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12 pages, 433 KiB  
Article
Cardiac Function in Women with and Without Previous Assisted Reproductive Technology: A Prospective Observational Cohort Study
by Freya Baird, Eleni Kakouri, Iulia Huluta, Ippokratis Sarris, Sesh K. Sunkara, Kypros H. Nicolaides and Nick Kametas
J. Clin. Med. 2025, 14(15), 5366; https://doi.org/10.3390/jcm14155366 - 29 Jul 2025
Viewed by 327
Abstract
Background: Previous research has linked hypertensive disorders of pregnancy (HDP) and long-term cardiovascular disease (CVD) with assisted reproductive technology (ART). It is not clear whether this reflects the background population cardiovascular profiles or whether ART independently increases the long-term risk for CVD [...] Read more.
Background: Previous research has linked hypertensive disorders of pregnancy (HDP) and long-term cardiovascular disease (CVD) with assisted reproductive technology (ART). It is not clear whether this reflects the background population cardiovascular profiles or whether ART independently increases the long-term risk for CVD and alters cardiovascular function. Furthermore, CVD has been associated with pathological cardiovascular function before and after the establishment of the disease. The aim of this study was to compare cardiac function in women attending for ART between those who had previous treatment and those who had not after controlling for demographic characteristics which have been shown to affect cardiovascular function. Methods: This was a prospective observational cohort study at a London fertility clinic. Women were consecutively enrolled between May 2021 and March 2022. Maternal demographics and cardiac function using transthoracic echocardiography were assessed before the current treatment cycle in the mid-luteal phase of the menstrual cycle. Maternal demographics included age, body mass index, smoking, race, and parity. Cardiovascular parameters included blood pressure and indices of left-ventricular systolic and diastolic function. Differences between cardiac variables after controlling for maternal demographics and history of previous ART were assessed by multivariate linear regression. Results: There were 232 healthy women who agreed to participate in the study; of those, 153 (58%) had undergone previous ART. After controlling for maternal demographic characteristics, previous assisted reproductive technology was not an independent predictor of cardiac function. Conclusions: Previous ART is not associated with significant changes in cardiac function. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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20 pages, 887 KiB  
Review
Epigenetics of Endometrial Cancer: The Role of Chromatin Modifications and Medicolegal Implications
by Roberto Piergentili, Enrico Marinelli, Lina De Paola, Gaspare Cucinella, Valentina Billone, Simona Zaami and Giuseppe Gullo
Int. J. Mol. Sci. 2025, 26(15), 7306; https://doi.org/10.3390/ijms26157306 - 29 Jul 2025
Viewed by 250
Abstract
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries. Risk factors for EC include metabolic alterations (obesity, metabolic syndrome, insulin resistance), hormonal imbalance, age at menopause, reproductive factors, and inherited conditions, such as Lynch syndrome. For the inherited forms, several [...] Read more.
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries. Risk factors for EC include metabolic alterations (obesity, metabolic syndrome, insulin resistance), hormonal imbalance, age at menopause, reproductive factors, and inherited conditions, such as Lynch syndrome. For the inherited forms, several genes had been implicated in EC occurrence and development, such as POLE, MLH1, TP53, PTEN, PIK3CA, PIK3R1, CTNNB1, ARID1A, PPP2R1A, and FBXW7, all mutated at high frequency in EC patients. However, gene function impairment is not necessarily caused by mutations in the coding sequence of these and other genes. Gene function alteration may also occur through post-transcriptional control of messenger RNA translation, frequently caused by microRNA action, but transcriptional impairment also has a profound impact. Here, we review how chromatin modifications change the expression of genes whose impaired function is directly related to EC etiopathogenesis. Chromatin modification plays a central role in EC. The modification of chromatin structure alters the accessibility of genes to transcription factors and other regulatory proteins, thus altering the intracellular protein amount. Thus, DNA structural alterations may impair gene function as profoundly as mutations in the coding sequences. Hence, its central importance is in the diagnostic and prognostic evaluation of EC patients, with the caveat that chromatin alteration is often difficult to identify and needs investigations that are specific and not broadly used in common clinical practice. The different phases of the healthy endometrium menstrual cycle are characterized by differential gene expression, which, in turn, is also regulated through epigenetic mechanisms involving DNA methylation, histone post-translational modifications, and non-coding RNA action. From a medicolegal and policy-making perspective, the implications of using epigenetics in cancer care are briefly explored as well. Epigenetics in endometrial cancer is not only a topic of biomedical interest but also a crossroads between science, ethics, law, and public health, requiring integrated approaches and careful regulation. Full article
(This article belongs to the Section Molecular Oncology)
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12 pages, 1773 KiB  
Article
Dietary, Body Composition, and Blood Leptin Variations in Fit-Model Female Athletes During the Pre-Competition Period
by Ramutis Kairaitis, Petras Minderis, Inga Lukonaitienė, Gediminas Mamkus, Tomas Venckūnas and Sigitas Kamandulis
Nutrients 2025, 17(14), 2299; https://doi.org/10.3390/nu17142299 - 12 Jul 2025
Viewed by 586
Abstract
Background: The Fit-Model in bodybuilding is a relatively new category designed for women seeking a balanced physique, avoiding excessive muscularity and extreme leanness. This study examined the dietary strategies, body composition changes, and plasma leptin fluctuations of Fit-Model athletes during a seven-week pre-competition [...] Read more.
Background: The Fit-Model in bodybuilding is a relatively new category designed for women seeking a balanced physique, avoiding excessive muscularity and extreme leanness. This study examined the dietary strategies, body composition changes, and plasma leptin fluctuations of Fit-Model athletes during a seven-week pre-competition phase. Methods: Twelve females (age: 27.6 ± 4.4 years, body mass: 60.0 ± 6.2 kg) preparing for a national championship were monitored for energy and macronutrient intakes, total, lean, and fat mass, plasma leptin levels, and menstrual cycle characteristics. The five highest-ranked athletes were selected to compete at the world championship, allowing for comparisons between national and international athletes. Results: Low carbohydrate intake was reported, and total energy intake decreased from 1700 to 1520 kcal/day approaching the contest day. Athletes experienced an average body mass loss of 4.2 kg, with no clear relationship between final weight or fat mass and competitive success. Plasma leptin levels were markedly low during all 7 weeks of preparation with a further decline before the contest, but did not correlate with either changes in body composition and weight or energy or macronutrient intakes. Menstrual cycle disturbances were prevalent, with only two athletes maintaining regular cycles by the end of the preparation. Conclusions: Fit-Model athletes undergo a considerable decline in body weight and fat mass during the final weeks before the contest, yet these changes do not appear to be decisive for performance outcomes. Persistently low leptin levels and menstrual irregularities call for strategies that balance physique optimization with endocrine health to support both the performance and well-being of athletes. Full article
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16 pages, 918 KiB  
Systematic Review
miRNA in Endometriosis—A New Hope or an Illusion?
by Anna Dryja-Brodowska, Bogdan Obrzut, Maciej Obrzut and Dorota Darmochwał-Kolarz
J. Clin. Med. 2025, 14(14), 4849; https://doi.org/10.3390/jcm14144849 - 8 Jul 2025
Viewed by 428
Abstract
Background: Endometriosis is a complex, estrogen-dependent condition that can significantly impact women’s quality of life and fertility. Current diagnostic strategies remain invasive and often prolonged, demonstrating the need for reliable, non-invasive biomarkers. In this context, microRNAs (miRNAs), due to their stability in blood [...] Read more.
Background: Endometriosis is a complex, estrogen-dependent condition that can significantly impact women’s quality of life and fertility. Current diagnostic strategies remain invasive and often prolonged, demonstrating the need for reliable, non-invasive biomarkers. In this context, microRNAs (miRNAs), due to their stability in blood and regulatory roles in inflammation and cell proliferation, have emerged as promising candidates. Methods: This review systematically analyzes 17 studies published between 2010 and 2025 that investigated the diagnostic utility of circulating and tissue-based miRNAs in endometriosis. Results: A wide range of dysregulated miRNAs was identified, with miR-125b-5p, miR-451a, and miR-3613-5p showing the most consistent alterations across studies. However, diagnostic performance varied considerably—largely due to methodological heterogeneity. Key differences were observed in sample type (serum, plasma, endometrium), patient selection, and control group definition. The menstrual cycle phase and hormonal status were often not matched or reported, limiting reproducibility. Conclusions: Despite encouraging findings, the current evidence base is weakened by inconsistent protocols and limited validation. Standardized, multicenter research with well-characterized patient cohorts is essential to the establishment of clinically applicable miRNA-based diagnostics. If validated, miRNAs may offer a transformative, non-invasive approach for earlier detection and improved management of endometriosis. Full article
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13 pages, 1218 KiB  
Article
Endothelial Protein Changes Indicative of Endometriosis in Unexplained Infertility, an Exploratory Study
by Heba Malik, Sirine Zamouri, Samir Akkawi, Siddh Mehra, Rana Mouaki, Thozhukat Sathyapalan, Manjula Nandakumar, Alexandra E. Butler and Stephen L. Atkin
Int. J. Mol. Sci. 2025, 26(13), 6485; https://doi.org/10.3390/ijms26136485 - 5 Jul 2025
Viewed by 467
Abstract
Previous research has linked both endothelial protein changes and vitamin D with infertility. This study was undertaken to investigate the association of proteins associated with endothelial function and vitamin D status in the luteal phase at day 21 in a group of non-obese [...] Read more.
Previous research has linked both endothelial protein changes and vitamin D with infertility. This study was undertaken to investigate the association of proteins associated with endothelial function and vitamin D status in the luteal phase at day 21 in a group of non-obese women prior to in vitro fertilization (IVF) with either unexplained infertility (UI) or male factor infertility (MFI). Twenty-five non-obese Caucasian women from a UK academic center with MFI (n = 14) and UI (n = 11) were recruited. Blood was withdrawn at day 21 of the menstrual cycle at the time of mock embryo transfer. Vitamin D parameters were measured by tandem mass spectroscopy. Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement was undertaken for 20 protein markers of endothelial dysfunction. Baseline demographics did not differ between groups and parameters of response following IVF did not differ. Vitamins D2 and D3, and 1,25 Vitamin D3 did not differ between groups. In UI, markers of endothelial activation/dysfunction were investigated; vascular cell adhesion molecule 1 (VCAM-1) decreased and this is associated with endothelial stress; vascular endothelial growth factor (VEGF) decreased and this may suggest impaired endometrial angiogenesis; while intercellular adhesion molecule 1 (ICAM-3) increased (p < 0.05) and is associated with increased immunological activity. A marker of vascular integrity, angiopoietin-1, increased while soluble angiopoietin-1 receptor (sTie-2) decreased (p < 0.05), suggesting increased vascular development. Endothelial markers of inflammation, coagulation, and endothelial progenitor cells were unchanged. Vitamin D and its metabolites show no relationship to UI, but endothelial activation/dysfunction and vascular integrity changes in VCAM-1, VEGF, sICAM-3, angiopoietin-1, and sTie-2 may contribute to UI, though the mechanisms through which they work require further evaluation; however, these protein changes have been associated with endometriosis, raising the suggestion that subclinical/undiagnosed endometriosis may have contributed to UI in these subjects. Full article
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12 pages, 652 KiB  
Review
Unraveling the Contribution of Estrobolome Alterations to Endometriosis Pathogenesis
by Giulia Nannini, Francesco Cei and Amedeo Amedei
Curr. Issues Mol. Biol. 2025, 47(7), 502; https://doi.org/10.3390/cimb47070502 - 1 Jul 2025
Cited by 1 | Viewed by 412
Abstract
Endometriosis (EMS) is a long-term inflammatory disease. It represents one of the most prevalent gynecological conditions, impacting an estimated 5% of reproductive women. Therefore, endometriosis contributes to substantial worldwide health challenges and healthcare costs. In EMS disease, endometrial glandular and stromal tissues are [...] Read more.
Endometriosis (EMS) is a long-term inflammatory disease. It represents one of the most prevalent gynecological conditions, impacting an estimated 5% of reproductive women. Therefore, endometriosis contributes to substantial worldwide health challenges and healthcare costs. In EMS disease, endometrial glandular and stromal tissues are abnormally located outside the uterus. Similarly to the natural endometrium, these tissues grow and proliferate in response to estrogen-dependent signals. The pain and limited effectiveness of treatments are often linked to the inflammatory reaction triggered by EMS-associated ectopic tissue. This is especially amplified during the peaks of estrogen release that occur as the menstrual cycle transitions from the proliferative phase to ovulation. Maintaining the integrity of the mucosal lining, defending against pathogenic insults, and controlling physiological processes are all made possible by a healthy, balanced state of gut biomass. Additionally, numerous intestinal bacteria have been discovered to possess estrogen-metabolizing enzymes, which affect the estrobolome and, consequently, influence estrogen-related disorders. Therefore, there is increasing interest in understanding the role of microbiota and the estrobolome in endometriosis pathogenesis. This review will focus on the role of microbiota and the impact of estrobolome alterations in endometriosis pathogenesis. Full article
(This article belongs to the Section Molecular Medicine)
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12 pages, 5835 KiB  
Article
Transitional Lesions, One More Step Towards Understanding the Pathogenesis of Adenomyosis
by Emilie Wacheul, Marie-Madeleine Dolmans, Jérôme Ambroise, Jacques Donnez and Alessandra Camboni
J. Clin. Med. 2025, 14(13), 4578; https://doi.org/10.3390/jcm14134578 - 27 Jun 2025
Viewed by 350
Abstract
Background/Objectives: Adenomyosis is a benign gynecological disorder associated with abnormal uterine bleeding, dysmenorrhea, and subfertility. Its pathogenesis has not yet been elucidated. The most widely accepted theory points to repeated mechanical or hormonal stress at the endometrial–myometrial interface, leading to activation of the [...] Read more.
Background/Objectives: Adenomyosis is a benign gynecological disorder associated with abnormal uterine bleeding, dysmenorrhea, and subfertility. Its pathogenesis has not yet been elucidated. The most widely accepted theory points to repeated mechanical or hormonal stress at the endometrial–myometrial interface, leading to activation of the tissue injury and repair (TIAR) mechanism. Studies suggest that the immune system may play a role in disease pathogenesis, but inconsistencies persist due to differences in studied samples and evaluated menstrual cycle phases. The goal of our study was to apply a novel technique (multiplex) to investigate different immune cell phenotypes in uteri from adenomyosis patients according to the cycle phase. Methods: This study analyzed immune cell populations in adenomyotic uteri using immunohistochemistry and multiplex immunofluorescence on 30 adenomyotic and 15 healthy hysterectomy samples. Results: Compared to eutopic endometrium, transitional and adenomyotic lesions displayed reduced immune infiltrates, particularly T cells, NK cells, B cells, macrophages, and dendritic cells. Conversely, mast cells were significantly elevated in transitional lesions. Conclusions: The present study suggests mast cell implication in adenomyosis development and pain, through their implication in tissue remodeling, angiogenesis, and neurogenic inflammation. Transitional lesions highlighted the progressive nature of adenomyosis, supporting the TIAR hypothesis. These findings emphasize the importance of mast cells in disease progression and underscore the need for further studies to explore immune-targeted therapies. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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12 pages, 475 KiB  
Review
Does the Menstrual Phase Matter in Vascular Endothelial Responses to Acute Exercise? A Narrative Review of the Literature
by Sairos Ghniem, Ellen A. Dawson and Andrea Tryfonos
Sports 2025, 13(7), 210; https://doi.org/10.3390/sports13070210 - 27 Jun 2025
Viewed by 405
Abstract
Women have a lower age-matched cardiovascular risk than men, largely due to estrogen’s protective role in endothelial function. While exercise improves vascular health, acute vascular responses are influenced by factors such as age, fitness level, metabolic status, and exercise modality. In premenopausal women, [...] Read more.
Women have a lower age-matched cardiovascular risk than men, largely due to estrogen’s protective role in endothelial function. While exercise improves vascular health, acute vascular responses are influenced by factors such as age, fitness level, metabolic status, and exercise modality. In premenopausal women, fluctuations in estrogen levels during the menstrual cycle may further affect vascular reactivity. Here, we review current evidence on acute exercise-induced vascular responses in women, emphasizing menstrual phase influences and key biomarkers such as flow-mediated dilation (FMD), along with others including vascular conductance and pulse wave velocity (PWV). Despite limited and heterogeneous evidence, shear-induced vascular responses, (including FMD) following acute exercise, appear to be relatively stable across menstrual cycle phase, suggesting that strict phasic control may not always be necessary. However, future high-quality studies are needed to further clarify this response. In contrast, other vascular assessments that rely more heavily on neural components—such as vascular conductance and PWV—show greater estrogen sensitivity. Nonetheless, the inconsistencies between studies again underscore the need for future research with hormonal verification. Morever, adequate sample sizes, and standardized exercise protocols will improve both consistency and help develop and promote the inclusion of women in vascular research. Full article
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14 pages, 567 KiB  
Review
Pathophysiology of Endometriosis: Insights from Immunohistochemical Analysis of Ectopic and Eutopic Tissues
by Fahad T. Alotaibi
Int. J. Mol. Sci. 2025, 26(13), 5998; https://doi.org/10.3390/ijms26135998 - 22 Jun 2025
Viewed by 551
Abstract
Endometriosis is a complex gynecological disorder characterized by the presence of endometrial-like tissue outside the uterus, leading to chronic pain and infertility. Immunohistochemistry (IHC) serves as a vital technique for elucidating the molecular and cellular differences between ectopic endometriotic tissues and eutopic endometrium. [...] Read more.
Endometriosis is a complex gynecological disorder characterized by the presence of endometrial-like tissue outside the uterus, leading to chronic pain and infertility. Immunohistochemistry (IHC) serves as a vital technique for elucidating the molecular and cellular differences between ectopic endometriotic tissues and eutopic endometrium. IHC reveals significant variations in the expression of inflammatory markers, adhesion molecules, and cell cycle regulators. This literature review compiles findings from various studies that assess the role of key proteins, such as leukemia inhibitory factor (LIF), cyclooxygenase-2 (COX-2), and b-cell lymphoma 2 (BCL-2), across different menstrual phases and lesion types. Notably, elevated LIF levels and increased mast cell activity in ectopic tissues underscore the inflammatory landscape of endometriosis. Additionally, altered expression of adhesion molecules like integrins and cluster of differentiation 44 (CD44) suggests modified cellular interactions, while apoptotic markers reveal a survival advantage for ectopic cells. These insights enhance our understanding of endometriosis pathophysiology. Full article
(This article belongs to the Section Molecular Endocrinology and Metabolism)
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13 pages, 921 KiB  
Article
Age-Related Dynamics in Endometrial Vascularity: A Comprehensive Three-Dimensional Ultrasound Evaluation During Follicular and Luteal Phases
by Badreldeen Ahmed and Justin C. Konje
J. Clin. Med. 2025, 14(12), 4332; https://doi.org/10.3390/jcm14124332 - 18 Jun 2025
Viewed by 470
Abstract
Objective: Transvaginal ultrasonography plays a crucial role in contemporary fertility management, offering insights into uterine and endometrial blood flow. Three-dimensional ultrasonography utilizing power Doppler angiography (3D-CPA) allows precise measurement of endometrial volume and vascular parameters, such as the vascularization index (VI), blood flow [...] Read more.
Objective: Transvaginal ultrasonography plays a crucial role in contemporary fertility management, offering insights into uterine and endometrial blood flow. Three-dimensional ultrasonography utilizing power Doppler angiography (3D-CPA) allows precise measurement of endometrial volume and vascular parameters, such as the vascularization index (VI), blood flow index (FI), and vascularization flow index (VFI); variables that indirectly assess endometrial receptivity and integrity. Doppler technology allows for the capture of changes in the uterus induced by hormonal-related fluctuations during the menstrual cycle, revealing a significant correlation between endometrial receptivity and vascularity. Age-related changes in endometrial function are implicated in declining fertility, with limited research exploring this aspect. The aim of this study was to investigate the impact of aging on various ultrasound parameters of the uterus, including endometrial vascularity. Methods: A retrospective cross-sectional study of women who attended the Feto-Maternal Centre from January 2022 to December 2023. Each woman whose menstrual cycle was regular underwent 3D ultrasound with power Doppler as part of the routine assessment of the pelvis. Parameters assessed include the VI, FI, and VFI as well as uterine volume, endometrial volume, and endometrial thickness. The women were grouped based on age, and the variables measured in the follicular and luteal phases were compared between the age groups using SPSS version 30 September 2024. Results: A total of 907 women (427 follicular and 480 luteal phase) were studied: 297 (131 follicular and 166 luteal) were 20–29 years old; 471 (240 follicular and 231 luteal) were aged 30–39; and 139 (56 follicular and 83 luteal) were aged 40–49. Uterine volume, endometrial volume, and thickness increased significantly and steadily with age. VI, VFI, and FI decreased significantly with age in the follicular phase, but in the luteal phase there was no statistically significant difference in any of these indices with age. Conclusions: Uterine volume, endometrial thickness, and endometrial volume increased with age, but the vascular indices decreased with age in the follicular but not in the luteal phase. These age-related changes in endometrial vascularity may partly explain the decrease in age-related fertility. Further research is needed to comprehensively explore the complexities of uterine aging and its implications for female fertility. Full article
(This article belongs to the Special Issue Ultrasound Diagnosis of Obstetrics and Gynecologic Diseases)
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11 pages, 531 KiB  
Article
Effects of Menstrual Cycle on Exercise Treadmill Parameters and Cardiac Troponin Release in Premenstrual Women
by Aysu Oktay, Inanc Torustag, Ferruh Kemal Isman and Mehmet Agirbasli
Diagnostics 2025, 15(12), 1548; https://doi.org/10.3390/diagnostics15121548 - 18 Jun 2025
Viewed by 552
Abstract
Background: The diagnostic accuracy of the exercise treadmill test (ETT) remains suboptimal in premenopausal women. Menstrual cycle phases display hormonal variations and biological effects in premenopausal women. The early and late follicular phases of the menstrual cycle demonstrate nearly four-fold differences in estrogen [...] Read more.
Background: The diagnostic accuracy of the exercise treadmill test (ETT) remains suboptimal in premenopausal women. Menstrual cycle phases display hormonal variations and biological effects in premenopausal women. The early and late follicular phases of the menstrual cycle demonstrate nearly four-fold differences in estrogen levels. Methods: This study assessed the variability in ETT results between the early and late follicular phases in premenopausal women. This study included premenopausal females with regular menstrual cycles and chest pain. As per the study protocol, patients underwent two separate ETTs at the early and late follicular phases of the menstrual cycle. Hormones and high-sensitivity cardiac troponin T (hs-cTnT) were measured. The primary endpoint was the ST segment/heart rate (HR) index. The secondary endpoints were maximum ST/HR slope, ST segment depression, HR and blood pressure (BP) response, exercise capacity, and hs-cTnT change after ETT. Results: False-positive ETT results were common in premenopausal women. The early follicular phase displayed significantly higher hs-cTnT and BP responses to ETT compared to the late follicular phase. This study reports that ETT results are similar between the early and late follicular phases of the menstrual cycle in premenopausal women. Biological variability is observed in the BP and hs-cTnT response to ETT between the two phases. Conclusions: The menstrual cycle phase (early versus late follicular phase) did not affect the ETT results. The consideration of estrogen and hormonal status when evaluating the diagnostic test results can improve our understanding of cardiovascular disease in women. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Cardiovascular Diseases)
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15 pages, 2547 KiB  
Case Report
Heart Rate Variability Measurements Across the Menstrual Cycle and Oral Contraceptive Phases in Two Olympian Female Swimmers: A Case Report
by Marine Dupuit, Kilian Barlier, Benjamin Tranchard, Jean-François Toussaint, Juliana Antero and Robin Pla
Sports 2025, 13(6), 185; https://doi.org/10.3390/sports13060185 - 12 Jun 2025
Viewed by 1311
Abstract
The heart rate variability (HRV), influenced by female sex hormone fluctuations, is an indicator of athletes’ adaptation. This case study explores HRV responses over 18 months across a natural menstrual cycle (MC) and during oral contraceptive (OC) use in two Olympic female swimmers. [...] Read more.
The heart rate variability (HRV), influenced by female sex hormone fluctuations, is an indicator of athletes’ adaptation. This case study explores HRV responses over 18 months across a natural menstrual cycle (MC) and during oral contraceptive (OC) use in two Olympic female swimmers. HRV measurements—including mean heart rate (HR); root mean square of successive differences (RMSSD); and frequency-domain indices—were collected at rest in supine (SU) and standing (ST) positions across two competitive seasons. Nocturnal HR and RMSSD were assessed using the Ōura® ring. MC and OC phases were identified through specific tracking, and training load was controlled. In both athletes, resting HR was lower during bleeding phases, increasing from menstruation to the luteal phase (MC) and from withdrawal to active pill phases (OC). In the ST position, RMSSD was higher but decreased throughout the phases. Nocturnal measurements confirmed these trends. Overall, findings suggest a phase-related parasympathetic overactivity shift. This study provides novel insights into HRV responses across hormonal cycles in elite female athletes, which present unique characteristics. Such monitoring tools may support a data-informed approach to guide and periodize training more effectively. Full article
(This article belongs to the Special Issue Women's Special Issue Series: Sports)
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11 pages, 463 KiB  
Article
Impact of the Menstrual Cycle on Glycemic Control in Women with Type 1 Diabetes and the Potential Role of AHCL Systems
by Angelo Milioto, Chiara Gulisano, Giordano Spacco, Giulia Siri, Benedetta Caccia, Maria Grazia Calevo, Nicola Minuto, Davide Carlo Maggi, Marta Bassi and Francesco Cocchiara
Diabetology 2025, 6(6), 53; https://doi.org/10.3390/diabetology6060053 - 6 Jun 2025
Viewed by 844
Abstract
Background/Objectives: Hormonal fluctuations during the menstrual cycle can affect glycemic control in women with type 1 diabetes (T1D), especially during the luteal phase, when increased insulin resistance may lead to prolonged hyperglycemia. Advanced Hybrid Closed-Loop (AHCL) systems could help manage these hormone-driven [...] Read more.
Background/Objectives: Hormonal fluctuations during the menstrual cycle can affect glycemic control in women with type 1 diabetes (T1D), especially during the luteal phase, when increased insulin resistance may lead to prolonged hyperglycemia. Advanced Hybrid Closed-Loop (AHCL) systems could help manage these hormone-driven fluctuations. This study aimed to assess glycemic control across menstrual phases and explore the role of AHCL systems in counteracting the related glucose variability. Methods: A retrospective study was conducted including women with T1D and regular menstrual cycles (study group) and women on estroprogestin therapy (control group). Each group was subdivided by insulin delivery method (AHCL vs. non-AHCL). Glycemic metrics and insulin requirements were compared between the follicular and luteal phases, and between groups. Results: The study included 94 women (62 in the study group, 32 in the control group). In the study group, glycemic control worsened during the luteal phase, with increased average glucose, glycemic variability, and time above range > 250 mg/dL (+0.93%, p = 0.03) and reduced time in range 70–180 mg/dL. These changes were more pronounced among AHCL users, who also showed a significant increase in bolus insulin. No phase-related differences were observed in the control group or among non-AHCL users. Significantly higher insulin needs during the follicular phase were found in the study group compared with the controls. Conclusions: This study confirmed a worsening in glycemic control in women affected by T1D during the luteal phase of the menstrual cycle, suggesting a need for more tailored management. The clear efficacy of AHCL systems in counteracting hormone-related glycemic fluctuations has not been proved, highlighting the need for further research in larger, more homogeneous cohorts. Full article
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14 pages, 505 KiB  
Article
The Influence of the Menstrual Cycle on Electrical Thresholds for Sensory and Pain Perception: Implications for Exercise and Rehabilitation in Women With and Without Primary Dysmenorrhea—A Pilot Study
by Ana Cristina Morales-Lalaguna, Izarbe Ríos-Asín, Pilar Pardos-Aguilella, Jorge Pérez-Rey, Elena Estébanez-de-Miguel and Miguel Malo-Urriés
Healthcare 2025, 13(11), 1240; https://doi.org/10.3390/healthcare13111240 - 24 May 2025
Viewed by 690
Abstract
Background: Hormonal fluctuations during the menstrual cycle (MC) influence pain perception, potentially affecting exercise performance and rehabilitation in women. This effect may be more pronounced in individuals with primary dysmenorrhea (PD), requiring tailored physiotherapeutic and exercise interventions. Objective: To analyze the [...] Read more.
Background: Hormonal fluctuations during the menstrual cycle (MC) influence pain perception, potentially affecting exercise performance and rehabilitation in women. This effect may be more pronounced in individuals with primary dysmenorrhea (PD), requiring tailored physiotherapeutic and exercise interventions. Objective: To analyze the influence of MC phases on sensory electrical threshold (SET) and pain electrical threshold (PET) in eumenorrheic women with and without PD, considering the potential implications for physical activity and rehabilitation. Methods: An observational longitudinal study was conducted with 34 physically active women, divided into a control group (CG) and a PD group. SET and PET were measured using transcutaneous electrical nerve stimulation (TENS) at the forearm (peripheral site) and lower abdomen (pain-referred site) across five MC phases. Pain intensity was assessed using a Visual Analog Scale (VAS). Results: SET and PET were significantly lower in the premenstrual phase (p < 0.001), suggesting increased pain sensitivity. VAS scores were higher in the PD group during all phases, except for the follicular phase (p < 0.033), with the highest pain levels recorded in the menstrual and premenstrual phases. While no significant differences in SET and PET were found between groups across most phases, the PD group exhibited a significantly higher SET in the forearm during the premenstrual phase (p = 0.005), potentially indicating altered central pain modulation. Conclusions: MC-related hormonal fluctuations affect pain sensitivity, particularly in women with PD. These findings underscore the need for phase-specific exercise adaptations and rehabilitation strategies to improve performance, pain management, and recovery in physically active women. Full article
(This article belongs to the Special Issue Physical Therapy and Rehabilitation in Sports)
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17 pages, 607 KiB  
Systematic Review
Evaluation the Impact of Hormonal Fluctuations During the Menstrual Cycle on the Performance of Female Athletes—Systematic Review
by Ainize Elorduy-Terrado, Gema Torres-Luque, Krizia Radesca, Guillermo Muñoz-Andradas, Marisa Saenz-Bravo and Diego Domínguez-Balmaseda
Muscles 2025, 4(2), 15; https://doi.org/10.3390/muscles4020015 - 19 May 2025
Cited by 1 | Viewed by 2167
Abstract
This systematic review aims to evaluate the impact of hormonal fluctuations during the menstrual cycle on the performance of female athletes. Methods: Following PRISMA guidelines, a comprehensive search was conducted in Scopus, Web of Science, and PubMed databases using the keywords: (“Menstrual cycle”) [...] Read more.
This systematic review aims to evaluate the impact of hormonal fluctuations during the menstrual cycle on the performance of female athletes. Methods: Following PRISMA guidelines, a comprehensive search was conducted in Scopus, Web of Science, and PubMed databases using the keywords: (“Menstrual cycle”) AND (“performance” OR “female athlete” OR “sport” AND NOT “male”); AND NOT (“contraceptive”). Inclusion criteria focused on original studies published between 2013 and 2023, in English or Spanish, involving eumenorrheic female athletes without menstrual disorders or oral contraceptive use. The studies were critically assessed using the McMaster scientific review method. Results: Thirteen eligible articles were reviewed, comprising a total sample of 152 athletes. Significant findings include increased flexibility during the ovulatory phase and enhanced aerobic and anaerobic capacities in the luteal phase. Additionally, the menstrual and premenstrual phases notably influenced aerobic and anaerobic capacities, performance perception, symptomatology, and exercise-induced muscle damage. Conclusion: Hormonal fluctuations can impact female athletes’ performance. However, further research is warranted due to inconsistent results stemming from variations in cycle phases studied, lack of standardized methodologies, small sample sizes, and short observation periods. Full article
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