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

1
Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, 69115 Heidelberg, Germany
2
Women’s Mental Health Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
3
Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA 92697-7085, USA
4
Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, 89081 Ulm, Germany
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1946; https://doi.org/10.3390/jcm8111946
Received: 30 September 2019 / Revised: 1 November 2019 / Accepted: 4 November 2019 / Published: 12 November 2019
(This article belongs to the Special Issue Autonomic Nervous System: From Bench to Bedside)
Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased exponentially in recent years. However, the understanding of sources of within-person change (i.e., intra-individual variance) in CVA is lagging behind. This systematic review and meta-analysis summarizes and quantifies current empirical evidence of within-person changes in measures of CVA across the menstrual cycle in naturally-cycling premenopausal females. We conducted an extensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in five databases to identify observational studies with repeated measures of CVA in at least two menstrual cycle phases. A broad meta-analysis (nstudies = 37; nindividuals = 1,004) revealed a significant CVA decrease from the follicular to luteal phase (d = −0.39, 95% CI (−0.67, −0.11)). Furthermore, 21 studies allowed for finer-grained comparisons between each of two cycle phases (menstrual, mid-to-late follicular, ovulatory, early-to-mid luteal, and premenstrual). Significant decreases in CVA were observed from the menstrual to premenstrual (nstudies = 5; nindividuals = 200; d = −1.17, 95% CI (−2.18, −0.17)) and from the mid-to-late follicular to premenstrual phases (nstudies = 8; nindividuals = 280; d = −1.32, 95% CI (−2.35, −0.29)). In conclusion, meta-analyses indicate the presence of CVA fluctuations across the menstrual cycle. Future studies involving CVA should control for cycle phase. Recommendations for covarying or selecting cycle phase are provided. View Full-Text
Keywords: female health; menstrual cycle; ovarian hormones; cardiac vagal activity; heart rate variability; cardiac vagal tone female health; menstrual cycle; ovarian hormones; cardiac vagal activity; heart rate variability; cardiac vagal tone
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MDPI and ACS Style

Schmalenberger, K.M.; Eisenlohr-Moul, T.A.; Würth, L.; Schneider, E.; Thayer, J.F.; Ditzen, B.; Jarczok, M.N. A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies. J. Clin. Med. 2019, 8, 1946.

AMA Style

Schmalenberger KM, Eisenlohr-Moul TA, Würth L, Schneider E, Thayer JF, Ditzen B, Jarczok MN. A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies. Journal of Clinical Medicine. 2019; 8(11):1946.

Chicago/Turabian Style

Schmalenberger, Katja M.; Eisenlohr-Moul, Tory A.; Würth, Lena; Schneider, Ekaterina; Thayer, Julian F.; Ditzen, Beate; Jarczok, Marc N. 2019. "A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies" J. Clin. Med. 8, no. 11: 1946.

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