Abstract
Estradiol is an ovarian steroid hormone that peaks shortly before ovulation and significantly affects various brain regions and neurotransmitter systems, with similar and differential effects with progesterone, another ovarian hormone. Studies investigating the neurocognitive processes during the menstrual cycle have focused on the early follicular phase (EFP) characterized by low estradiol and progesterone levels and the mid-luteal phase (MLP) with high estradiol and progesterone levels. However, most studies have failed to include the ovulatory phase, characterized by high estradiol and low progesterone levels. Given the various hormonal changes in the menstrual cycle, we revisited studies suggesting that the menstrual cycle did not affect verbal and spatial abilities and observed that many contain mixed results. Comparing these studies makes it possible to identify relevant modulating factors, such as sample size, participant age, accurate selection of days for testing, asymmetrical practice effects, genetic polymorphisms, and task difficulty. More robust findings are related to improved mental rotation capacity during EFP with challenging tasks and differences in brain activation among menstrual cycle phases during the execution of spatial and verbal tasks. During MLP, less robust findings were observed, possibly modulated by the complex effects of the two hormones on the brain. In conclusion, we propose that it is crucial to include all three menstrual cycle phases and consider these modulating factors to avoid confounding findings.
Highlights
Ovarian hormones are steroids that interact with specific receptors, which induce a wide range of slow genomic and fast non-genomic effects [1,2]
The menstrual cycle typically exhibits the existence of three distinct hormonal phases: the early follicular phase (EFP) with low levels of both estradiol and progesterone; the ovulatory phase (OP) with high levels of estradiol but low levels of progesterone; and the mid-luteal phase (MLP) with high levels of both estradiol and progesterone (Fig. 1; for review see [3])
By comparing women during EFP and MLP, pioneering studies have suggested that these behavioral differences could be attributed to the increase in estradiol and progesterone levels [7] and estradiol levels when comparing women during EFP and OP [8] (Table 2)
Summary
Ovarian hormones are steroids that interact with specific receptors, which induce a wide range of slow genomic and fast non-genomic effects [1,2]. Estradiol and progesterone are lipophilic and pass through the blood-brain barrier; this characteristic allows both hor mones to act on many brain structures involved in behavior [2,4,5] The influence of these sex hormones on cognitive processes is often inves tigated through studies comparing womenâs performance with a natural menstrual cycle in different experimental tasks during EFP and MLP and examining whether the behavioral effects correlate with participantsâ estradiol and progesterone levels. Despite observing expected behavioral sex differences in multiple tasks, they found no hypothesized relationships between sex hormone levels and cognitive performance Given this background, the present review aimed to explore the extent to which the absence of behavioral differences among menstrual cycle phases nor significant correlations with the levels of the ovarian hormones, rule out menstrual cycle influences on neurocognitive pro cesses, considering the existence of complex interactions between the effects of estradiol and progesterone on the brain
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