individual's response to exercise performance across the MC.

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