WOMEN'S HEALTH
Reliable research and evidence-based recommendations scarce for women who exercise according to menstrual cycle
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A REVIEW CO-AUTHORED BY MCMASTER RESEARCHERS MAI WAGEH, ALYSHA D’SOUZA, AND STU PHILLIPS FOUND A LACK OF EVIDENCE TO SUPPORT EXERCISE RECOMMENDATIONS BASED ON MENSTRUAL CYCLE PHASES
view moreCREDIT: GEORGIA KIRKOS/MCMASTER UNIVERSITY
Hamilton, ON, December 5, 2023 – There is no shortage of advice for women on what to eat, how to train, or what supplements to take during their menstrual cycles, but a new review by an international team of scientists has found little evidence to support such recommendations.
In fact, they found sparse research on women and exercise at all, and even less on the effect of their periods on sports performance, physiology, or physical fitness.
The authors of the paper, from McMaster University, Manchester Metropolitan University and the Australian Catholic University in Melbourne, are calling for much more high quality, standardized research on women.
A key finding from the review was that hormonal levels vary substantially between women during their menstrual periods and between the cycles of individual women. Virtually no woman has a standard version of a menstrual cycle, which is typically 28 days long, with ovulation consistently occurring on day 14.
"The data suggests that from woman to woman, there are significant variations in estrogen and progesterone, the primary hormones that characterize the phases of the menstrual cycle," says co-lead author Alysha D'Souza, a graduate student in the Department of Kinesiology at McMaster University.
The findings are published in the most recent edition of the Journal of Applied Physiology.
"Hormone levels can vary substantially. Not just between two women, but within one woman from one cycle to the next," says Mai Wageh, a PhD candidate in the Department of Kinesiology at McMaster and co-lead author of the article.
The findings prompted D'Souza and Wageh to dig deeper into physiological differences across the menstrual cycle, broadly categorized into follicular, ovulatory, and luteal phases. They found few or no differences when they looked at exercise results across the cycle phases and examined women’s use of fat versus carbohydrates, the potential for muscle growth, or blood-vessel function.
The review relied on various methods, including a systematic review and meta-analysis, narrative interpretation and a previous umbrella review.
"Many women are following advice and planning exercises and practices based on some ostensible benefit of menstrual cycle phase-based exercise. We saw no evidence that such practice is science-based," said Stuart Phillips, a professor in the Department of Kinesiology at McMaster and senior author of the review.
"Women can feel better or worse, and some are even incapacitated during various phases of their cycle," said Wageh. "You need an individualized approach to training. Track your cycle and your symptoms in each phase and adjust your exercise plan accordingly. There is no one-size-fits-all approach."
The next steps for this work will be to determine whether symptoms often associated with menstruation are cycle-related or due to other stressors, including lack of sleep, poor nutrition, or work and relationship-related issues.
High resolution photos and video related to this study can be found at:
https://photos.app.goo.gl/qrr27ua7qj4UBoc56
Alysha D’Souza and Mai Wageh, co-lead authors of the review and graduate students in the Department of Kinesiology at McMaster University.
Stu Phillips, senior author of the study and a professor in the Department of Kinesiology at McMaster University
CREDIT
Georgia Kirkos/McMaster University
JOURNAL
Journal of Applied Physiology
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Menstrual cycle hormones and oral contraceptives: a multimethod systems physiology-based review of their impact on key aspects of female physiology
ARTICLE PUBLICATION DATE
26-Nov-2023
COI STATEMENT
S.M.P. reports personal fees from Nestle Health Sciences and nonfinancial support from Enhanced Recovery outside the submitted work. S.M.P. has patents licensed to Exerkine but reports no financial gains from patents or related work. M.A.T. is President and CEO of Exerkine Corporation who develops post-exercise recovery drinks for athletes but none that are sex-specific. None of the other authors has any conflicts of interest, financial or otherwise, to disclose
Decades after blood pressure-related pregnancy complications, Hispanic/Latina women can have changes in heart structure and function
Findings highlight importance of early monitoring and management of hypertension during and after pregnancy
Findings highlight importance of early monitoring and management of hypertension during and after pregnancy
Hispanic/Latina women with a history of hypertensive disorders of pregnancy (HDP) – conditions marked by high blood pressure during pregnancy – are more likely to have abnormalities in their heart structure and function decades later when compared with women without a history of HDP, according to a National Institutes of Health-supported study. The findings, published in the journal Hypertension, also suggest that while having high blood pressure later in life can contribute to these abnormalities, HDP play the greater role, significantly raising a woman’s risk of developing cardiovascular disease.
“The changes in cardiac structure and function that this study uncovers are known predictors of cardiovascular events such as heart failure and even death,” said Jasmina Varagic, Ph.D., program officer in the Vascular Biology and Hypertension branch at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. “These findings emphasize the importance of recognizing HDP as an important risk factor for these future problems, especially in this understudied population of women.”
The rates of HDP, which include preeclampsia, eclampsia, and gestational hypertension, more than doubled between 2007-2019 in the U.S., with Hispanic/Latina women having the highest rate of over 60 cases per 1000 live births. Previous studies have shown that among women who have HDP, up to 20% will continue to have high blood pressure six months after giving birth and will also have up to a 10-fold lifetime risk of chronic hypertension. But researchers were unclear just how HDP was driving the high risk of cardiovascular disease many of these women later developed.
“Prior to our study the question was: Do abnormalities in the structure and function of the heart develop because of the HDP itself, or because many of the women who have HDP then go on to develop chronic high blood pressure?” asked Odayme Quesada, M.D., medical director for The Christ Hospital Women's Heart Center, and lead author on the study. “Our study helps to answer this question.”
For the study, the researchers used participants in the NHLBI-funded Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center community-based cohort of Hispanic/Latino adults. The cohort included 5,168 women who had at least one prior pregnancy and whose average age was 58.7 years – well past childbearing age – at the time of the study.
The participants underwent ultrasound scans to look for alterations in the structure and function of the heart, focusing on the left ventricle, considered the workhorse of the heart that pumps blood into the body. Researchers looked for alterations in the thickness and shape of the ventricle, and how well the heart squeezes and relaxes. The researchers found that prior HDP was associated with alterations in how the heart contracts and relaxes, increased thickness of the heart wall, and higher rates of abnormal geometry in the left ventricle. These abnormalities, particularly in the geometry of the left ventricle, are known to predict future cardiovascular events, including heart failure, ischemic heart disease, and sudden cardiac death.
The researchers also discovered that having hypertension later in life only accounted for part of the changes seen in heart structure and function. For example, they found that hypertension experienced by the women at the time of the study explained only 14% of the risk of having abnormal geometry of the left ventricle, while the rest was explained by having HDP at the time of their pregnancies.
“This underscores the importance of early surveillance for heart abnormalities in women whose pregnancy is complicated by HDP, and also the importance of managing high blood pressure to prevent later life cardiovascular disease,” said Varagic. She added that factors beyond blood pressure that link HDP to later life heart abnormalities need further investigation.
Study: Quesada, O. Cardiac Abnormalities in Hispanic/Latina Women with Prior De Novo Hypertensive Disorders of Pregnancy. Hypertension. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.21248
Funding: This study is supported by NHLBI contracts N01-HC65233, N01-HC65234, N01-HC65235, N01-HC65236, and N01-HC65237, and grants K23-HL136853 and K23-HL151867, with additional support for HCHS/SOL from the National Center on Minority Health and Health Disparities, the National Institute on Deafness and Other Communications Disorders, the National Institute of Dental and Craniofacial Research, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the Office of Dietary Supplements.
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About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov
JOURNAL
Hypertension
ARTICLE TITLE
Cardiac Abnormalities in Hispanic/Latina Women with Prior De Novo Hypertensive Disorders of Pregnancy.
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