Abstract
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.
Highlights
Regular fluctuations in ovarian hormone levels, estrogen and progesterone during the normal ovulatory cycle, produce profound alterations on the body homeostasis of women between the ages of13–50 years (Marsh and Jenkins, 2002; Janse de Jonge, 2003)
Because progesterone concentration may be associated with perceptual responses (Gonda et al, 2008; Romans et al, 2013; Reynolds et al, 2018), we investigated the influence of menstrual cycle phase on the individual’s perception during the task performed, which was typically estimated with the Ratings of Perceived Exertion (RPE) scale
During a functional isometric fatiguing task using the whole body, there was no effect of menstrual cycle phase on the total body RPE results (Birch and Reilly, 1999, 2002), but the local leg RPE was greater during the follicular compared to the luteal phase (Birch and Reilly, 2002)
Summary
Regular fluctuations in ovarian hormone levels, estrogen and progesterone during the normal ovulatory cycle, produce profound alterations on the body homeostasis of women between the ages of years (Marsh and Jenkins, 2002; Janse de Jonge, 2003). The obtained effect sizes may provide valuable information for studies that need to control and test for fatigability across the cycle The goal of this mini-review is to summarize the effects of the ovarian hormonal fluctuations on the exercise-induced reduction in force during fatiguing contractions with emphasis on the effect size. We focused on studies that describe the metrics of motor output (time to failure, maximal voluntary contraction, power, work, etc.), and we included studies that reported exercise-induced reduction in force during both the luteal and follicular phases. For the knee extensor muscles, some reported a ∼26% greater time to task failure during the mid-luteal phase compared to the early follicular phase during an intermittent isometric contraction (effect size: −0.84; Table 1; Ansdell et al, 2019).
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