HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies

Hannah Klusmann; Lars Schulze; Sinha Engel; Elise Bücklein; Daria Daehn; Serena Lozza-Fiacco; Angelika Geiling; Caroline Meyer; Elizabeth Andersen; Christine Knaevelsrud; Sarah Schumacher

doi:10.1016/j.yfrne.2022.100998

HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies

Front Neuroendocrinol. 2022 Jul:66:100998. doi: 10.1016/j.yfrne.2022.100998. Epub 2022 May 18.

Authors

Affiliations

¹ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany. Electronic address: h.klusmann@fu-berlin.de.
² Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. Electronic address: lars.schulze@fu-berlin.de.
³ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany. Electronic address: s.engel@fu-berlin.de.
⁴ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Lise-Meitner-Str. 16, 89081 Ulm, Germany. Electronic address: elise.buecklein@uni-ulm.de.
⁵ Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. Electronic address: d.daehn@fu-berlin.de.
⁶ School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA. Electronic address: serena_fiacco@med.unc.edu.
⁷ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany. Electronic address: angelika.geiling@fu-berlin.de.
⁸ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany. Electronic address: caroline.meyer@fu-berlin.de.
⁹ School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA. Electronic address: elizabeth_andersen@med.unc.edu.
¹⁰ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany. Electronic address: christine.knaevelsrud@fu-berlin.de.
¹¹ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany. Electronic address: sarah.schumacher@health-and-medical-university.de.

PMID: 35597328
DOI: 10.1016/j.yfrne.2022.100998

Abstract

Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (d_SMC = 0.12, p =.004, [0.04 - 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (d_SMC = 0.17, [0.02 - 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.

Keywords: Allopregnanolone; Cortisol; Estradiol; Estrogen; Female; HPA axis; HPG axis; Menstrual cycle; Progesterone; Women.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Female
Humans
Hydrocortisone* / analysis
Hypothalamo-Hypophyseal System* / physiology
Menstrual Cycle / physiology
Middle Aged
Pituitary-Adrenal System / physiology
Saliva / chemistry
Young Adult

Substances

Hydrocortisone