Vascular Dynamics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
Am J Physiol Heart Circ Physiol. 2020 Dec 1;319(6):H1327-H1337. doi: 10.1152/ajpheart.00341.2020. Epub 2020 Oct 16.
Fluctuations in endogenous hormones estrogen and progesterone during the menstrual cycle may offer vasoprotection for endothelial and smooth muscle (VSM) function. While numerous studies have been published, the results are conflicting, leaving our understanding of the impact of the menstrual cycle on vascular function unclear. The purpose of this systematic review and meta-analysis was to consolidate available research exploring the role of the menstrual cycle on peripheral vascular function. A systematic search of MEDLINE, Web of Science, and EMBASE was performed for articles evaluating peripheral endothelial and VSM function across the natural menstrual cycle: early follicular (EF) phase versus late follicular (LF), early luteal, mid luteal, or late luteal. A meta-analysis examined the effect of the menstrual cycle on the standardized mean difference (SMD) of the outcome measures. Analysis from 30 studies ( = 1,363 women) observed a "very low" certainty of evidence that endothelial function increased in the LF phase (SMD: 0.45, = 0.0001), with differences observed in the macrovasculature but not in the microvasculature (SMD: 0.57, = 0.0003, I = 84%; SMD: 0.21, = 0.17, I = 34%, respectively). However, these results are partially explained by differences in flow-mediated dilation [e.g., discrete (SMD: 0.86, = 0.001) vs. continuous peak diameter assessment (SMD: 0.25, = 0.30)] and/or menstrual cycle phase methodologies. There was a "very low" certainty that endothelial function was largely unchanged in the luteal phases, and VSM was unchanged across the cycle. The menstrual cycle appears to have a small effect on macrovascular endothelial function but not on microvascular or VSM function; however, these results can be partially attributed to methodological differences.
月经周期中内源性雌激素和孕激素的波动可能为内皮和平滑肌 (VSM) 功能提供血管保护。虽然已经发表了许多研究，但结果相互矛盾，我们对月经周期对血管功能的影响仍不清楚。本系统评价和荟萃分析的目的是整合现有的研究，探讨月经周期对外周血管功能的作用。系统检索了 MEDLINE、Web of Science 和 EMBASE 中的文章，评估了整个自然月经周期中外周血管内皮和 VSM 功能：卵泡早期 (EF) 期与卵泡晚期 (LF)、黄体早期、中期或晚期。荟萃分析检查了月经周期对结局测量的标准化均数差 (SMD) 的影响。对 30 项研究（= 1363 名女性）的分析发现，证据确定性非常低，表明 LF 期内皮功能增加（SMD：0.45，= 0.0001），在大血管中观察到差异，但在微血管中没有观察到差异（SMD：0.57，= 0.0003，I = 84%；SMD：0.21，= 0.17，I = 34%，分别）。然而，这些结果部分可以用血流介导的扩张差异来解释[例如，离散 (SMD：0.86，= 0.001) 与连续峰值直径评估 (SMD：0.25，= 0.30)]和/或月经周期阶段方法。月经周期中内皮功能在黄体期基本不变，VSM 在整个周期中不变，这一结果具有非常低的确定性。月经周期对外周大血管内皮功能的影响很小，但对微血管或 VSM 功能没有影响；然而，这些结果部分归因于方法学上的差异。
