Psychological responses to training and competition can vary across the menstrual cycle, yet phase-specific patterns in active and trained women remain poorly characterised. To synthesise current evidence on psychological outcomes across the phases of the natural menstrual cycle in active women and athletes. This systematic review followed PRISMA guidelines. Studies were eligible if they assessed psychological outcomes across at least two menstrual cycle phases in women with natural menstrual cycles (≥18 years) who were engaged in structured training or physically active (≥150 min of moderate-to-vigorous activity per week) for at least 3 months. Five studies were identified through database searches (PubMed, Scopus, Web of Science, SPORTDiscus) and screened independently by two reviewers. Outcomes were analysed narratively due to the heterogeneity of results. The methodological quality of the included studies was independently assessed using the Quality Assessment Tool for Quantitative Studies. Across studies, the menstrual and luteal phases were associated with reductions in positive mood and motivation, increased somatic complaints, and elevated emotional tension. Cognitive-affective outcomes such as attention and perceived performance were also impaired, particularly in the late luteal phase. In contrast, the follicular phase showed more favourable psychological functioning. The ovulatory phase was often not verified in the studies. Perceived interference and negative menstrual attitudes moderated several outcomes independent of physiological measures. Psychological states may vary across the menstrual cycle, with evidence suggesting greater vulnerability during the luteal and menstrual phases. These findings support the relevance of cycle-informed monitoring and the potential value of individualised support strategies in sport contexts.

This study aimed to analyze potential menstrual cycle-related changes in physical parameters associated with performance and injury risk, focusing on neuromuscular control and motor performance in physically active young females. Twenty-two healthy participants with regular menstrual cycles (24-34days) were examined sequentially during the follicular phase (day 3), ovulatory phase (within 48h after a positive urine LH test), and luteal phase (7days post-ovulation). Ovulation was indicated by a positive urinary LH surge test. The assessments included countermovement jump (CMJ), squat jump (SJ), postural control, ankle dorsiflexion range of motion (ROM), and isokinetic concentric maximal strength. Statistical analyses involved one-way repeated-measures ANOVA or the Friedman test for non-normally distributed data. Significant effects across the menstrual cycle were found for maximum concentric flexion strength (p=0.003; =0.037) and ankle ROM (p=0.043; =0.010). Post hoc analysis revealed a significant increase in concentric flexion strength from the follicular to the luteal phase (p=0.004), whereas no significant pairwise differences were observed for ankle ROM. Concentric flexion strength increased significantly from the follicular to the luteal phase (+7.4%), and ankle ROM showed a trend toward improvement, with the highest values observed in the luteal phase (+3.8%). In contrast, CMJ, SJ, and postural control remained constant across all phases. Overall, neuromuscular and motor performance parameters appear largely consistent throughout the menstrual cycle, with only small fluctuations in strength and flexibility. These findings suggest that menstrual cycle-related changes have limited functional relevance but may still warrant consideration in future studies investigating individual responses and injury risk.

In many species, chemosensory cues convey important information about reproductive status, but their role in shaping social interactions among women is less understood. Here, we combined functional neuroimaging with behavioral measures to test how chemosignals from women at different reproductive stages [menstruation, ovulation (OV), and early pregnancy (PRG)] affect social perception in female recipients across their own menstrual cycle. Chemosignal donors were screened and tracked for cycle phase (n = 59) and pregnancy status (n = 36). Female functional MRI participants (n = 33) completed a single-blind within-subject crossover design with two sessions, one during menstruation and one during ovulation. The participants rated attractiveness, desired proximity, and pregnancy status of standardized female faces while being unknowingly exposed to the axillary chemosignals. Neuroimaging analyses showed OV chemosignals to elicit greater activation across frontal, parietal, temporal, and subcortical regions, including the temporoparietal junction, insula, hippocampus, hypothalamus, and basal ganglia. PRG chemosignals were associated with more circumscribed responses, particularly in the prefrontal and cingulate areas. These effects were modulated by the recipient's own cycle phase, with broader networks being engaged during ovulation than menstruation. Behaviorally, the participants maintained a greater distance from faces paired with PRG but approached them more closely during their own ovulation. Attractiveness ratings and pregnancy categorizations were unaffected by chemosensory condition or cycle phase. Together, these findings demonstrate that subtle chemosensory signals shape female social cognition in a cycle-dependent manner, highlighting an adaptive mechanism by which chemosensory cues guide competition, vigilance, and affiliation without necessarily altering explicit judgments.

Knowledge of menstrual physiology is crucial for midwifery students. Menstrual physiology encompasses vital information regarding ovulation periods, fertile windows, and related hormones. A lack of understanding can lead to inaccuracies in providing patient education and risks reinforcing misconceptions about menstruation. Technology-based learning media, such as animated videos and e-books, are options to enhance student knowledge. This study aims to determine the effectiveness of video and e-book learning media on knowledge of menstrual physiology among Applied Bachelor of Midwifery students. This research employed a quasi-experimental two-group pretest-posttest design. The study was conducted at the Department of Midwifery, Poltekkes Kemenkes Jambi. The population consisted of 60 fifth-semester midwifery students. Using a total sampling technique, 60 participants were divided into two groups: the odd-numbered attendance group (30 students) as the Video group and the even-numbered attendance group (30 students) as the E-book group. The results indicated that both video and e-book media significantly influenced the increase in student knowledge, with a p-value of 0.001<0.05. Regarding the comparison of effectiveness between the two, the mean difference was 1.10 with a p-value of 0.12>0.05, indicating no significant difference between the two media. Both video and e-book media are effective for use as learning tools. The selection and utilization of these media should be tailored to the learning preferences and needs of the students.

ABSTRACT Fluctuations in female sex hormones throughout the menstrual cycle (MC) can affect the body’s various metabolisms, leading to changes in physical performance parameters. This study examines lower limb strength and balance in the three phases of the MC in order to investigate the potential impact of the MC on athletic performance in female athletes. The study was conducted with 21 elite female athletes aged 20–25 y. The evaluations were performed during the early follicular (days 2–3), ovulation (days 13–14), and mid luteal (days 21–22) phases of MC. Subjects were subjected to the Y balance test (YBT), isokinetic strength test, single leg hop tests (SLHTs) (single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH)) and dynamic/static balance tests. There was no statistically significant difference in lower extremity strength, strength asymmetries, or YBT test between sides and phases (p > 0.05). In isokinetic static balance, significance was observed in the mid-luteal phase in the forward-backward oscillation, while significance was observed in the medium-lateral speed in the ovulation phase (p < 0.05). In dynamic balance, the forward-backward oscillation of the trunk and the total oscillation were significant in the ovulation phase (p < 0.05). The MC phases had no effect on lower extremity strength, strength asymmetries, or YBT test; however, the lowest results in isokinetic balance tests were obtained in the ovulatory phase, while the highest results were obtained in the early follicular phase.

To determine whether menstrual-cycle (MC) phase is associated with changes in pelvic floor muscle (PFM) function, focusing on myoelectric excitation (intravaginal sEMG) at rest and during standardized contraction tasks, and on mechanical strength assessed by dynamometry and digital palpation. Prospective observational, within-subject study in 23 healthy nulliparous eumenorrheic women (18–35 years) not using hormonal contraceptives. Each participant was assessed in early follicular (EFP), ovulatory (OP), and mid-luteal (MLP) phases, confirmed using urinary luteinizing hormone (LH) testing, basal temperature, and transvaginal ultrasonography. Outcomes included Modified Oxford Scale (MOS), Pelvibex® dynamometry (passive, active, net force), and intravaginal sEMG (MVC plus Glazer protocol: baseline, phasic, tonic, endurance, baseline post-endurance). Friedman tests with Holm-adjusted post hoc comparisons and Spearman correlations were applied. Voluntary contraction sEMG (MVC, phasic, tonic, endurance) showed no significant phase differences (p > 0.05). Resting sEMG differed by phase: baseline average and peak amplitude was lower in OP vs. EFP (pHolm = 0.012; pHolm = 0.018, respectively). Strength outcomes (MOS and dynamometric measures) did not differ across phases (all p > 0.05). sEMG exhibited strong within-phase coherence and cross-phase stability, while baseline myoelectric excitation correlated inversely with force measures. MC phase was associated with subtle modulation of baseline PFM myoelectric excitation (most consistently lower at ovulation), without detectable phase-related changes during voluntary contractions or in mechanical strength. Baseline sEMG amplitude showed inverse associations with active force, suggesting that higher residual excitation may be associated with reduced mechanical strength. Overall, electrophysiological and force-based outcomes should be interpreted cautiously.

To evaluate the feasibility of intravoxel incoherent motion (IVIM) MRI for noninvasive assessment of uterine perfusion and diffusion characteristics across different phases of the menstrual cycle. This prospective study included 27 volunteers with regular menstrual cycles (28±7d) from December 2020 to May 2023. A zoomed field-of-view single-shot spin-echo echo-planar imaging (SE-EPI) sequence was used to obtain multi-b DWI images. Mono-exponential DWI derived apparent diffusion coefficient (ADC) and IVIM-derived parameters including diffusion D, pseudo diffusion D* and perfusion fraction f in the uterine corpus and cervix were analyzed during the menstrual cycle. Statistics analysis was performed by 1-way analysis of variance (ANOVA). A total of 21 healthy female participants (mean age: 26.64±4.72y) were recruited for analysis. Both D and ADC values in each layer of the uterine corpus were lowest during the menstrual phase. However, there was no statistically significant difference in ADC of myometrium between the menstrual and ovulatory phases ( P =0.177). The D values of the 3 layers of the uterine corpus gradually increase from the menstrual phase to the luteal phase, whereas the 3-zone structure of the cervix has the highest D value in the ovulatory phase. During the luteal phase, the D* and f values of the endometrium and cervical mucus layer were lower than those of the other 2 layers ( P <0.05). IVIM MRI enables noninvasive quantification of uterine perfusion and diffusion dynamics and reveals characteristic variations in the uterine corpus and cervix throughout the menstrual cycle.

The incidence of ankle sprains and chronic ankle instability is higher in women than in men. One sex-specific factor may be the greater ligamentous laxity in women compared with men, potentially influenced by estrogen and relaxin activity. This study aimed to investigate changes in ankle joint laxity and its association with hormone levels in women with and without recurrent ankle sprains. Eleven female college students with recurrent ankle sprains and seven students with no or a single prior sprain participated. Ankle joint laxity was assessed using an ankle arthrometer with a 125-N load for anterior-posterior displacement and with a 4000 N-mm for inversion-eversion rotation. Serum estradiol and relaxin-2 levels were measured. Ankle laxity assessments and blood sampling were performed in the follicular, ovulation, and luteal phases of the participant's individual menstrual cycle. A significant group×phase interaction was found for inversion-eversion ankle joint laxity; however, post hoc analyses adjusted for Bonferroni multiple comparisons were not significant, implying a lack of clinical interest or potential sampling fluctuations. A positive correlation was found between serum relaxin-2 level and anterior-posterior ankle joint laxity during the luteal phase (r=0.557 and p=0.048). This association should be interpreted as an observational finding that may help generate hypotheses regarding potential hormone-related factors in ankle sprains in women.

Keratoconus (KC) is a progressive bilateral corneal ectatic disorder characterized by corneal thinning, irregular astigmatism, and subsequent vision impairment. The main purpose of this study is to investigate sex hormone-mediated variations in corneal morphology and biomechanics among KC patients, with stratification by age, gender, and menstrual phase. This cross-sectional study enrolled 435 participants (KC: n = 180; control: n = 255). Serum testosterone (T), estradiol (E2), and progesterone levels were measured using chemiluminescent immunoassay. Serum sex hormones and corneal morphological and biomechanical parameters were analyzed across three age groups (≤ 20, 21–30, > 30 years) and menstrual phases (follicular, luteal, and ovulatory phase). Statistical analyses included Mann-Whitney U tests and Spearman correlations. Male KC patients exhibited significantly lower E2 (95.23 ± 27.80 vs. 110.60 ± 28.25 pmol/L; P < 0.001) and T (11.73 ± 4.17 vs. 13.17 ± 4.57 nmol/L; P = 0.013) versus controls. While, females KC patients showed significantly lower T (0.84 ± 0.34 vs. 0.96 ± 0.54 nmol/L; P = 0.041) versus controls. E2 levels were significantly lower in the male KC group compared to the male control group across all age groups (P < 0.017). T levels between the KC and control groups differed most markedly in the 21–30 years group (P = 0.031). Biomechanically, E2 levels were negatively correlated with Belin/Ambrosio enhanced ectasia total deviation index and Integrated Radius both in the ≤ 20 and > 30 years group in males. T levels were significantly lower in KC female patients aged 21–30 years during the luteal phase compared to controls; however, no significant correlation was found between T levels and any of the measured corneal parameters. The associations between sex hormones and KC progression varied depending on the specific hormone and sex. In males, higher E2 and T levels were associated with more favorable corneal biomechanical and morphological outcomes. Our data identified the 21–30-year age period as exhibiting the most pronounced associations between sex hormones and corneal parameters. These findings highlight the necessity for longitudinal and interventional studies to clarify any causal role of sex hormones in KC progression and their potential therapeutic relevance.

Introduction &amp; Purpose: Subjective perceptions of the menstrual cycle (MC) and physical activity (PA) suggest that the MC may negatively affect PA, particularly when premenstrual symptoms are present (Kolic et al., 2021). However, most existing studies are cross-sectional (Goaplan et al., 2024), which limits causal interpretation and may introduce bias (Matsumoto et al., 2021). Therefore, this study aimed to examine daily fluctuations in PA and premenstrual symptoms across two consecutive MCs using a longitudinal design. Methods: Participants were eligible if they were between 18–35 years old, had a natural MC lasting 21–35 days, and were not pregnant or breastfeeding for at least six months. Over two consecutive MCs, participants completed daily assessments via the m-path app (KU Leuven, Belgium). Data included MC tracking (MC day, basal body temperature, LH surge), premenstrual symptoms (Screening Instrument for Premenstrual Symptoms [SIPS]), and self-reported moderate-to-vigorous PA (MVPA, Godin–Shephard Leisure-Time Physical Activity Questionnaire). The MC was divided into five phases according to Elliott-Sale et al. (2025): menstrual (MP), follicular (FP), ovulatory (OP), luteal (LP), and premenstrual phase (PP). Linear mixed models were applied to examine differences in MVPA across MC phases, including premenstrual symptoms as covariates. Results: Thirty-five participants (age: 26.5 ± 5.4 years) were included. The average MC length was 28.7 ± 2.6 days. Based on the SIPS, eight participants were classified as having PMS and two as having PMDD. Across 1,407 observations, no significant effect of MC phase on MVPA was found (MP: 51.0 ± 7.5 min/day; FP: 50.3 ± 7.0; OP: 52.2 ± 7.6; LP: 45.6 ± 7.7; PP: 54.5 ± 7.6; p &gt; 0.05). Premenstrual symptoms showed no significant associations with PA. Discussion: MVPA remained stable across MC phases, even when symptoms occurred. This suggests that the MC and subjective symptom perception may not substantially affect PA in active women. However, these effects may vary in populations with distinct activity levels, such as sedentary women or elite athletes. Future studies should incorporate objective PA measures and examine psychosocial mediators of PA behavior across the MC. Conclusion: In active women, PA behavior appears consistent across MC phases, despite the presence of premenstrual symptoms.

The Emergency contraception pills (ECPs) are being used worldwide to prevent unwanted pregnancy, but the most important issue is still unanswered: whether they are effective when taken during or after ovulation, especially when taken near the luteinizing hormone (LH) surge. The knowledge of the time of efficacy and mechanism of action is essential to proper patient counseling, shared decision-making, and informed choice of contraceptives. It is a This systematic review (no meta-analysis) is written in accordance with PRISMA 2020 and is registered in the prospective in PROSPERO (CRD420251238977). A careful search of PubMed/MEDLINE, Embase, Scopus, Cochrane Central, ClinicalTrials.gov, ProQuest Dissertations, and WHO ICTRP (January 2000-November 2025) was carried out to find articles that reported the outcome of pregnancy, ovulation outcome, or the mechanism of such drugs levonorgestrel and/or ulipristal acetate and/or mifepristone. The study designs that were included were 13 randomized controlled trials, 8 prospective cohort studies, 6 pharmacodynamic trials and 6 mechanistic studies. Cochrane RoB 2.0, the Newcastle-Ottawa Scale, or an established pharmacologic appraisal tool was used to assess risk of bias, and certainty of evidence was assessed using GRADE. 33 articles (n = 5,382 women) were included. In line with our interest, the results are arranged in terms of time with respect to ovulation. The effect of levonorgestrel (LNG) declined significantly with the increase in the dose to ovulation. Pregnancy rates when LNG was given > 72 h before expected ovulation were also low at only 0.6–1.8%. Effectiveness dropped as timing got to ovulation: at 24–72 h before ovulation, it increased to 2.0-8.3%; during the peri-ovulatory period, it rose to 18.5–35.2%. The LH surge became even more fertile with a pregnancy rate of 40.3–59.8%, which was similar to uninformed cycles. Ulipristal acetate (UPA) was also found to be significantly less effective than LNG in the peri-ovulatory window (8.2–15.3%) and was also capable of delaying ovulation in approximately 60–78 per cent of users, but was not capable of doing so once ovulation had occurred (29–37% pregnancy). A mainly anti-ovulatory effect was established by mechanical research: at therapeutic doses, neither LNG nor UPA produced statistically significant effects on fertilization, implantation, or early embryo viability. This systematic review indicates that the timing of ovulation plays a key role in determining the effectiveness of oral emergency contraceptive pills. It has been found that levonorgestrel is very effective if taken before the luteinizing hormone surge, whereas ulipristal acetate can possibly maintain its effectiveness till the early peri, ovulatory phase. The evidence from the studies, however, does not show a significant pregnancy risk reduction when these drugs are taken after ovulation, but it is not very certain due to ethical and methodological limitations in this phase. Since this review is based on the qualitative synthesis without the meta, analysis, the findings should be considered as descriptive trends rather than the quantitative effect estimations. The outcomes of this review advocate cycle, stage informed counseling and align with the present clinical guidelines that recommend the copper intrauterine device as the most effective emergency contraceptive method when ovulation is likely to have already taken place.

Concentrations of female sex hormones fluctuate during the menstrual cycle (MC), while hormonal contraceptives (HC) generally suppress hypothalamic-pituitary-ovarian axis function resulting in lower concentrations of endogenous estradiol (E2) and progesterone (P4). Little attention has been paid to changes in androgen concentrations during MC and HC phases. Therefore, the aim of this study was to investigate changes in androgen concentrations over the MC and HC phases. The study was a cross-sectional analysis across MC and HC phases using four time points. E2, P4, follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (tT), free testosterone (fT), sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) were analyzed from the serum of healthy, physically active, naturally menstruating (NM = 36), hormonal intrauterine device using (IUD = 12) and combined HCs using (CHC = 25) females. In NM, concentrations of tT (β = 0.16, p = 0.050), fT (β = 1.85, p < 0.001) and DHEA (β = 5.29, p = 0.045) were significantly higher at ovulatory phase and concentrations of DHEA-S at the mid-follicular phase (β = 0.32, p = 0.012) compared to bleeding. In IUD, tT concentrations fluctuated significantly being highest at mid-cycle (β = 0.34, p = 0.001) compared to the sample defined as measurement 1 (based on bleeding and/or hormonal concentrations). In CHC, concentrations of E2, P4, tT, fT, DHEA, and DHEA-S remained unchanged between the HC phases. Since the endogenous hormonal milieu, including androgens, may affect female physiology, considering the fluctuation in androgen levels over the MC and HC phases may be of importance in physiological research.

Surge release of luteinizing hormone (LH) from the pituitary is essential for fertility, as it triggers ovulation. Secretoneurin (SN), a conserved peptide derived from secretogranin-2, stimulates LH release, but its relationship to periovulatory changes in classical reproductive hormones remains unclear. We measured fluctuations of two reproductive steroids and three peptides in the hypothalamus, pituitary, and ovary of female mice during the periovulatory period using a novel nano LC-MS/MS protocol. Immunohistochemistry for SN and GnRH was performed on brain samples. GT1-7 GnRH neuronal cells were exposed to various doses of SN and processed for PCR determination of Gnrh1 mRNA levels. A subset of these samples was subjected to RNA sequencing for pathway analysis. P4, E2, AVP, GnRH1, and SN varied across the cycle, whereas OXT was relatively stable. Ovarian P4 was highest at proestrus, while E2 peaked at diestrus. Hypothalamic P4 was elevated at diestrus, whereas pituitary P4 remained low and variable. AVP peaked at proestrus in both the hypothalamus and pituitary. SN levels were highest in the hypothalamus and pituitary at proestrus. GnRH1 increased in the hypothalamus and pituitary at proestrus but was undetectable in ovary. Regression analysis revealed a moderate positive association between hypothalamic SN and GnRH1. SN-immunoreactive fibers were found near GnRH neurons in the median and medial preoptic areas. In vitro, SN increased Gnrh1 mRNA in GT1-7 cells in a time- and dose-dependent manner. RNA sequencing after 6 h SN treatment highlights key signaling cascades including MAPK, transcriptional regulation, and calcium signaling pathways. Six upregulated TFs predicted to bind to the mouse Gnrh1 promoter were also linked to significant enrichment in ribosome-related processes, protein synthesis, and cellular component organization pathways. These findings identify a periovulatory association between SN and GnRH1 and provide a foundation for targeted studies needed to test causality in the mammalian reproductive neuroendocrine network.

The most common cause of female infertility is ovulatory disorders, accounting for approximately 57.5% of female infertility diagnoses, indicating that ovulation monitoring plays a pivotal role in fertility management. However, almost all of the current monitoring techniques face limitations in real-time accuracy and continuous data acquisition, hindering the development of reproductive medicine. In this work, it is first designed a noninvasive and real-time ovulation monitoring approach utilizing an Ag/HfO2/FTO memristor by using HfO2 as the functional layer of the device. By analyzing the I-V curve characteristics of saliva and urine samples across follicular, ovulatory, and luteal phases, it can be identified distinct peak current signatures with stable bipolar resistive switching over 100 cycles, which addresses critical limitations of current methods by offering noninvasive and real-time detection of the fertility window. Further, the as-proposed de novo theoretical mechanism is the modulation of the memristive switching behavior through hormone-driven ionic variations in biofluids, enabling real-time detection of ovulation phases. Therefore, this technology can be integrated into assisted reproductive technologies and smart home appliances, such as intelligent toilets and smart electric toothbrushes for noninvasive, real-time, and dynamic ovulation monitoring.

Exercise interventions are less effective in generating weight loss in females compared with males suggesting that the menstrual cycle may be important. Fluctuations in ovarian hormones are proposed to alter the appetite-regulatory response to exercise across the menstrual cycle and no study has assessed the response in all distinct hormonal phases. To compare postexercise appetite-regulating parameters after a single bout of moderate-intensity continuous training (MICT) across three distinct menstrual phases. Thirteen females (24 ± 4 y; 24.8 ± 5.4 kg·m -2 ) completed 30 min of MICT running in the follicular phase (FP), ovulatory phase (OP), and luteal phase (LP). Acylated ghrelin, active glucagon-like peptide-1 (GLP-1), plasma glucose, insulin, blood lactate, and appetite perceptions were measured preexercise, 0, 30, 60, and 120 min postexercise. Energy intake was recorded for a 3-d period (day before, of, and after each session). Acylated ghrelin was not different across phases ( P = 0.672, η p2 = 0.032) and only showed a main effect of time ( P = 0.006, η p2 = 0.757) increasing with time. Active GLP-1 was not different across phases ( P = 0.735, η p2 = 0.025) and had a main effect of time ( P < 0.001, η p2 = 0.569) decreasing with time. Appetite perceptions were not different across phases ( P = 0.577, η p2 = 0.045) and exhibited a main effect of time ( P < 0.001, η p2 = 0.786) increasing with time. There was no effect of phase for energy intake ( P = 0.544, η p2 = 0.065). Finally, there were no differences in plasma glucose, insulin, or blood lactate across phases ( P > 0.421, η p2 < 0.070). There were no divergent appetite responses after MICT running across three hormonally distinct phases (mid-FP, OP, mid-LP) of the menstrual cycle in young eumenorrheic females not using oral contraceptives.

Purpose : This study aimed to investigate phase-specific symptom patterns across the menstrual and hormonal contraceptive (HC) cycles in exercising females. A total of 42 participants were initially screened; eight were excluded due to not meeting hormonal criteria for eumenorrheic status, resulting in a final sample of 20 eumenorrheic and 14 HC users. Participants completed the Daily Record of Severity of Problems questionnaire daily over one hormonal cycle. Hormonal profiles were verified through serum hormone analysis. Symptom data were analyzed by grouping days into hormonal phases. Results : In eumenorrheic females, symptom severity peaked during the early follicular and late luteal phases, particularly in mood, behavior, and pain dimensions. The ovulatory, early luteal, and midluteal phases were the most stable, with minimal symptom expression. In contrast, HC users showed fewer fluctuations, though pain-related symptoms increased during the withdrawal bleeding phase. When comparing groups, eumenorrheic participants reported significantly more intense and frequent symptoms across all phases, especially in behavior and impairment dimensions during bleeding and late luteal phase. Conclusions : These findings highlight the importance of monitoring menstrual beyond the bleeding phase, as key symptomatology arises in less visible phases, such as the late luteal phase. Moreover, the relative stability observed in ovulatory, early luteal, and midluteal phases may represent favorable phases for athletic performance, given the minimal presence of adverse symptoms. HC use appears to attenuate but not suppress symptoms.

Background: Fluctuations in estrogen and progesterone across the menstrual cycle may influence cognitive and neuromuscular performance, yet previous findings have remained inconsistent because many studies have assessed isolated outcomes or relied solely on calendar-based phase estimation. Objective: To evaluate variations in cognitive performance, muscle strength, and endurance across menstrual cycle phases and examine their association with circulating estrogen and progesterone levels in healthy young women. Methods: This descriptive repeated-measures study was conducted in Lahore, Pakistan, among 60 healthy women aged 18-30 years with regular menstrual cycles. Assessments were performed during the follicular, ovulatory, and luteal phases. Serum estrogen and progesterone concentrations were measured by enzyme-linked immunosorbent assay. Cognitive performance was assessed using the Stroop Color-Word Test and Digit Span Test, while neuromuscular performance was evaluated using quadriceps maximal voluntary isometric contraction and plank endurance. Data were analyzed using repeated-measures ANOVA and Pearson correlation tests. Results: Estrogen peaked during ovulation (187.5 ± 25.8 pg/mL), whereas progesterone was highest in the luteal phase (11.8 ± 2.7 ng/mL) (p &lt; 0.001 for both). Stroop reaction time improved significantly during ovulation (689 ± 78 ms) compared with the follicular phase (732 ± 84 ms) (p = 0.012). Quadriceps strength was highest during ovulation (317.9 ± 34.5 N) and differed significantly across phases (p = 0.021). Digit Span scores and plank endurance also showed their highest mean values during ovulation. Estrogen correlated positively with cognitive performance (r = 0.42, p &lt; 0.05), while progesterone correlated positively with muscular endurance (r = 0.39, p &lt; 0.05). Conclusion: Cognitive and neuromuscular performance varied across menstrual cycle phases, with the most favorable overall outcomes observed during ovulation. These findings support consideration of menstrual physiology as a relevant biological variable in female performance research and individualized training or workload planning.

This systematic review and meta-analysis aimed to investigate the effects of menstrual cycle phases on women’s physical performance. Data from 78 studies were analyzed, encompassing assessments of both aerobic capacity and muscular strength. The findings indicate that menstrual cycle phases exert only a minimal influence on physical performance, with small and clinically insignificant differences between phases. The most pronounced variation was observed between the early and late follicular phases, yet these differences did not reach clinical relevance. Network meta-analysis supported these outcomes, demonstrating minor fluctuations in performance across the menstrual cycle. The overall quality of evidence was rated as low, underscoring the need for further high-quality research. In conclusion, the influence of menstrual cycle phases on physical performance appears to be minimal, and training recommendations should be individualized, considering each woman’s specific physiological responses and needs. Methods: The review was based on an analysis of articles published in the PubMed, Scopus, and Web of Science databases between 2005 and 2025, using the following keywords: menstrual cycle, cycle phases, eumenorrhea, physical performance, endurance, muscle strength, VO₂max, lactate threshold, hormonal contraception, estrogens, progesterone, recovery, fatigue, RPE, training, women’s sport. Only peer-reviewed, full-text articles published in English were included. The selection encompassed original research studies, systematic reviews, meta-analyses, and expert consensus statements, with a particular focus on studies evaluating the effects of menstrual cycle phases on physical performance, strength and power parameters, as well as recovery and fatigue perception indicators. The analysis integrated physiological, hormonal, and metabolic mechanisms with findings from clinical and sports performance studies to provide a comprehensive understanding of the relationship between menstrual cycle phases and female exercise capacity. Results: Analyses of systematic reviews and meta-analyses indicate that the influence of menstrual cycle phases on physical performance is small but detectable in certain measures. Meta-analyses have shown slight advantages in selected strength metrics (e.g., isometric and isokinetic strength) during the late follicular and ovulatory phases, although the observed effects are small and heterogeneous. Most studies do not confirm significant differences in VO₂max or time to exhaustion between menstrual phases. Experimental data suggest a protective effect of estradiol on muscle damage and a faster recovery following eccentric exercise. Biomechanical analyses and review studies also point to increased joint laxity around ovulation, which may partly explain the higher risk of anterior cruciate ligament (ACL) injuries observed during this period, although the overall quality of evidence remains limited. Conclusions: A review of the current literature indicates that the phases of the menstrual cycle may modulate women’s maximal strength. Isometric and isokinetic performance measures tend to exhibit a slight improvement during the late follicular phase and ovulation; however, these effects are generally small and often lack clinical significance. In terms of aerobic capacity (VO₂max and time to exhaustion), the evidence does not demonstrate consistent or substantial variations across menstrual cycle phases. Muscle recovery and susceptibility to damage appear to be more favorable during periods of elevated estrogen concentrations. Conversely, biomechanical parameters, including ligament laxity and neuromuscular control, may fluctuate throughout the cycle, potentially increasing injury risk near ovulation, although empirical support for this association remains limited.

BackgroundSmall extracellular vesicles (sEVs) mediate intercellular communication by transporting microRNAs and proteins. Endometrial sEVs have been implicated in embryo implantation due to their content of implantation-related molecules; however, their precise functions and underlying mechanisms remain unclear. This study aimed to identify proteins in endometrial sEVs that contribute to embryo implantation and to clarify their functional significance.MethodsUterine fluid (UF) samples were collected from five women in each of the ovulatory and implantation phases. UF-derived sEVs (UF-sEVs) were isolated using a combination of size-exclusion chromatography and ultrafiltration, and their proteomic profiles were compared between phases. In parallel, hormone-treated Ishikawa cells—a human endometrial adenocarcinoma cell line—were used to model the proliferative and implantation phases in vitro, and sEVs derived from these cells (Ishikawa-sEVs) were similarly analysed. Galectin-3, a protein upregulated in both UF-sEVs and Ishikawa-sEVs during the implantation phase and known to be involved in cytotrophoblast (CT) cell fusion, was selected for functional validation. CT cell fusion assays were performed using Ishikawa-sEVs from galectin-3 knockdown (Gal3-KD) and non-target knockdown (NT-KD) cells.ResultsWe identified 2,041 and 1,386 proteins in UF-sEVs from the ovulatory and implantation phases, respectively. Comparative analysis revealed 318 differentially expressed proteins (140 upregulated and 178 downregulated) during the implantation phase, including proteins related to immune response, cell adhesion, and migration. In Ishikawa-sEVs, we identified 913 and 915 proteins in the proliferative and implantation phases, respectively, with 68 differentially expressed proteins (44 upregulated and 24 downregulated). Implantation-phase Ishikawa-sEVs significantly promoted CT cell fusion compared with proliferative-phase sEVs. Moreover, Gal3-KD in Ishikawa cells significantly reduced the fusion-promoting effect of the sEVs, suggesting that galectin-3-enriched endometrial sEVs may facilitate CT fusion and subsequent differentiation into syncytiotrophoblast (ST) during implantation.ConclusionsOur findings demonstrate that endometrial sEVs enriched in galectin-3 during the implantation phase promote CT differentiation into ST, underscoring a novel role for sEV-mediated protein delivery in regulating early placental development and suggesting potential diagnostic and therapeutic applications in reproductive medicine.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12964-025-02586-1.

Background: The menstrual cycle is governed by estrogen and progesterone, which show variation during the menstrual cycle, affecting the physiology of the whole body, including the oral cavity. However, few studies are available to show the normal changes in salivary composition during the menstrual cycle. So this study assessed the changes in the salivary composition of calcium, magnesium, sodium, potassium and inorganic phosphate during the different phases of the menstrual cycle. Additionally, salivary H2O2 scavenging activity, total antioxidant properties and changes in pH during preovulatory, ovulatory and post-ovulatory phases were estimated biochemically.  Methodology: Unstimulated 5ml of saliva was collected from 50 female patients during pre-ovulatory, ovulatory and post-ovulatory phases using the spitting method. The salivary pH was estimated using a digital pH meter. Salivary electrolyte testing was done using atomic absorption spectrophotometer. Total antioxidant property and hydrogen peroxide scavenging property were determined using a UV spectrophotometer. For continuous variables, ANOVA with Repeated Measures was used and if significant Bonferroni post hoc test was done to determine which menstrual phase significantly differed from the other. For categorical variables, the Friedman test was used. After the existence of variance among the phases was confirmed in the Friedman test, the Wilcoxon signed-rank test was applied to understand how significantly each phase differed from the other. The level of significance was set at 0.05.  Results: It was found that during the ovulatory phase of the menstrual cycle, all the salivary tested components increased significantly when compared to pre and post-ovulatory phases.  Conclusion: Saliva can be used as a supplementary tool to detect the ovulatory phase.