The influence of the menstrual cycle and hormonal contraceptives on cardiorespiratory fitness in physically active women: A systematic review and meta-analysis

Lea Franziska Schumpf; Christian Braun; Adriana Peric; Michael Johannes Schmid; Dirk Lehnick; Corina Christmann-Schmid; Christine Brambs

doi:10.1016/j.heliyon.2023.e17049

The influence of the menstrual cycle and hormonal contraceptives on cardiorespiratory fitness in physically active women: A systematic review and meta-analysis

Heliyon. 2023 Jun 7;9(6):e17049. doi: 10.1016/j.heliyon.2023.e17049. eCollection 2023 Jun.

Authors

Lea Franziska Schumpf¹, Christian Braun¹, Adriana Peric², Michael Johannes Schmid³, Dirk Lehnick⁴, Corina Christmann-Schmid¹, Christine Brambs¹

Affiliations

¹ Gynecology, Luzerner Kantonsspital, Lucerne, Switzerland.
² Gynecologic Endocrinology, Zollikerberg Hospital, Zurich, Switzerland.
³ Institute of Sport Science, University of Bern, Bern, Switzerland.
⁴ Biostatistics & Methodology, Dept. of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.

Abstract

Objective: To systematically review and summarize the existing evidence related to the influence of the menstrual cycle (MC) and hormonal contraceptive (HC) use on $\dot{V}$ O_2max in physically active women.

Methods: This systematic review and meta-analysis conforms to the PRISMA statement guidelines. Four (sub-)meta-analyses were performed. Two focused on longitudinal studies examining the same women several times to compare the $\dot{V}$ O_2max during the different menstrual phases or oral contraceptive (OC) use and withdrawal. Two meta-analyses examined if there is a difference in $\dot{V}$ O_2max between OC users and normally menstruating women by analyzing cross-sectional studies assigning physically active women to one of these two groups as well as intervention-based studies (cross-over studies, randomized controlled trials considering only the data of the intervention group) comparing women intra-individually with and without OCs.

Results: Nine of the included studies (107 women) evaluated the influence of the MC, five studies (69 women) the impact of OCs on $\dot{V}$ O_2max, and six studies investigated both topics (88 women). A mean difference of $\dot{V}$ O_2max -0.03 ml/kg/min (95%CI -1.06 to 1.01) between the early follicular and luteal menstrual phase was observed. Between the active and inactive phases of OCs, a mean difference of -0.11 ml/kg/min (95%CI -2.32 to 2.10) was found. The inter-individual comparison of naturally menstruating women and OC users showed a mean difference in $\dot{V}$ O_2max of 0.23 ml/kg/min (95% CI -2.33 to 2.79) in favor of OC use. The intra-individual comparison of the same women showed a mean decrease in $\dot{V}$ O_2max of -0.84 ml/kg/min (95% CI -2.38 to 0.70) after a new start with OCs.

Conclusions: Our meta-analyses showed no effects of the MC or the OCs on $\dot{V}$ O_2max. More high-quality studies are needed determining the MC phases more precisely, including OCs with the current standard formulations and comparing the influence of different progestins.

Keywords: Cardiorespiratory fitness; Hormonal contraceptive; Menstrual cycle; Physically active women.