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The Effect of Menstrual Cycle on Perceptual Responses in Athletes: A Systematic Review With Meta-Analysis

ABSTRACT: This article aimed to investigate the effects of menstrual cycle phases on perceptual responses in athletes by means of systematic review and meta-analysis. The search was conducted in the PubMed, Web of Science, and Sport Discus databases considering articles with two or more menstrual phases for comparison. The PECO criteria were used for the keywords “menstrual cycle,” “athletes,” and “perceptual responses” with their respective entry terms. Of 1.165 records identified, 14 articles were available for the final evaluation, while eight articles were eligible for a meta-analysis. The perceptual responses evaluated in the studies were: motivation, competitiveness, sleep quality, stress, muscle soreness, fatigue, perceived effort, mood, menstrual symptoms, perceived endurance, and readiness. The meta-analysis was conducted for perceived effort only. The results showed that the level of perceived exertion does not differ two phases of the menstrual cycle (MD = 3.03, Q = 1.58, df = 1, p = 0.209), whereas RPE was 19.81 ± 0.05 and 16.27 ± 0.53 at day 1–5 and day 19–24, respectively. Two studies found statistically significant changes in motivation and competitiveness during the cycle, with better outcomes in ovulatory phase compared to follicular and luteal. One study found an increase in mood disturbance in the pre-menstrual phase (vs. mid-cycle); one decreased vigor in the menstrual phase (vs. luteal); one increased the menstrual symptoms in the follicular phase (vs. ovulation), and one study reported increased fatigue and decreased sleep quality on luteal phase (vs. follicular). The remaining studies and variables were not affected by the menstrual cycle phase. Based on the results from the studies selected, some perceptual responses are affected in different menstrual cycle phases. A “favorable” subjective response in athletes was noticed when the ovarian hormones present an increase in concentration levels compared to phases with lower concentration. Different perceptual variables and methodological approaches limit the generalization of the conclusion.

SUBMITTER: Paludo A

PROVIDER: S-EPMC9328165 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men.To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL.Systematic review; Level of evidence, 4.Searches were conducted using MEDLINE (1946-August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included athletic injuries, knee injuries, ligaments, joint instability, menstrual cycle, ovulation, hormones, and contraceptives. Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase.The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.

Project description:BackgroundConcentrations of endogenous sex hormones fluctuate across the menstrual cycle (MC), which could have implications for exercise performance in women. At present, data are conflicting, with no consensus on whether exercise performance is affected by MC phase.ObjectiveTo determine the effects of the MC on exercise performance and provide evidence-based, practical, performance recommendations to eumenorrheic women.MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for published experimental studies that investigated the effects of the MC on exercise performance, which included at least one outcome measure taken in two or more defined MC phases. All data were meta-analysed using multilevel models grounded in Bayesian principles. The initial meta-analysis pooled pairwise effect sizes comparing exercise performance during the early follicular phase with all other phases (late follicular, ovulation, early luteal, mid-luteal and late luteal) amalgamated. A more comprehensive analysis was then conducted, comparing exercise performance between all phases with direct and indirect pairwise effect sizes through a network meta-analysis. Results from the network meta-analysis were summarised by calculating the Surface Under the Cumulative Ranking curve (SUCRA). Study quality was assessed using a modified Downs and Black checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group.ResultsOf the 78 included studies, data from 51 studies were eligible for inclusion in the initial pairwise meta-analysis. The three-level hierarchical model indicated a trivial effect for both endurance- and strength-based outcomes, with reduced exercise performance observed in the early follicular phase of the MC, based on the median pooled effect size (ES0.5 = - 0.06 [95% credible interval (CrI): - 0.16 to 0.04]). Seventy-three studies had enough data to be included in the network meta-analysis. The largest effect was identified between the early follicular and the late follicular phases of the MC (ES0.5 = - 0.14 [95% CrI: - 0.26 to - 0.03]). The lowest SUCRA value, which represents the likelihood that exercise performance is poor, or among the poorest, relative to other MC phases, was obtained for the early follicular phase (30%), with values for all other phases ranging between 53 and 55%. The quality of evidence for this review was classified as "low" (42%).ConclusionThe results from this systematic review and meta-analysis indicate that exercise performance might be trivially reduced during the early follicular phase of the MC, compared to all other phases. Due to the trivial effect size, the large between-study variation and the number of poor-quality studies included in this review, general guidelines on exercise performance across the MC cannot be formed; rather, it is recommended that a personalised approach should be taken based on each individual's response to exercise performance across the MC.

Project description:BACKGROUND:Several studies have highlighted the substantial role of the athlete's redox and inflammation status during the training process. However, many factors such as differences in testing protocols, assays, sample sizes, and fitness levels of the population are affecting findings and the understanding regarding how exercise affects related biomarkers in adolescent athletes. OBJECTIVES:To search redox homeostasis variables' and inflammatory mediators' responses in juvenile athletes following short- or long-term training periods and examine the effect size of those variations to training paradigms. METHODS:A PRISMA-compliant systematic review and meta-analysis were conducted. The entire content of PubMed (MEDLINE), Scopus, and Science Direct were systematically searched until December 2019. Studies with outcomes including (1) a group of adolescent athletes from any individual or team sport, (2) the assessment of redox and/or inflammatory markers after a short- (training session or performance testing) or longer training period, and (3) variables measured in blood were retained. The literature search initially identified 346 potentially relevant records, of which 36 studies met the inclusion criteria for the qualitative synthesis. From those articles, 27 were included in the quantitative analysis (meta-analysis) as their results could be converted into common units. RESULTS:Following a short training session or performance test, an extremely large increase in protein carbonyls (PC) (ES 4.164; 95% CI 1.716 to 6.613; Z = 3.333, p = 0.001), a large increase in thiobarbituric acid reactive substances (TBARS) (ES 1.317; 95% CI 0.522 to 2.112; Z = 3.247, p = 0.001), a large decrease in glutathione (GSH) (ES - 1.701; 95% CI - 2.698 to - 0.705; Z = - 3.347, p = 0.001), and a moderate increase of total antioxidant capacity (TAC) level (ES 1.057; 95% CI - 0.044 to 2.158; Z = 1.882, p = 0.060) were observed. Following more extended training periods, GSH showed moderate increases (ES 1.131; 95% CI 0.350 to 1.913; Z = 2.839, p = 0.005) while TBARS displayed a small decrease (ES 0.568; 95% CI - 0.062 to 1.197; Z = 1.768, p = 0.077). Regarding cytokines, a very large and large increase were observed in IL-6 (ES 2.291; 95% CI 1.082 to 3.501; Z = 3.713, p = 0.000) and IL-1 receptor antagonist (ra) (ES 1.599; 95% CI 0.347 to 2.851; Z = 2.503, p = 0.012), respectively, following short-duration training modalities in juvenile athletes. CONCLUSIONS:The results showed significant alterations in oxidative stress and cytokine levels after acute exercise, ranging from moderate to extremely large. In contrast, the variations after chronic exercise ranged from trivial to moderate. However, the observed publication bias and high heterogeneity in specific meta-analysis advocate the need for further exploration and consistency when we deal with the assessed variables to ascertain the implications of structured training regimes on measured variables in order to develop guidelines for training, nutritional advice, and wellbeing in young athletes. TRIAL REGISTRATION:PROSPERO CRD42020152105.

Project description:To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs.Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls' MHM.India.Adolescent girls.Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time.Data from 138 studies involving 193 subpopulations and 97,070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I(2) 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I(2) 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I(2) 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I(2) 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I(2) 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I(2) 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I(2) 97.8%, n=17). Half of the girls' homes had a toilet (PP 51%, 36% to 67%, I(2) 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0-7).Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed.CRD42015019197.

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The Effect of Menstrual Cycle on Perceptual Responses in Athletes: A Systematic Review With Meta-Analysis

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