Women's Health

Menstrual cycle, hormones, perimenopause, and cycle-synced interventions for energy, mood, and performance.

Research synthesis8 min read

What the Women's Health & Hormonal Research Actually Shows

Hormonal health affects energy, mood, cognition, and metabolism — but has been systematically understudied. Here's what the evidence actually supports and what's worth measuring.

The Research Gap — and Why It Matters

Women's health has been systematically understudied. The NIH only mandated inclusion of women in federally funded clinical trials in 1993. Before that, most foundational drug, nutrition, and exercise research was conducted on male subjects, with findings extrapolated across sex — an assumption that fails routinely when examined.

The consequences are significant: women metabolize medications differently, respond to exercise protocols differently, and have distinct cardiovascular disease presentations that were missed in male-dominated research for decades. This is not a minor gap. It is a reason to be especially attentive to study populations when evaluating evidence in this domain.

The good news: the last decade has seen a substantial increase in high-quality women's health research, particularly on the menstrual cycle, perimenopause, and hormonal contraception. The evidence base is now large enough to draw specific, actionable conclusions.

The Menstrual Cycle as a Biological Variable

The menstrual cycle is a repeating natural experiment that most women do not track systematically enough to understand. Across the roughly 28-day cycle, estrogen, progesterone, LH, and FSH follow predictable trajectories that affect cognition, mood, energy, pain tolerance, and physical performance.

Key findings from cycle-phase research:

Follicular phase (days 1–14, rising estrogen): Some studies report differences in verbal memory, fine motor skill, attention, and hippocampal structure or activity across cycle phases, but findings are not uniform enough to make a simple "best phase" rule. Protopopescu et al. reported hippocampal structural differences and higher verbal declarative memory in a late-follicular/postmenstrual scan compared with a late-luteal/premenstrual scan; this should be treated as mechanistic background, not a direct performance prescription.

Ovulation (day ~14): Pain tolerance is at its monthly peak due to estrogen's analgesic effect. This is the optimal window for procedures, dental work, or high-intensity training with elevated injury risk.

Luteal phase (days 15–28, rising progesterone): Resting metabolic rate increases approximately 100–300 kcal/day. Carbohydrate cravings increase due to progesterone's effect on serotonin production. Sleep architecture shifts: body temperature rises, REM sleep decreases, sleep quality ratings decline in the week before menstruation. Core body temperature remains approximately 0.3–0.5°C elevated throughout luteal phase.

Premenstrual (days 24–28): PMS affects 75% of women to some degree; PMDD (a diagnosable disorder with functional impairment) affects approximately 5–8%. The DSM-5 criteria for PMDD require prospective symptom tracking for two cycles — which is itself an acknowledgment that retrospective report is insufficient.

The key insight for self-experimentation: tracking symptoms, performance, and mood by cycle phase for 2–3 months reveals whether and how much your own performance varies, which is not predictable from population data alone.

Exercise Performance and the Menstrual Cycle

A systematic review and meta-analysis by McNulty et al. (78 studies, over 1,000 women) found large variation between studies and mostly low-quality evidence. Average effects of menstrual-cycle phase on exercise performance were small enough that general training rules should not be formed from the literature alone. The more defensible takeaway is personalized: track your own performance and recovery by cycle phase before changing training.

Strength training adaptations may be modulated by cycle phase. A 2021 RCT by Wikström-Frisén et al. found that women who performed higher volume training in the follicular phase and lower volume in the luteal phase gained significantly more muscle mass than those following a flat weekly schedule (p = 0.04). The sample was small (n = 59) but the mechanistic logic is sound: estrogen is anabolic and has anti-catabolic effects on muscle.

Injury risk: ACL tears are approximately 2–8x more likely during ovulation in female athletes (across multiple prospective studies), likely due to estrogen's effect on ligament laxity. This is a meaningful enough finding to influence training periodization.

Contraception and Biological Measurement

Hormonal contraception — used by approximately 65% of women of reproductive age — alters the endocrine environment substantially. This has direct implications for self-experimentation.

Combined oral contraceptives suppress endogenous estrogen and progesterone and replace them with synthetic analogs. The result: the natural cycle-phase variation in cognition, mood, and performance is largely eliminated. HRV patterns differ from naturally cycling women. SHBG (sex hormone binding globulin) rises, which lowers free testosterone and can reduce libido and mood in a subset of users.

A 2016 Danish cohort study (n = 1,061,997, 13-year follow-up) found combined OCP users had significantly higher rates of antidepressant initiation versus non-users (hazard ratio 1.23 overall, rising to 1.80 for adolescents). The study was observational with confounders, but the size and effect consistency are notable.

For self-experimenters on hormonal contraception: cycle-phase protocols do not apply. Tracking should be week-over-week rather than cycle-phase-relative. This doesn't make measurement less useful — it makes it differently structured.

Perimenopause: The Understudied Transition

Perimenopause — the 4–10 year transition leading to menopause — is one of the most biologically disruptive periods in female physiology, and one of the most poorly managed in clinical practice. The average age of onset is mid-40s; menopause (12 months of amenorrhea) occurs at a median age of 51.

During perimenopause, estrogen fluctuates unpredictably rather than following a predictable cycle. These fluctuations drive the classic symptoms: vasomotor events (hot flashes), sleep disruption, mood instability, cognitive changes (the "brain fog" that women consistently report but was historically dismissed), and changes in body composition.

The cognitive effects are real and measurable. A longitudinal study by Maki et al. followed women through the menopause transition and found objective declines in verbal memory and processing speed during perimenopause, with partial recovery post-menopause — suggesting a transitional, not permanent, effect.

Hormone Replacement Therapy (HRT): The WHI (Women's Health Initiative) study in 2002 caused a major shift away from HRT and estrogen-progestogen therapy. Subsequent analyses and newer research have made the picture more nuanced. The 2022 North American Menopause Society position statement concludes that, for many women younger than 60 or within 10 years of menopause onset and without contraindications, the benefit-risk ratio is favorable for treating vasomotor symptoms and preventing bone loss. For women who start later, the balance is less favorable because absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia are higher. This is clinical decision territory, not a self-experimentation protocol.

Modern formulations (transdermal estradiol, micronized progesterone) have a better safety profile than the conjugated equine estrogen + medroxyprogesterone acetate used in WHI. This distinction matters for clinical decision-making.

Bone Density, Estrogen, and the Long Game

Bone density peaks around age 30 and declines from there, with a sharp acceleration in the first 5–10 years post-menopause due to estrogen loss. The lifetime fracture risk for women is approximately 50% — higher than for breast cancer, heart attack, and stroke combined.

Resistance training is the most effective non-pharmacological intervention for bone density preservation. A meta-analysis by Zhao et al. (2015, 13 RCTs) found resistance training significantly increased lumbar spine BMD in postmenopausal women (standardized mean difference 0.38, p < 0.001). Impact exercise (jumping protocols) shows larger effects than non-impact resistance training on hip bone density specifically.

DEXA scans (dual-energy X-ray absorptiometry) measure bone mineral density with high precision and are the gold standard for tracking.

What to Measure

Cycle tracking (Clue, Natural Cycles, or paper log): day of cycle, energy (1–10), mood (1–10), pain, sleep quality — minimum 2–3 cycles for pattern recognition
Basal body temperature: rises 0.2–0.5°C at ovulation; tracked with a basal thermometer (±0.01°C precision), confirms ovulation timing and luteal phase length
HRV by cycle phase: document whether HRV follows the expected drop in luteal phase; individual variation is high
Vasomotor event frequency and severity (for perimenopause): log time, duration, and sleep disruption; establishes baseline for intervention trials
DEXA scan (every 2–3 years from age 40+): bone density, visceral fat, lean mass — more informative than the scale

What to Experiment With

→ Resistance training periodization by cycle phase (higher volume follicular, lower volume luteal) → 3-month strength progression and subjective recovery rating Tests the Wikström-Frisén protocol on your own data. The experiment requires consistent cycle tracking and workout logging simultaneously.

→ Magnesium glycinate (300–400 mg/day, days 14–28) → PMDD or PMS symptom severity in luteal phase A 1991 RCT by Facchinetti et al. found magnesium supplementation significantly reduced premenstrual mood symptoms (p < 0.01). Small study, but mechanistically plausible and easy to test with cycle-tracked symptom logs.

→ Consistent sleep timing (within 30-minute window) → sleep quality rating and HRV across cycle phases Tests whether circadian consistency modulates the luteal-phase sleep disruption that most cycling women experience; requires 2-cycle baseline before intervention.

→ Time-restricted eating window → fasting glucose, energy, and cycle regularity tracked over 3 months Intermittent fasting research is almost entirely conducted on men; the evidence for women specifically is mixed, with some data suggesting menstrual cycle disruption at aggressive restriction. This experiment tests your personal response rather than assuming male findings apply.

Measuring Your Own Hormonal Patterns

The 28-day cycle is a natural experiment that most women run without tracking the outcome variables. Two cycles of structured daily logging — energy, mood, sleep, pain, performance — provides more personalized information than any population study. Layer in basal body temperature and HRV and you have a multivariate dataset specific to your physiology. This is the foundation of evidence-based self-management in women's health.

Full article →Test this on yourself →

Evidence base

Min quality:

50 papers

Meta-analysisTop journalWikiHigh evidence score

Lifestyle changes in women with polycystic ovary syndrome

Siew S Lim, Samantha K Hutchison, Emer Van Ryswyk +3 more · Cochrane Database of Systematic Reviews · 2019 · 379 citations

This comprehensive review found that lifestyle changes (diet, exercise, and behavioral interventions) may lead to a modest reduction in body weight, Body Mass Index (BMI), and the Free Androgen Index (FAI) in women with Polycystic Ovary Syndrome (PCOS), suggesting that these interventions can help manage some key symptoms, though their impact on fertility and glucose tolerance remains uncertain.

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Meta-analysisWikiHigh evidence score

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline

Margaret E. Wierman, Wiebke Arlt, Rosemary Basson +5 more · The Journal of Clinical Endocrinology & Metabolism · 2014 · 355 citations

This clinical practice guideline, based on a systematic review of existing evidence, concludes that testosterone therapy should not be used routinely in women for any indication except short-term treatment of hypoactive sexual desire disorder in postmenopausal women, and even then only with careful monitoring because long-term safety data are lacking and no physiological testosterone preparations are approved for women in most countries.

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Meta-analysisHigh evidence score

Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors—An Endocrine Society Scientific Statement

Sherita Hill Golden, Arleen F. Brown, Jane A. Cauley +6 more · The Journal of Clinical Endocrinology & Metabolism · 2012 · 403 citations

OBJECTIVE: The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. PARTICIPANTS IN DEVELOPMENT OF SCIENTIFIC STATEMENT: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement. EVIDENCE: The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorder or condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders. consensus process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolic syndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. CONCLUSIONS: Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.

RCTLeading journalWikiHigh evidence score

Comparison of High-Intensity Interval Training and Moderate-to-Vigorous Continuous Training for Cardiometabolic Health and Exercise Enjoyment in Obese Young Women: A Randomized Controlled Trial

Zhaowei Kong, Xitao Fan, Shengyan Sun +3 more · PLoS ONE · 2016 · 184 citations

Both high-intensity interval training (HIIT) and moderate-to-vigorous continuous training (MVCT) improved cardiorespiratory fitness by about 9–10% over 5 weeks in obese young women, but HIIT was more enjoyable and required half the exercise time (20 minutes vs. 40 minutes per session), making it a time-efficient alternative for people who struggle with exercise adherence.

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RCTTop journalWikiHigh evidence score

Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms

Susan M. McCurry, Katherine A. Guthrie, Charles M. Morin +13 more · JAMA Internal Medicine · 2016 · 178 citations

Six telephone-delivered sessions of cognitive behavioral therapy for insomnia (CBT-I) over 8 weeks produced a 5.2-point greater reduction in insomnia severity compared to a menopause education control, with 84% of CBT-I participants achieving no-insomnia status by 24 weeks, and the benefits persisted even though hot flash frequency itself did not change.

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RCTHigh evidence score

Hormone replacement therapy is associated with improved cognition and larger brain volumes in at-risk APOE4 women: results from the European Prevention of Alzheimer’s Disease (EPAD) cohort

Rasha N.M. Saleh, Michael Hornberger, Craig Ritchie +1 more · Alzheimer s Research & Therapy · 2023 · 144 citations

BACKGROUND: The risk of dementia is higher in women than men. The metabolic consequences of estrogen decline during menopause accelerate neuropathology in women. The use of hormone replacement therapy (HRT) in the prevention of cognitive decline has shown conflicting results. Here we investigate the modulating role of APOE genotype and age at HRT initiation on the heterogeneity in cognitive response to HRT. METHODS: The analysis used baseline data from participants in the European Prevention of Alzheimer's Dementia (EPAD) cohort (total n= 1906, women= 1178, 61.8%). Analysis of covariate (ANCOVA) models were employed to test the independent and interactive impact of APOE genotype and HRT on select cognitive tests, such as MMSE, RBANS, dot counting, Four Mountain Test (FMT), and the supermarket trolley test (SMT), together with volumes of the medial temporal lobe (MTL) regions by MRI. Multiple linear regression models were used to examine the impact of age of HRT initiation according to APOE4 carrier status on these cognitive and MRI outcomes. RESULTS: APOE4 HRT users had the highest RBANS delayed memory index score (P-APOE*HRT interaction = 0.009) compared to APOE4 non-users and to non-APOE4 carriers, with 6-10% larger entorhinal (left) and amygdala (right and left) volumes (P-interaction= 0.002, 0.003, and 0.005 respectively). Earlier introduction of HRT was associated with larger right (standardized β= -0.555, p=0.035) and left hippocampal volumes (standardized β= -0.577, p=0.028) only in APOE4 carriers. CONCLUSION: HRT introduction is associated with improved delayed memory and larger entorhinal and amygdala volumes in APOE4 carriers only. This may represent an effective targeted strategy to mitigate the higher life-time risk of AD in this large at-risk population subgroup. Confirmation of findings in a fit for purpose RCT with prospective recruitment based on APOE genotype is needed to establish causality.

Meta-analysisTop journalHigh evidence score

Postmenopausal Estrogen and Prevention Bias

Elizabeth Barrett‐Connor · Annals of Internal Medicine · 1991 · 379 citations

Brief Report15 September 1991Postmenopausal Estrogen and Prevention BiasElizabeth Barrett-Connor, MDElizabeth Barrett-Connor, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-6-455 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the last decade many investigators reported that postmenopausal women taking estrogen were at reduced risk for cardiovascular disease compared with women not taking estrogen (1). Many clinicians in the United States now believe that replacement estrogen prevents heart disease. The results are fairly consistent and biologically plausible. Replacement estrogen lowers low-density lipoprotein (LDL) cholesterol and raises high-density lipoprotein (HDL) cholesterol (2) and may also lower blood pressure, blood glucose, and plasma insulin (3). If estrogen does prevent heart disease, the quantitative benefit would far exceed any known or postulated adverse events, including cancer (4).Observational studies suffer from several...References1. Barrett-ConnorBush ET. Estrogen and coronary heart disease in women. JAMA. 1991;265:1861-7. CrossrefMedlineGoogle Scholar2. TikkanenNikkiläVartiainen MEE. Natural oestrogen as an effective treatment for type-II hyperlipoproteinaemia in postmenopausal women. Lancet. 1978;2:490-1. CrossrefMedlineGoogle Scholar3. Barrett-Connor E. Putative complications of estrogen replacement therapy: hypertension, diabetes, thrombophlebitis, and gallstones. In: Korenman SG, ed. The Menopause. Norwell, Massachusetts: Serono Symposia; 1990:199-209. Google Scholar4. ErnsterBushHugginsHulkaKelseySchottenfeld VTGBJD. Benefits and risks of menopausal estrogen and/or progestin hormone use. Prev Med. 1988;17:201-23. CrossrefMedlineGoogle Scholar5. CauleyCummingsBlackMascioliSeeley JSDSD. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163:1438-44. CrossrefMedlineGoogle Scholar6. Barrett-ConnorWingardCriqui EDM. Postmenopausal estrogen use and heart disease risk factors in the 1980s. JAMA. 1989;261:2095-100. CrossrefMedlineGoogle Scholar7. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. New Engl J Med. 1980;303:1038-41. CrossrefMedlineGoogle Scholar8. HorwitzViscoliBerkmanDonaldsonHorwitzMurray RCLRSC. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990;336:542-5. CrossrefMedlineGoogle Scholar9. BergkvistAdamiPerssonHooverSchairer LHIRC. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med. 1989;321:293-7. CrossrefMedlineGoogle Scholar10. BergkvistAdamiPerssonBergstromKrusemo LHIRU. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol. 1989;130:221-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of California, San Diego; La Jolla, California. For the current author address, see end of text. 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Hulley, MD, MPHSex Steroids and Osteoporosis: The Role of Estrogens and AndrogensThe past, the present and the future o oestrogen and progestogen therapy for cardiovascular disease in postmenopausal womenHormone Replacement Therapy Should Not Be Used as Secondary Prevention of Coronary Heart DiseaseCognitive decline in women in relation to non-protein-bound oestradiol concentrationsEstrogen is associated with improved survival in aging women with congestive heart failure: analysis of the vesnarinone studiesPostmenopausal estrogen therapy and depressive symptoms in older womenHormone replacement therapy in relation to risk of lobular and ductal breast carcinoma in middle-aged womenLower Extremity Arterial Disease in Older Women: The Rancho Bernardo StudyPreventive health care for older women: Life-style recommendations and new directionsLong-term estrogen replacement therapy is associated with improved exercise capacity in postmenopausal women without known coronary artery diseaseSelf-rated health, life satisfaction and personal characteristics of post-menopausal women under estrogen replacement therapyHormone therapy had no significant effect on the secondary prevention of coronary heart disease in postmenopausal womenHas the Impact of Hormone Replacement Therapy on Health-Related Quality of Life Been Undervalued?Correlates of high HDL cholesterol among women with coronary heart diseaseOverview of Women's Decision Making Regarding Elective Hysterectomy, Oophorectomy, and Hormone Replacement TherapyHormone replacement therapy and glucose tolerance in EPIC-Norfolk: a population-based studyCognitive Changes and Aging: Is Estrogen a Factor?The Treatment of Estrogen Deficiency in Women at Risk for Breast Cancer and Survivors of the DiseaseThe Risks and Benefits of Hormone Replacement Therapy—Weighing the EvidenceEpidemiology: Methodologic Challenges in the Study of MenopauseThe Epidemiology of Cardiovascular Disease and Postmenopausal Hormone TherapyThe effect of menopause on blood lipid and lipoprotein levelsThe Effect of Menopause and Perimenopause on the Course of EpilepsyEnhanced Cognitive Performance with Estrogen Use in Nondemented Community-Dwelling Older WomenAssociation Between Bone Mineral Density and Cognitive Decline in Older WomenPostmenopausal hormone therapy, SERMs, and coronary heart disease in womenHormone replacement therapy in postmenopausal women protects against smoking-induced changes in vascular structure and functionPredictors of Quality of Life in Women: Hormone Therapy Self-Efficacy and Health-Promoting BehaviorsPostmenopausal Hormone Replacement Therapy: Effect on Diagnosis and Outcome in Early-Stage Invasive Breast Cancer Treated With Conservative Surgery and RadiationAlternatives to the Use of Estrogen in Postmenopausal WomenSelective Estrogen Receptor Modulators: Clinical Spectrum*The Efficacy of Hormonal Therapy for Reducing Coronary Artery Disease in WomenEstrogen Replacement Therapy and Incidence of Self-Reported Physician-Diagnosed ArthritisUse of Hormone Replacement Therapy by Postmenopausal Women in the United StatesNancy L. 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Ayanian, MD, MPPThe Danish osteoporosis prevention study (DOPS): project design and inclusion of 2000 normal perimenopausal womenLow use of long‐term hormone replacement therapy in DenmarkPhyto-oestrogens: A potential role in the prevention of CHD?Hormone Replacement TherapyFrauen und HerzerkrankungOral contraceptives and colorectal tumorsThe Epidemiology of Coronary Heart Disease and HRT What are the Contentious Issues?Transdermal estrogen replacement therapy and plasma lipids in 693 French womenThe hormone replacement therapy self‐efficacy scaleEffects of Estrogen Replacement Therapy on PET Cerebral Blood Flow and Neuropsychological PerformanceEstrogen for women at varying risk of coronary diseaseHeart and Estrogen/progestin Replacement Study (HERS)Rethinking Estrogen and the BrainHORMONE REPLACEMENT THERAPY, HEART DISEASE, AND OTHER CONSIDERATIONSHormones and the cardiologistThe Relationship Between Fat Distribution and Coronary Risk Factors in Sedentary Postmenopausal Women On and Off Hormone Replacement TherapyEstrogen after ischemic stroke: Clinical basis and design of The Women's Estrogen for Stroke TrialThrombosis and Heart Attacks with Contraceptive and Menopausal HormonesOestrogen replacement therapy and coronary heart diseaseHormone replacement therapy: Prevalence, compliance and the 'healthy women' notionHealth status of hormone replacement therapy users and non-users as determined by the SF-36 quality-of-life dimensionA systematic review of the skeletal effects of estrogen therapy in postmenopausal women. II. An assessment of treatment effectsElectrocardiogram pattern in hypercholesterolemic women: the influence of hormone replacement therapyRelation between hormone replacement therapy in women and coronary artery disease estimated by electron beam tomographyPostmenopausal Hormone Therapy and MortalityCardiovascular Disease in WomenEstrogen and heart disease: trials to prevent tribulationsMenopause and post-menopausePostmenopausal Hormone Therapy and MortalityÖstrogene zur Prävention der koronaren Herzkrankheit?THE EFFECTS OF HORMONE REPLACEMENT THERAPY ON CORONARY HEART DISEASEHormone replacement therapy and major risk factors for reproductive cancers, osteoporosis, and cardiovascular diseases: Evidence of confounding by exposure characteristicsHomoeopathic treatment during the menopausePrevalence and characteristics associated with use of hormone replacement therapy in BritainMenopause: Problems and Interventions in the United StatesMedicalization of Menopause and Public HealthEstrogen ReplacementChanges in plasma lipids and lipoproteins associated with starting or stopping postmenopausal hormone replacement therapyEstrogen Therapy, Atherosclerosis, and Clinical Cardiovascular EventsWhy cardiologists should be interested in estrogenPostmenopausal Estrogen and Progestin Use and the Risk of Cardiovascular DiseaseMammography using in a community-based sample of older womenThe menopause, hormone replacement, and cardiovascular disease: the epidemiologic evidenceCross-talk about the menopause: enhancing provider-patient interactions about the menopause and hormone therapyCardiovascular Risk Reduction in WomenPrevention of OsteoporosisSex Hormones and the VasculaturePostmenopausal estrogen and heart diseaseSCREENING, HEALTH PROMOTION, AND PREVENTION IN WOMENHormone replacement therapy and cardiovascular risk: the cardiovascular physicians' viewpointFactors contributing to skeletal health of postmenopausal Mexican-American womenUse of hormone replacement therapy by Melbourne womenFracture protection provided by long-term estrogen treatmentMenopausePostmenopausal hormone therapy and atherosclerotic diseaseDeterminants of first prescription of hormone replacement therapy. A follow-up study among 1689 women aged 45–60 yearsEffects of estrogens on lipoprotein metabolism and cardiovascular disease in womenDo women taking hormone replacement therapy have a higher uptake of screening mammograms?CALCIUM, ESTROGEN, AND PROGESTIN IN THE TREATMENT OF OSTEOPOROSISPostmenopausal estrogen replacement: A long-term cohort studyImpact of the menopause on the epidemiology and risk factors of coronary artery heart disease in womenPostmenopausal estrogen and the risk of breast cancerCorrelates of Impaired Function in Older WomenHormonal Treatment of Postmenopausal WomenHormonal treatment for the climacteric: alleviation of symptoms and prevention of postmenopausal diseaseCoronary heart disease, the menopause, and hormone replacement therapy.Epidemiologic Studies on Ert and Cardioprotection: State of the Art on HRT and Cardiovascular DiseaseSex steroids and lipoprotein metabolismHormone replacement therapy: the need for reconsideration.Editor's note: Estrogen therapy for the prevention of coronary heart disease: What are the facts?Endocrine disordersThe Menopause: Health Implications and Clinical ManagementGender, Health, and Responsible ResearchThe epidemiology of osteoporosis5 Oestrogens and atherosclerotic vascular disease—lipid factors6 Epidemiological overview of oestrogen replacement and cardiovascular disease7 Hormone replacement therapy and cancerWinner of the Young Clinical investigater Manuscript Award: Hysterectomy Status and Preventive Health Behaviors in Older WomenPostmenopausal hormone replacement therapy.Do current regimes of hormone replacement therapy protect against subsequent fractures?The Prevention and Treatment of OsteoporosisEstrogen Therapy for Osteoporosis—Even in the ElderlySusan M. Ott, MDSafety of post-menopausal hormone replacementPostmenopausal Estrogen Therapy and Cardiovascular DiseasePostmenopausal Estrogen and Prevention BiasMaryann NapoliEvidence-Based Medicine and GeriatricsSpezielle therapeutische Probleme im höheren AlterPromoting Informed Decision Making: Hormone Replacement TherapyA Summary of the Evidence Relating Postmenopausal Hormone Use and Large Bowel Cancer Risk 15 September 1991Volume 115, Issue 6Page: 455-456KeywordsBlood plasmaCardiovascular therapyCholesterolEstrogensGlucoseHigh density lipoproteinInsulinLow density lipoproteinObservational studiesRisk management Issue Published: 15 September 1991 PDF DownloadLoading ...

RCTHigh evidence score

Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice

Andrea R. Genazzani, P. Monteleone, Andrea Giannini +1 more · Human Reproduction Update · 2021 · 86 citations

BACKGROUND: Menopausal symptoms can be very distressing and considerably affect a woman's personal and social life. It is becoming more and more evident that leaving bothersome symptoms untreated in midlife may lead to altered quality of life, reduced work productivity and, possibly, overall impaired health. Hormone therapy (HT) for the relief of menopausal symptoms has been the object of much controversy over the past two decades. At the beginning of the century, a shadow was cast on the use of HT owing to the concern for cardiovascular and cerebrovascular risks, and breast cancer, arising following publication of a large randomized placebo-controlled trial. Findings of a subanalysis of the trial data and extended follow-up studies, along with other more modern clinical trials and observational studies, have provided new evidence on the effects of HT. OBJECTIVE AND RATIONALE: The goal of the following paper is to appraise the most significant clinical literature on the effects of hormones in postmenopausal women, and to report the benefits and risks of HT for the relief of menopausal symptoms. SEARCH METHODS: A Pubmed search of clinical trials was performed using the following terms: estrogens, progestogens, bazedoxifene, tibolone, selective estrogen receptor modulators, tissue-selective estrogen complex, androgens, and menopause. OUTCOMES: HT is an effective treatment for bothersome menopausal vasomotor symptoms, genitourinary syndrome, and prevention of osteoporotic fractures. Women should be made aware that there is a small increased risk of stroke that tends to persist over the years as well as breast cancer risk with long-term estrogen-progestin use. However, healthy women who begin HT soon after menopause will probably earn more benefit than harm from the treatment. HT can improve bothersome symptoms, all the while conferring offset benefits such as cardiovascular risk reduction, an increase in bone mineral density and a reduction in bone fracture risk. Moreover, a decrease in colorectal cancer risk is obtainable in women treated with estrogen-progestin therapy, and an overall but nonsignificant reduction in mortality has been observed in women treated with conjugated equine estrogens alone or combined with estrogen-progestin therapy. Where possible, transdermal routes of HT administration should be preferred as they have the least impact on coagulation. With combined treatment, natural progesterone should be favored as it is devoid of the antiapoptotic properties of other progestogens on breast cells. When beginning HT, low doses should be used and increased gradually until effective control of symptoms is achieved. Unless contraindications develop, patients may choose to continue HT as long as the benefits outweigh the risks. Regular reassessment of the woman's health status is mandatory. Women with premature menopause who begin HT before 50 years of age seem to have the most significant advantage in terms of longevity. WIDER IMPLICATIONS: In women with bothersome menopausal symptoms, HT should be considered one of the mainstays of treatment. Clinical practitioners should tailor HT based on patient history, physical characteristics, and current health status so that benefits outweigh the risks.

StudyLeading journalModerate

2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013

Mary Jane De Souza, Aurelia Nattiv, Elizabeth A. Joy +8 more · British Journal of Sports Medicine · 2014 · 634 citations

The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction and (3) low bone mineral density. Female athletes often present with one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhoea and osteoporosis. This consensus statement represents a set of recommendations developed following the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the screening, diagnosis and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team and implementation of treatment contracts. This consensus paper has been endorsed by the Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians and other healthcare professionals, the American College of Sports Medicine and the American Medical Society for Sports Medicine.

RCTHigh evidence score

Exogenous progesterone for smoking cessation in men and women: a pilot double‐blind, placebo‐controlled randomized clinical trial

Nicole Tosun, Ann Fieberg, Lynn E. Eberly +4 more · Addiction · 2019 · 48 citations

BACKGROUND AND AIMS: In some clinical studies men and women have been found to differ in their ability to quit smoking, perhaps as a result of progesterone. The primary aim of this study was to provide a preliminary test of whether progesterone (PRO), compared with placebo (PBO), was more effective for smoking cessation in men and women. DESIGN: Pilot double-blind, placebo-controlled randomized clinical trial. SETTING: Minneapolis/St Paul metro area, Minnesota, USA. PARTICIPANTS: A total of 216 participants were randomized, including 113 men (18-60 years; PRO = 56, PBO = 57) and 103 women (18-50 years, pre-menopausal with self-reported regular menstrual cycles; PRO = 51, PBO = 52). INTERVENTION: Participants were randomized (1 : 1 within sex group) to either PRO (200 mg twice daily) or PBO. Participants were assigned a quit date approximately 7 days after starting medication (luteal phase for women) and were followed for 12 weeks to assess relapse. MEASUREMENTS: The primary outcome was self-reported 7-day point prevalence abstinence (PPA) at week 4. Secondary outcomes included 7-day PPA at weeks 8 and 12, prolonged abstinence, continuous abstinence, urine cotinine < 50 ng/ml, expired carbon monoxide ≤ 5 parts per million (p.p.m.) and days to relapse. FINDINGS: There was a significant difference in 7-day PPA at week 4 among women [PRO: 18 (35.3%) versus PBO: 9 (17.3%), odds ratio (OR) = 2.61, 95% confidence interval (CI) = 1.04, 6.54, P = 0.041], but not among men [PRO: 13 (23.2%) versus PBO: 12 (21.1%), 1.13 (0.47, 2.76), P = 0.782]. There was some evidence that PRO delayed relapse in women (days to relapse; PRO: 20.5 ± 29.6 versus PBO: 14.3 ± 26.8, P = 0.03) but not in men (PRO: 13.4 ± 25.9 versus PBO: 13.3 ± 23.8, P = 0.69). CONCLUSIONS: Oral micronized progesterone may aid smoking cessation in women.

StudyModerate

Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

Susan Young, Nicoletta Adamo, Bryndís Björk Ásgeirsdóttir +19 more · BMC Psychiatry · 2020 · 469 citations

BACKGROUND: There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. METHODS: The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. RESULTS: A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. CONCLUSIONS: This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.

ObservationalLeading journalModerate

Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE

Mona Hashim, Asma A. Obaideen, Haitham Jahrami +7 more · Nutrients · 2019 · 177 citations

Premenstrual syndrome (PMS) is a cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life. Little is known about PMS in the United Arab Emirates (UAE). This study aimed to determine the prevalence and severity of PMS among university students in Sharjah, UAE, and clarify its associations with dietary habits, lifestyle behaviors, and anthropometric factors. A cross-sectional study was conducted on female college students at the University of Sharjah, UAE. Data were collected using self-administered questionnaires and anthropometric assessments. Descriptive statistics and multiple logistic regression analyses were performed. Participants were 300 adult university students aged 18–24 years (mean age 20.07 ± 1.53 years). In total, 95% of participants reported at least one PMS symptom during their menstrual period. The prevalence of PMS was 35.3%, with mild symptoms being the most commonly reported. Multiple regression analysis showed that smoking was associated with increased risk of reporting psychological (OR 2.5, 95% CI 1.1–5.8; p < 0.05) and behavioral symptoms (OR 2.2, 95% CI 1.0–4.9; p < 0.05), while high calorie/fat/sugar/salt foods intake was associated with increased risk of reporting physical symptoms (OR 3.2, 95% CI 1.4–7.3; p < 0.05). However, fruit consumption (OR 0.34, 95% CI 0.125–0.92; p < 0.05) was associated with a decreased risk of reporting behavioral symptoms. A high prevalence of PMS was reported among university students, with smoking and high calorie/fat/sugar/salt food consumption identified as strong risk factors for PMS.

ObservationalTop journalModerate

Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey

Mahbub‐Ul Alam, Stephen P. Luby, Amal Halder +7 more · BMJ Open · 2017 · 283 citations

BACKGROUND: Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls. METHODS: We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering. RESULTS: Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=-5.4; CI -10 to -1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14). CONCLUSION: Risk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a positive social environment around menstrual issues has the potential to benefit students by reducing school absence.

RCTTop journalHigh evidence score

Dose–response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial

Christopher E. Kline, Xuemei Sui, Martica H. Hall +4 more · BMJ Open · 2012 · 87 citations

OBJECTIVE: To investigate whether a dose-response relationship existed between exercise and subjective sleep quality in postmenopausal women. This objective represents a post hoc assessment that was not previously considered. DESIGN: Parallel-group randomised controlled trial. SETTING: Clinical exercise physiology laboratory in Dallas, Texas. PARTICIPANTS: 437 sedentary overweight/obese postmenopausal women. INTERVENTION: Participants were randomised to one of four treatments, each of 6 months of duration: a non-exercise control treatment (n=92) or one of three dosages of moderate-intensity exercise (50% of VO(2peak)), designed to meet 50% (n=151), 100% (n=99) or 150% (n=95) of the National Institutes of Health Consensus Development Panel physical activity recommendations. Exercise dosages were structured to elicit energy expenditures of 4, 8 or 12 kilocalories per kilogram of body weight per week (KKW), respectively. Analyses were intent to treat. PRIMARY OUTCOME MEASURES: Continuous scores and odds of having significant sleep disturbance, as assessed by the Sleep Problems Index from the 6-item Medical Outcomes Study Sleep Scale. Outcome assessors were blinded to participant randomisation assignment. RESULTS: Change in the Medical Outcomes Study Sleep Problems Index score at 6 months significantly differed by treatment group (control: -2.09 (95% CI -4.58 to 0.40), 4 KKW: -3.93 (-5.87 to -1.99), 8 KKW: -4.06 (-6.45 to -1.67), 12 KKW: -6.22 (-8.68 to -3.77); p=0.04), with a significant dose-response trend observed (p=0.02). Exercise training participants had lower odds of having significant sleep disturbance at postintervention compared with control (4 KKW: OR 0.37 (95% CI 0.19 to 0.73), 8 KKW: 0.36 (0.17 to 0.77), 12 KKW: 0.34 (0.16 to 0.72)). The magnitude of weight loss did not differ between treatment conditions. Improvements in sleep quality were not related to changes in body weight, resting parasympathetic control or cardiorespiratory fitness. CONCLUSION: Exercise training induced significant improvement in subjective sleep quality in postmenopausal women, with even a low dose of exercise resulting in greatly reduced odds of having significant sleep disturbance. TRIAL REGISTRATION NUMBER: clinicaltrials.gov identifier: NCT00011193.

ObservationalModerate

Dietary creatine intake and depression risk among U.S. adults

Amanda V. Bakian, Rebekah S. Huber, Lindsay S. Scholl +2 more · Translational Psychiatry · 2020 · 85 citations

Creatine monohydrate is actively being researched for its antidepressant effects, yet little is known about the link between dietary creatine and depression risk. This study examines the association between dietary creatine and depression in U.S. adults, using data from the 2005 to 2012 National Health and Nutrition Examination Survey (NHANES). Patient health questionnaire, dietary creatine intake and covariates were obtained on 22,692 NHANES participants ≥20 years of age. Depression prevalence was calculated within quartiles of dietary creatine intake. Adjusted logistic regression models were formulated to determine the relationship between dietary creatine intake and depression risk. Additional covariates included income to poverty ratio, race/ethnicity, sex, age, education level, body mass index, healthcare access, smoking status, physical activity, and antidepressant/anxiolytic medication use. Models were further stratified by sex, age group, and antidepressant/anxiolytic medication use. Depression prevalence was 10.23/100 persons (95% CI: 8.64-11.83) among NHANES participants in the lowest quartile of dietary creatine intake compared with 5.98/100 persons (95% CI: 4.97-6.98) among participants in the highest quartile (p < 0.001). An inverse association was measured between dietary creatine and depression (adjusted odds ratio (AOR) = 0.68, 95% CI: 0.52-0.88). Dietary creatine's negative association with depression was strongest in females (AOR = 0.62, 95% CI: 0.40-0.98), participants aged 20-39 years (AOR = 0.52, 95% CI: 0.34-0.79) and participants not taking antidepressant/anxiolytic medication (AOR = 0.58, 95% CI: 0.43-0.77). Study results indicate a significant negative relationship between dietary creatine and depression in a nationally representative adult cohort. Further research is warranted to investigate the role creatine plays in depression, particularly among women and across the lifespan.

StudyTop journalModerate

A citizen-science-enabled catalogue of the vaginal microbiome and associated factors

Sarah Lebeer, Sarah Ahannach, Thies Gehrmann +14 more · Nature Microbiology · 2023 · 153 citations

Understanding the composition and function of the vaginal microbiome is crucial for reproductive and overall health. Here we established the Isala citizen-science project to analyse the vaginal microbiomes of 3,345 women in Belgium (18-98 years) through self-sampling, 16S amplicon sequencing and extensive questionnaires. The overall vaginal microbiome composition was strongly tied to age, childbirth and menstrual cycle phase. Lactobacillus species dominated 78% of the vaginal samples. Specific bacterial taxa also showed to co-occur in modules based on network correlation analysis. Notably, the module containing Lactobacillus crispatus, Lactobacillus jensenii and Limosilactobacillus taxa was positively linked to oestrogen levels and contraceptive use and negatively linked to childbirth and breastfeeding. Other modules, named after abundant taxa (Gardnerella, Prevotella and Bacteroides), correlated with multiple partners, menopause, menstrual hygiene and contraceptive use. With this resource-rich vaginal microbiome map and associated health, life-course, lifestyle and dietary factors, we provide unique data and insights for follow-up clinical and mechanistic research.

ObservationalTop journalModerate

The association between recreational physical activity and depression in the short sleep population: a cross-sectional study

Yanwei You, Mengxian Wei, Yuquan Chen +4 more · Frontiers in Neuroscience · 2023 · 49 citations

Background: Short sleep is more common in the modern society. Recreational physical activity (RPA) like exercise brings both mental and physiological benefits to depression; paradoxically, lack of sleep is harmful. Evidence on the association between RPA and depression in the short sleep population is limited. Methods: Participants with short sleep condition from the National health and Nutrition Examination Surveys (NHANES 2007-2018) were included in the present study. Short sleep condition was defined as ≤ 7 h per night. Sleep duration and RPA status were self-reported in NHANES by the Physical Activity Questionnaire using a 7-day recall method. Multivariable logistic regression was applied to evaluate the association between RPA and depression. Additionally, the non-linear relationship between RPA and depression was evaluated using the threshold effect analysis and restricted cubic spline. Results: This cross-sectional study comprised 6,846 adults' data, and the weighted participants were 52,501,159. The weighted prevalence of depression was higher in females, which took up 65.85% of all depression patients. In fully adjusted models, sufficient volume of RPA was associated with lower depression risks, with OR (95% CI) =0.678 (0.520, 0.883). Further analysis revealed a U-shaped association between RPA and incident depression, and the inflection point was 640 MET-minutes/week. When RPA <640 MET-minutes/week, increased RPA was associated with lower risk of incident depression, with OR (95% CI) = 0.891 (0.834, 0.953). When RPA ≥ 640 MET-minutes/week, the benefits of RPA seemed to be not significant, with OR (95% CI) = 0.999 (0.990, 1.009). Conclusion: Our findings observed associations between RPA condition and incident depression in the short sleep population. Moderate RPA was beneficial to maintain mental health and associated with lower incidence of depression for short sleepers, but excessive RPA might increase the risk of depression. For general short sleepers, keeping the RPA volume approximately 640 MET-minutes/week was beneficial to lower risks of depression. Gender difference should be considered as an important factor for further studies to examine these relationships and explore mechanisms.

StudyModerate

All around suboptimal health — a joint position paper of the Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine

Wei Wang, Yuxiang Yan, Zheng Guo +12 more · The EPMA Journal · 2021 · 162 citations

First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person. This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.

StudyLeading journalModerate

The Challenge of Applying and Undertaking Research in Female Sport

Stacey Emmonds, Omar Heyward, Ben Jones · Sports Medicine - Open · 2019 · 253 citations

In recent years there has been an exponential rise in the professionalism and success of female sports. Practitioners (e.g., sport science professionals) aim to apply evidence-informed approaches to optimise athlete performance and well-being. Evidence-informed practices should be derived from research literature. Given the lack of research on elite female athletes, this is challenging at present. This limits the ability to adopt an evidence-informed approach when working in female sports, and as such, we are likely failing to maximize the performance potential of female athletes. This article discusses the challenges of applying an evidence base derived from male athletes to female athletes. A conceptual framework is presented, which depicts the need to question the current (male) evidence base due to the differences of the "female athlete" and the "female sporting environment," which pose a number of challenges for practitioners working in the field. Until a comparable applied sport science research evidence base is established in female athletes, evidence-informed approaches will remain a challenge for those working in female sport.

StudyLeading journalModerate

The Importance of Nutrition in Menopause and Perimenopause—A Review

Alíz Erdélyi, Erzsébet Pálfi, László Tűű +5 more · Nutrients · 2023 · 93 citations

Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.

ObservationalModerate

Changes in six domains of cognitive function with reproductive and chronological ageing and sex hormones: a longitudinal study in 2411 UK mid-life women

Fanny Kilpi, Ana Gonçalves Soares, Abigail Fraser +5 more · BMC Women s Health · 2020 · 56 citations

BACKGROUND: There may be changes in cognitive function in women going through the menopause. The current evidence remains unclear, however, whether these changes occur over and above those of general ageing. We aimed to evaluate the potential impact of the menopause (assessed by reproductive age and hormone levels) on cognitive function in women in mid-life accounting for the underlying effects of ageing. METHODS: The study was based on the follow up of women originally enrolled in pregnancy in a birth cohort when resident in the South West of England, UK between 1991 and 1992. Using up to three repeated measurements in 2411 women (mean age 51 at first assessment), we modelled changes in six cognitive function domains: immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence and verbal fluency. The exposures of interest were reproductive age measured as years relative to the final menstrual period (FMP), chronological age and reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH) and anti-Müllerian hormone (AMH)). RESULTS: Processing speed (- 0.21 (95% CI - 0.36 to - 0.06) standard deviation (SD) difference per 10 years since FMP), immediate verbal episodic memory (- 0.15 (95% CI - 0.35 to 0.06)) and delayed verbal episodic memory (- 0.17 (95% CI - 0.37 to 0.03)) declined with reproductive age. Reproductive hormones were not robustly associated with processing speed, but FSH and LH were both negatively associated with immediate (- 0.08 (95% CI - 0.13 to - 0.02) SD difference per SD difference in hormone level) and delayed verbal episodic memory (- 0.08 (95% CI - 0.13 to - 0.03)). There was little consistent evidence of cognitive function declining with menopause in other cognitive domains. CONCLUSIONS: Of the cognitive domains tested only verbal episodic memory declined both in relation to age since the menopause and in conjunction with the reproductive hormones that reflect the menopause. This decline was independent of normal ageing and suggests that the menopause is associated with a mild impact on this specific domain of cognitive function.

StudyTop journalModerate

Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition

Jennifer L. Gordon, David R. Rubinow, Tory A. Eisenlohr‐Moul +3 more · JAMA Psychiatry · 2018 · 239 citations

Importance: The menopause transition and early postmenopausal period are associated with a 2- to 4-fold increased risk for clinically significant depressive symptoms. Although a few studies suggest that hormone therapy can effectively manage existing depression during this time, to our knowledge, there have been no studies testing whether hormone therapy can prevent the onset of perimenopausal and early postmenopausal depressive symptoms. Objective: To examine the efficacy of transdermal estradiol plus intermittent micronized progesterone (TE+IMP) in preventing depressive symptom onset among initially euthymic perimenopausal and early postmenopausal women. A secondary aim was to identify baseline characteristics predicting TE+IMP's beneficial mood effects. Design, Setting, and Participants: Double-blind, placebo-controlled randomized trial at the University of North Carolina at Chapel Hill from October 2010 to February 2016. Participants included euthymic perimenopausal and early postmenopausal women from the community, aged 45 to 60 years. Interventions: Transdermal estradiol (0.1 mg/d) or transdermal placebo for 12 months. Oral micronized progesterone (200 mg/d for 12 days) was also given every 3 months to women receiving active TE, and identical placebo pills were given to women receiving placebo. Main Outcome Measures: Scores on the Center for Epidemiological Studies-Depression Scale (CES-D), assessed at baseline and months 1, 2, 4, 6, 8, 10, and 12 after randomization, and the incidence of clinically significant depressive symptoms, defined as a CES-D score of at least 16. Results: Of 172 participants, 130 were white (76%), and 70 were African American (19%), with a mean household income of $50 000 to $79 999. The mean age was 51 years, and 43 developed clinically significant depressive symptoms. Women assigned to placebo were more likely than those assigned to TE+IMP to score at least 16 on the CES-D at least once during the intervention phase (32.3% vs 17.3%; odds ratio [OR], 2.5; 95% CI, 1.1-5.7; P = .03) and had a higher mean CES-D score across the intervention period (P = .03). Baseline reproductive stage moderated the effect of treatment (β, -1.97; SEM, 0.80; P for the interaction = .03) such that mood benefits of TE+IMP vs placebo were evident among women in the early menopause transition (β, -4.2; SEM, 1.2; P < .001) but not the late menopause transition (β, -0.9; SEM, 0.3; P = .23) or among postmenopausal women (β, -0.3; SEM, 1.1; P = .92). Stressful life events in the 6 months preceding enrollment also moderated the effect of treatment on mean CES-D score such that the mood benefits of TE+IMP increased with a greater number of events (β, 1.22; SEM, 0.40; P = .003). Baseline estradiol levels, baseline vasomotor symptoms, history of depression, and history of abuse did not moderate treatment effects. Conclusions: Twelve months of TE+IMP were more effective than placebo in preventing the development of clinically significant depressive symptoms among initially euthymic perimenopausal and early postmenopausal women. Trial Registration: clinicaltrials.gov Identifier: NCT01308814.

ObservationalLeading journalModerate

The association between pubertal status and depressive symptoms and diagnoses in adolescent females: A population-based cohort study

Gemma Lewis, Gemma Lewis, Konstantinos Ioannidis +7 more · PLoS ONE · 2018 · 71 citations

BACKGROUND: There is an association between puberty and depression, but many things remain poorly understood. When assessing puberty in females, most studies combine indicators of breast and pubic hair development which are controlled by different hormonal pathways. The contributions of pubertal timing (age at onset) and pubertal status (stage of development, irrespective of timing) are also poorly understood. We tested the hypothesis that stage of breast development in female adolescents, controlled largely by increased estradiol, would be more strongly associated with depression than pubic hair development which occurs in both males and females, and is controlled by adrenal androgens. We investigated whether this association was independent of pubertal timing. METHODS: ROOTS is an ongoing cohort of 1,238 adolescents (54% female) recruited in Cambridgeshire (UK) at age 14.5, and followed-up at ages 16 and 17.5. Depression was assessed using the Mood and Feelings Questionnaire (MFQ) and clinical interview. Breast and pubic hair development were assessed at 14.5, using Tanner rating scales. RESULTS: For each increase in Tanner breast stage at 14.5, depressive symptoms increased by 1.4 MFQ points (95% CI 0.6 to 2.3), irrespective of age at onset. Pubic hair status was only associated with depressive symptoms before adjustment for breast status, and was not associated with depression in males. The same pattern was observed longitudinally, and for depression diagnoses. LIMITATIONS: We did not directly measure hormone levels, our findings are observational, and the study had a relatively low response rate. CONCLUSIONS: Females at more advanced stages of breast development are at increased risk of depression, even if their age at pubertal onset is not early. Alongside social and psychological factors, hormones controlling breast but not pubic hair development may contribute to increased incidence of female depression during puberty.

ObservationalModerate

Association between physical activity and menopausal symptoms in perimenopausal women

Min-Ju Kim, Juhee Cho, Younjhin Ahn +2 more · BMC Women s Health · 2014 · 102 citations

BACKGROUND: Physical activity may be an effective way of preventing or attenuating menopause-related symptoms, and it has been shown to improve quality of life in menopausal women. However, there have been some inconsistencies regarding between exercise and menopausal symptoms, and study investigating this association has been scarce in Korea. In this study, the association between physical activity and menopausal symptoms in perimenopausal women in Korea was assessed. METHODS: This cross-sectional observational study was conducted between November 2012 and March 2013. In total, 2,204 healthy women aged 44-56 years were recruited from a healthcare center at the Kangbuk Samsung hospitals for investigating women's attitudes towards menopause. To investigate the influence of physical activity on perimenopause-associated symptoms, 631 perimenopausal women were selected for this study. Their physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short form. The Menopause-specific Quality of Life (MENQOL) questionnaire was used to assess menopause-related symptoms. RESULTS: The study participants were, on average, 48.5 ± 2.7 years old and had a mean body mass index of 22.8 ± 3.1 kg/m2. The total MENQOL score and the psychosocial and physical subscores exhibited U-shaped trends in relation to the level of physical activity. Multiple linear regression analysis adjusted for confounding variables showed that perimenopausal women who performed moderate physical activity reported significantly lower psychosocial (β = -0.413, P = 0.012) and physical symptoms (β = -0.445, P = 0.002) than women who performed low physical activity. By contrast, a high level of physical activity did not influence the MENQOL total score and subscores relative to the low activity group. In addition, no associations were observed between physical activity and the vasomotor and sexual symptoms in any group. CONCLUSIONS: Moderate level of physical activity was associated with reduced psychosocial and physical menopause symptoms in perimenopausal Korean women. Although these findings must be confirmed by prospective longitudinal studies, they suggest that physical activity may improve the symptoms of menopause, thereby increasing quality of life.

StudyModerate

Sex and gender differences in health

Vera Regitz‐Zagrosek · EMBO Reports · 2012 · 572 citations

StudyLeading journalModerate

Premenstrual syndrome: new insights into etiology and review of treatment methods

Stefan Modzelewski, Aleksandra Julia Oracz, Xawery Żukow +3 more · Frontiers in Psychiatry · 2024 · 57 citations

Premenstrual syndrome (PMS) is a common disorder affecting women of reproductive age, with an estimated global prevalence of 47.8%, with severe symptoms occurring in 3-8%, significantly affecting daily functioning. GABA conductance and changes in neurosteroid levels, particularly allopregnanolone, are suspected to play a substantial role in the disorder's etiology. In this paper, we provide an overview of recent reports on the etiology and recognized therapeutic approaches, encompassing both pharmacological and non-pharmacological interventions. Our examination includes studies on SSRIs, hormonal agents, neurosteroids, supplementation, and therapeutic roles. We aim to determine the most favorable treatment regimen by comparing medication effects and alternative methods. The treatment of PMS is crucial for enhancing the quality of life for affected women. Medications used in PMS treatment should be individually selected to achieve the best therapeutic effect, considering the clinical situation of the patients.

StudyModerate

'The girl with her period is the one to hang her head' Reflections on menstrual management among schoolgirls in rural Kenya

Shannon A. McMahon, Peter J. Winch, Bethany A. Caruso +4 more · BMC International Health and Human Rights · 2011 · 308 citations

BACKGROUND: The onset of menstruation is a landmark event in the life of a young woman. Yet the complications and challenges that can accompany such an event have been understudied, specifically in resource-poor settings. As interventions aim to improve female attendance in schools, it is important to explore how menstruation is perceived and navigated by girls in the school setting. This research conveys rural Kenyan schoolgirls' perceptions and practices related to menstruation METHODS: Data were collected at six rural schools in the Nyanza Province of Western Kenya. Using focus group discussions, in-depth interviews, and field notes from observations, researchers collected information from 48 primary schoolgirls and nine teachers. Systematic analysis began with a reading of transcripts and debriefing notes, followed by manual coding of the narratives. RESULTS: Focus group discussions became opportunities for girls to share thoughts on menstruation, instruct one another on management practices and advise one another on coping mechanisms. Girls expressed fear, shame, distraction and confusion as feelings associated with menstruation. These feelings are largely linked to a sense of embarrassment, concerns about being stigmatized by fellow students and, as teachers explained, a perception that the onset of menstruation signals the advent of a girl's sexual status. Among the many methods for managing their periods, girls most frequently said they folded, bunched up or sewed cloth, including cloth from shirts or dresses, scraps of old cloth, or strips of an old blanket. Cloth was reported to frequently leak and cause chafing, which made school attendance difficult particularly as the day progressed. Attitudes and practices of girls toward menstruation have been arranged into personal, environmental and behavioural factors. CONCLUSION: Further research on menstrual management options that are practical, sustainable and culturally acceptable must be conducted to inform future programs and policies that aim to empower young girls as they transition into womanhood. Stakeholders working within this and similar contexts must consider systematic mechanisms to explain to young girls what menstruation is and how to manage it. Providing sanitary supplies or guiding girls on how to create supplies serve as critical components for future interventions.

ObservationalModerate

A population-based case–control study of urinary bisphenol A concentrations and risk of endometriosis

Kristen Upson, Sheela Sathyanarayana, Anneclaire J. De Roos +3 more · Human Reproduction · 2014 · 85 citations

STUDY QUESTION: Is bisphenol A (BPA) exposure associated with the risk of endometriosis, an estrogen-driven disease of women of reproductive age? SUMMARY ANSWER: Our study suggests that increased urinary BPA is associated with an increased risk of non-ovarian pelvic endometriosis, but not ovarian endometriosis. WHAT IS KNOWN ALREADY: BPA, a high-volume chemical used in the polymer industry, has been the focus of public and scientific concern given its demonstrated estrogenic effects in vivo and in vitro and widespread human exposure. Prior studies of BPA and endometriosis have yielded inconsistent results and were limited by the participant sampling framework, small sample size or use of serum (which has very low/transient concentrations) instead of urine to measure BPA concentrations. STUDY DESIGN, SIZE, DURATION: We used data from the Women's Risk of Endometriosis study, a population-based case-control study of endometriosis, conducted among female enrollees of a large healthcare system in the US Pacific Northwest. Cases were women with incident, surgically confirmed endometriosis diagnosed between 1996 and 2001 and controls were women randomly selected from the defined population that gave rise to the cases, without a current or prior diagnosis of endometriosis. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Total urinary BPA concentrations were measured in 143 cases and 287 population-based controls using single, spot urine samples collected after disease diagnosis in cases. Total urinary BPA concentration (free and conjugated species) was quantified using a high-performance liquid chromatography-mass spectrometry method. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression, adjusting for urinary creatinine concentrations, age and reference year. We also evaluated the association by disease subtypes, ovarian and non-ovarian pelvic endometriosis, that may be etiologically distinct. MAIN RESULTS AND THE ROLE OF CHANCE: We did not observe a statistically significant association between total urinary BPA concentrations and endometriosis overall. We did observe statistically significant positive associations when evaluating total urinary BPA concentrations in relation to non-ovarian pelvic endometriosis (second versus lowest quartile: OR 3.0; 95% CI: 1.2, 7.3; third versus lowest quartile: OR 3.0; 95% CI: 1.1, 7.6), but not in relation to ovarian endometriosis. LIMITATIONS, REASONS FOR CAUTION: Given the short elimination half-life of BPA, our study was limited by the timing of collection of the single urine sample, that occurred after case diagnosis. Thus, our BPA measurements may not accurately represent the participants' levels during the etiologically relevant time period for endometriosis development. In addition, since it was not feasible in this population-based study to surgically confirm the absence of disease, it is possible that some controls may have had undiagnosed endometriosis. WIDER IMPLICATIONS OF THE FINDINGS: By using population-based data, it is more likely that the controls represented the underlying frequency of BPA exposure in contrast to prior studies that used for comparison control women undergoing surgical evaluation, where the indication for surgery may be associated with BPA exposure. The significant associations observed in this study suggest that BPA may affect the normal dynamic structural changes of hormonally responsive endometrial tissue during the menstrual cycle, promoting the establishment and persistence of refluxed endometrial tissue in cases with non-ovarian pelvic endometriosis. Further research is warranted to confirm our novel findings in endometriosis subtypes that may be etiologically distinct. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the National Institutes of Health, National Institute of Environmental Health Sciences (grant number R03 ES019976), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01 HD033792); US Environmental Protection Agency, Science to Achieve Results (STAR) (grant number R82943-01-0) and National Institute of Nursing Research (grant number F31NR013092) to KU for training support. This work was supported in part by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, National Institute of Nursing Research or the National Institutes of Health. The authors have no actual or potential competing financial interests. TRIAL REGISTRATION NUMBER: Not applicable.

RCTHigh evidence score

The Role of Yoga in Balancing Hormones: A Comprehensive Research Review

SIDDAPPA NARAGATTI - · International Journal For Multidisciplinary Research · 2025 · 5 citations

Hormonal imbalances can profoundly affect physical and mental health, leading to an array of conditions that can significantly impact the quality of life. In recent years, there has been increasing interest in complementary and alternative therapies that can support hormonal regulation. Yoga, with its holistic approach combining physical postures, breathing exercises, and meditation, has emerged as a prominent practice not only for physical well-being but also as a potential therapeutic intervention for restoring hormonal balance. This comprehensive research review systematically examines the existing literature surrounding the efficacy of yoga in modulating hormone levels, elucidating its mechanisms of action, and identifying the populations that may benefit most from its practice. The review explores various aspects of yoga, including asanas (postures), pranayama (breath control), and meditation, and analyzes how these elements contribute to physiological changes in the body that can influence hormonal health. Key hormones such as cortisol, insulin, estrogen, progesterone, and thyroid hormones are scrutinized in the context of their responses to yoga practices, focusing on both quantitative and qualitative research findings. This analysis reveals compelling evidence that regular yoga practice may help mitigate stress-induced hormonal fluctuations, improve insulin sensitivity, and regulate the menstrual cycle in women, as well as enhance overall endocrine function. Further, the review investigates the implications of yoga in specific populations, including women experiencing perimenopause and menopause, individuals with polycystic ovary syndrome (PCOS), and those suffering from chronic stress or anxiety-related disorders. The inclusion of diverse demographic groups allows for a nuanced understanding of how yoga can be tailored to address specific hormonal issues among varied populations. The review also outlines potential mechanisms by which yoga exerts its influence on the endocrine system, including autonomic nervous system regulation, reduction of sympathetic nervous system overactivity, and modulation of inflammatory pathways. Importantly, emphasis is placed on the need for further empirical studies to deepen our understanding of the relationship between yoga and hormonal balance, particularly randomized controlled trials that can delineate causative effects from correlation. In conclusion, this comprehensive research review highlights the promising role of yoga as a non-invasive and cost-effective intervention for individuals seeking to achieve hormonal harmony in conjunction with conventional medical treatments. By synthesizing existing findings and identifying gaps in the literature, this review aims to provide valuable insights for healthcare practitioners, researchers, and individuals seeking holistic approaches to hormonal health. Future directions for research are proposed, advocating for interdisciplinary studies that further explore the intricate relationship between mind-body practices and hormonal regulation, ultimately enhancing the understanding of how yoga can be effectively integrated into health and wellness paradigms

StudyModerate

Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia

Teketo Kassaw Tegegne, Mitike Molla Sisay · BMC Public Health · 2014 · 347 citations

BACKGROUND: Adolescence in girls has been recognized as a special period marked with the onset of menarche. Even though menstruation is a natural process, it is associated with misconceptions, malpractices and challenges among girls in developing countries. However, much is not documented; school-absenteeism and dropout are a common problem among girls in rural Ethiopia. Focusing among school girls, this study has examined knowledge about menstruation, determinants of menstrual management and its influence on school-attendance in Northeast Ethiopia. METHODS: We conducted a mixed-method research combining quantitative and qualitative methods in Northeast Ethiopia. The quantitative study was conducted among 595 randomly selected adolescent school girls. Nine in-depth interviews; five school-dropout girls and four female teachers, and four focus group discussions among school girls were conducted in 2013. RESULTS: The mean age at menarche was 13.98 (±1.17) years. About 51% of girls had knowledge about menstruation and its management. Only a third of the girls used sanitary napkins as menstrual absorbent during their last menstruation. Girls from urban areas, had mothers of secondary and above education and, families of higher monthly expenditure had more chance of using sanitary napkins than their counterparts. More than half of the girls reported to have been absent from school during their menstruation period. Those who did not use sanitary napkins were more likely to be absent from school [AOR-95% C.I: 5.37 (3.02 - 9.55)]. Fifty eight percent of girls reported that their school-performance had declined after they had menarche. In addition, the qualitative study indicated that school-dropout was common among girls who experienced teasing and humiliation by classmates when their clothes were stained with blood as they do not use sanitary napkins. CONCLUSION: Though there is an effort to increase girls' school enrollment, lack of basic needs, like sanitary napkins that facilitate routine activates of girls at early adolescence are observed to deter girls' school-attendance in rural Ethiopia. Special support for girl students, especially when they have their first menstruation and separate functioning sanitary facilities are necessities that should be in school at all times if gender equality and girls empowerment is to be achieved.

Meta-analysisHigh evidence score

Optimal doses of different exercise types for improving depressive symptoms in climacteric women: a systematic review and network meta-analysis.

Wang H, Li S, Cui S +10 more · Front Psychol · 2026

StudyModerate

Oral contraceptive use in adolescence predicts lasting vulnerability to depression in adulthood

Christine Anderl, Gu Li, Frances S. Chen · Journal of Child Psychology and Psychiatry · 2019 · 102 citations

BACKGROUND: Previous evidence suggests that use of oral contraceptives (OCs), especially during adolescence, may increase women's vulnerability to depression in the short term. Here, we investigate whether women who had first used OC in adolescence show an increased prevalence of depression in the long term. METHODS: We examined 1,236 women in the United States National Health and Nutrition Examination Survey for whom information on depression and age at first OC use was publicly available. We compared women who reported first use of OCs in adolescence to women who had never used OCs and women who had first used OCs in adulthood on 1-year prevalence of major depressive disorder (MDD) assessed by trained interviewers. RESULTS: Compared with women who had used OCs during adolescence, women who had never used OCs were less likely to meet the criteria for MDD within the past year in adulthood [odds ratio (OR) = 0.31, 95% CI = 0.16-0.60], and so were women who only started using OCs in adulthood (OR = 0.54, 95% CI = 0.30-0.95). Third factors that have previously been proposed to explain the relationship between OC use and depression risk such as age at sexual debut, and, importantly, current OC use, did not account for the results in propensity score analyses. CONCLUSIONS: We show a long-term association between adolescent OC use and depression risk in adulthood regardless of current OC use. Our findings suggest that adolescence may be a sensitive period during which OC use could increase women's risk for depression, years after first exposure.

RCTHigh evidence score

Impact of phytoestrogen use on the quality of life of perimenopausal or postmenopausal women in Sinaloa, Mexico

Irene Estefanye Jimenez Leyva, Marco A. Castañeda, Gabriela del Carmen Angulo Trizón +7 more · Salud Ciencia y Tecnología · 2024 · 2 citations

Introduction: menopause causes clinical symptoms that significantly impact women’s quality of life. Phytoestrogens, such as soy isoflavones, have been studied as treatment for climacteric syndrome, showing improvements in vasomotor and psychological symptoms.Objective: to determine the impact of the use of phytoestrogens (soy isoflavones) on the quality of life of women with perimenopause or postmenopause at Family Medicine Unit No. 55 of the Mexican Social Security Institute in Culiacán, Sinaloa, Mexico. Method: a randomized clinical trial was conducted with 44 women aged 45 to 60 with climacteric symptoms. Participants were assigned to an experimental group (EG), which received 50 mg of soy isoflavones every 24 hours, and a control group (CG), which received a placebo for 12 weeks. The Menopause Rating Scale was applied before and after the intervention to evaluate somatic, psychological, and urogenital symptoms. Descriptive and inferential statistics were used. Results: supplementation with soy isoflavones in the EG showed significant improvements in overall quality of life (Cohen d = 1,54), as well as in the somatic (d = 1,52) and psychological (d = 1,10) subscales, indicating a large effect (d > 0,80). However, the urogenital dimension showed no significant effect (d = 0). The CG experienced a significant deterioration in these subscales. Conclusions: soy isoflavones significantly improved the quality of life of women in perimenopause and postmenopause in the somatic and psychological dimensions, showing a large effect. No changes were observed in the urogenital dimension

StudyModerate

Melatonin osteoporosis prevention study (MOPS): a randomized, double‐blind, placebo‐controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women

Mary P. Kotlarczyk, Holly C. Lassila, Christine K. O’Neil +4 more · Journal of Pineal Research · 2011 · 207 citations

The purpose of this double-blind study was to assess the effects of nightly melatonin supplementation on bone health and quality of life in perimenopausal women. A total of 18 women (ages 45-54) were randomized to receive melatonin (3mg, p.o., n=13) or placebo (n=5) nightly for 6months. Bone density was measured by calcaneal ultrasound. Bone turnover marker (osteocalcin, OC for bone formation and NTX for bone resorption) levels were measured bimonthly in serum. Participants completed Menopause-Specific Quality of Life-Intervention (MENQOL) and Pittsburgh Sleep Quality Index (PSQI) questionnaires before and after treatment. Subjects also kept daily diaries recording menstrual cycling, well-being, and sleep patterns. The results from this study showed no significant change (6-month-baseline) in bone density, NTX, or OC between groups; however, the ratio of NTX:OC trended downward over time toward a ratio of 1:1 in the melatonin group. Melatonin had no effect on vasomotor, psychosocial, or sexual MENQOL domain scores; however, it did improve physical domain scores compared to placebo (mean change melatonin: -0.6 versus placebo: 0.1, P<0.05). Menstrual cycling was reduced in women taking melatonin (mean cycles melatonin: 4.3 versus placebo: 6.5, P<0.05), and days between cycles were longer (mean days melatonin: 51.2 versus placebo: 24.1, P<0.05). No differences in duration of menses occurred between groups. The overall PSQI score and average number of hours slept were similar between groups. These findings show that melatonin supplementation was well tolerated, improved physical symptoms associated with perimenopause, and may restore imbalances in bone remodeling to prevent bone loss. Further investigation is warranted.

Meta-analysisHigh evidence score

Effects of Physical Exercise on Symptoms and Quality of Life in Women in Climacteric: A Systematic Review and Meta-Analysis.

Trujillo-Muñoz PJ, Sánchez-Ojeda MA, Rodríguez-Huamán EC +3 more · Healthcare (Basel) · 2025

Meta-analysisHigh evidence score

Mind-body therapies for sleep disturbances, depression, and anxiety in menopausal women: a systematic review and meta-analysis of randomized controlled trials.

Fan Z, Zhang Y, Shu Y +2 more · Front Public Health · 2025

Meta-analysisHigh evidence score

Impact of COVID-19 Vaccination on Menstrual Irregularities, Bleeding Patterns, and Cycle Duration: A Systematic Review and Meta-Analysis.

Bushi G, Gaidhane AM, Vadia N +11 more · Health Sci Rep · 2025

StudyModerate

Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice

Deanne McArthur, Alex Dumas, Kirsten Woodend +2 more · BMC Women s Health · 2014 · 153 citations

BACKGROUND: About half of women decrease their regular exercise during middle age. Concurrently, they experience a reduction in basal metabolic rate and loss of lean muscle as they transition to menopause. The combined effects place these women at increased risk for body weight gain and associated co-morbidities. Further research is required to better assess their barriers to regular exercise and to develop more applied knowledge aimed to improve the applicability of clinical interventions aimed at this population. The main aim of this study was to identify enablers and barriers influencing adherence to regular exercise in middle-aged women who exercise. METHODS: An interpretive description qualitative study was conducted using individual interviews. The two key questions were focused on planning to engage in physical activity and succeeding or planning to engage in physical activity and not succeeding. Inductive content analysis was used. RESULTS: Fifty-three women interviewed were aged 40-62 years and experiencing mild to moderate menopausal symptoms. Six broad themes influencing adhering to regular exercise were: routine, intrinsic motivation, biophysical issues, psychosocial commitments, environmental factors, and resources. Common sub-themes were identified as enabling factors: daily structure that incorporated physical activity (broad theme routine), anticipated positive feelings associated with physical activity (intrinsic), and accountability to others (psychosocial). Other common sub-themes identified as barriers were disruptions in daily structure (routine), competing demands (routine) and self-sacrifice (psychosocial). CONCLUSIONS: The most common barrier middle-aged women describe as interfering with adhering to regular exercise was attributable to the demands of this life stage at home and with others. Lack of time and menopausal symptoms were not identified as the common barriers. To support women to adhere to regular exercise, healthcare professionals should consider a narrative approach to assessing barriers and focus on enablers to overcoming identified barriers.

ObservationalModerate

Hormonal contraception and mental health: results of a population-based study

Elena Toffol, Oskari Heikinheimo, Päivikki Koponen +2 more · Human Reproduction · 2011 · 73 citations

BACKGROUND: The effects of oral contraceptives (OCs) on mental health are not clear, and no study has been focused on the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on mental health. The aim of this study was to analyse the association between the use of OCs and the LNG-IUS and psychological well-being and psychopathology. METHODS: The associations between the current use of OCs and the LNG-IUS, and their duration versus mood symptoms [Beck Depression Inventory (BDI)], psychological well-being [(General Health Questionnaire-12 (GHQ-12)] and recent psychiatric diagnoses [(Composite International Diagnostic Interview (CIDI)] were examined among women who participated in the Finnish-population-based Health 2000 study. Analyses were performed on the 30- to 54-year-old sample (n = 2310); some of the analyses were extended to include the younger age group (18- to 54-year-old sample; n = 3223). RESULTS: Overall, hormonal contraception was well tolerated with few significant effects on psychological well-being. The length of OC use was inversely associated with some BDI items ('dissatisfaction, irritability, lost interest in people, earlier waking and lost interest in sex'), and directly associated with 'worries about one's health' (BDI) and with a current diagnosis of 'alcohol dependence' (CIDI). The current use of the LNG-IUS was inversely associated with 'earlier waking' (BDI) and with 'impaired concentration' (GHQ), while the length of LNG-IUS use was inversely associated with 'strain' (GHQ). CONCLUSIONS: The influence of hormonal birth control on mental health is modest and mainly favourable. The length of current OC use seems to have some beneficial effects on mood although the longer the duration of use, the greater the association with a diagnosis of alcohol dependence. Knowledge of the use of hormonal contraception might be of value when assessing psychopathology in women. The cross-sectional design, with partly retrospective data collection, precludes any causal conclusions.

StudyModerate

Parting the Red Sea

Amanda Lazar, Norman Makoto Su, Jeffrey Bardzell +1 more · 2019 · 96 citations

Menopause is a major life change affecting roughly half of the population, resulting in physiological, emotional, and social changes. To understand experiences with menopause holistically, we conducted a study of a subreddit forum. The project was informed by feminist social science methodologies, which center knowledge production on women's lived experiences. Our central finding is that the lived experience of menopause is social: menopause is less about bodily experiences by themselves and more about how experiences with the body become meaningful over time in the social context. We find that gendered marginalization shapes diverse social relationships, leading to widespread feelings of alienation and negative transformation - often expressed in semantically dense figurative language. Research and design can accordingly address menopause not only as a women's health concern, but also as a matter of facilitating social support and a social justice issue.

Meta-analysisHigh evidence score

The effects of different exercises on weight loss and hormonal changes in women with polycystic ovarian syndrome: a network meta-analysis study.

Motaharinezhad F, Emadi A, Hosnian M +3 more · BMC Womens Health · 2024

Meta-analysisHigh evidence score

Effect of Menstrual Cycle Phase on Perceived Exertion During Aerobic Exercise in Eumenorrheic Women: A Systematic Review and Meta-analysis.

Prado RCR, Hackney AC, Silveira R +3 more · J Womens Pelvic Health Phys Ther · 2024

StudyLeading journalModerate

Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance

Georgie Bruinvels, Anthony C. Hackney, Charles R. Pedlar · Sports Medicine · 2022 · 68 citations

The authors present opinions based on their applied experiences of working with female athletes in combination with the existing evidence-based literature. Most of the existing menstrual cycle research focuses on a few steady-state time points within the pre-defined menstrual cycle phases, yet this disregards the day-to-day hormonal changes that women have to accommodate to perform optimally and consistently. The traditional research models are inadequate for studying symptoms and symptom management, and ultimately for supporting athletes to perform well throughout the entirety of their cycle. As such, the monitoring of the day-to-day variation, particularly during the transitions between menstrual cycle phases appears to be an important "overlooked" consideration. This is particularly pertinent considering the known intra-individual and inter-individual variation in menstrual cycle characteristics. Anecdotal and research evidence supports the idea that athletes can use non-pharmacological solutions to mitigate negative menstrual cycle symptoms and do not need to "grit their teeth and roll with it". However, further research (including case studies) is needed in this important research area. Such knowledge should be and needs to be widespread amongst practitioners and athletes as they should not have to figure this out alone. As such, researchers and practitioners need to put more work into understanding symptom aetiology, symptom clusters and their relationship with hormonal changes, menstrual cycle phases and transitions, with potential for a profound impact on individual athlete health and well-being. In so doing, those working with female athletes need to continue building on the recent progress made in educating athletes and practitioners; for example, normalising the discussion of and about the menstrual cycle and all of its implications.

ObservationalLeading journalModerate

Sex Steroid Hormone Profiles are Related to Sleep Measures from Polysomnography and the Pittsburgh Sleep Quality Index

Mary Fran Sowers, Huiyong Zheng, Howard M. Kravitz +6 more · SLEEP · 2008 · 131 citations

STUDY OBJECTIVES: To relate reproductive hormones (and the preceding 7-year rates of their change) to objectively and subjectively assessed sleep measures, independent of age, vasomotor symptom frequency, depressive symptoms, and body size. DESIGN: A cross-sectional sleep substudy nested in the Study of Women's Health Across the Nation (SWAN), a longitudinal study of the menopausal transition. SETTING: Community-based. PARTICIPANTS: 365 Caucasian, African American, and Chinese women. MEASUREMENTS AND RESULTS: Sleep duration, continuity, and architecture were measured during two nights of in-home polysomnography (PSG) studies. Participants completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep diaries for medication, vasomotor symptoms, lifestyle information and questionnaires for depressive symptoms. Blood collected annually in the years prior to sleep study was assayed for follicle stimulating hormone (FSH), estradiol (E2), and total testosterone (T). More rapid rate of FSH change was significantly associated with higher delta sleep percent, longer total sleep time (TST), but less favorable self-reported sleep quality (PSQI). Baseline E2 was modestly and negatively associated with sleep quality. Women in the lowest total testosterone quartile at baseline had more wake time after sleep onset (WASO) than women in the highest quartile. Lower E2/T ratio, an index reflecting the increasing androgenic environment with the menopause transition, was associated with less WASO. CONCLUSIONS: More rapid rate of FSH change was associated with longer sleep duration but poor sleep quality. Women with higher T or who were closer to the completion of the transition process (as indexed by a lower E2/T) had less sleep discontinuity (less WASO).

StudyModerate

Menopause and work: An electronic survey of employees’ attitudes in the UK

Amanda Griffiths, Sara MacLennan, Juliet Hassard · Maturitas · 2013 · 190 citations

OBJECTIVES: This study explored women's experiences of working through menopausal transition in the UK. It aimed to identify the perceived effects of menopausal symptoms on working life, to outline the perceived effects of work on menopausal symptoms, and to provide recommendations for women, healthcare practitioners and employers. METHODS: An electronic questionnaire was distributed to women aged 45-55 in professional, managerial and administrative (non-manual) occupations in 10 organisations. Items included: age, age and gender of line manager, educational level, job satisfaction; menopausal status; symptoms that were problematic for work; hot flushes; working conditions; work performance, disclosure to line managers; individual coping strategies; and, effective workplace adjustments and employer support. RESULTS: The final sample comprised 896 women. Menopausal transition caused difficulties for some women at work. The most problematic symptoms were: poor concentration, tiredness, poor memory, feeling low/depressed and lowered confidence. Hot flushes were particularly difficult. Some women felt work performance had been negatively affected. The majority of women were unwilling to disclose menopause-related health problems to line managers, most of whom were men or younger than them. Individual coping strategies were described. Four major areas for organisational-level support emerged: (i) greater awareness among managers about menopause as a possible occupational health issue, (ii) flexible working hours, (iii) access to information and sources of support at work, and (iv) attention to workplace temperature and ventilation. CONCLUSION: Employers and healthcare practitioners should be aware that menopausal transition causes difficulty for some women at work, and that much can be done to support them.

Meta-analysisHigh evidence score

Effects of Traditional Chinese Exercise on Menopausal Symptoms, Bone Health and Mental Health in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-Analysis.

Liu Y, He Y, Zhang Q +1 more · Biol Res Nurs · 2026

StudyModerate

Women and Smoking: The Effect of Gender on the Epidemiology, Health Effects, and Cessation of Smoking

Alicia M. Allen, Cheryl Oncken, Dorothy K. Hatsukami · Current Addiction Reports · 2014 · 158 citations

StudyModerate

Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study

Kai Triebner, Ane Johannessen, Luca Puggini +25 more · Journal of Allergy and Clinical Immunology · 2015 · 106 citations

StudyModerate

A Pilot Study on the Impact of Menstrual Cycle Phase on Elite Australian Football Athletes

Mikaeli A. Carmichael, Rebecca L. Thomson, Lisa Moran +4 more · International Journal of Environmental Research and Public Health · 2021 · 45 citations

The effect of the menstrual cycle on athlete performance, wellbeing and perceived exertion and fatigue is not well understood. Furthermore, it has not been investigated specifically in Australian Football athletes. This pilot study aimed to explore how naturally menstruating Australian Football athletes may be affected by menstrual cycle phase. The data collected from the routine monitoring of five naturally menstruating athletes (average menstrual cycle length of 28 ± 3 [SD] days) in one team (athlete age range 18–35 years) competing in the Women’s Australian Football League during the 2019 season were retrospectively analysed to compare performance (countermovement jump parameters and adductor squeeze pressure), perceived exertion, perceived fatigue and wellbeing (perceived sleep quality, stress and soreness) outcomes between the follicular and luteal phases. Performance, perceived exertion, stress and soreness did not appear to be affected by menstrual cycle phase (p > 0.17). However, perceived fatigue appeared to be significantly greater (p = 0.042) and sleep quality worse (p = 0.005) in the luteal phase. This pilot study suggests further research focusing on the effect of menstrual cycle phase on subjective fatigue and wellbeing is warranted.

StudyModerate

mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): rationale and study protocol for a pragmatic randomised controlled trial

Tomáš Větrovský, Norbert Král, Markéta Pfeiferová +18 more · BMC Public Health · 2023 · 26 citations

BACKGROUND: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. METHODS: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. DISCUSSION: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05351359, 28/04/2022).