Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Inselspital Bern, University of Bern, Friedbuehlstrasse 19, 3010, Bern, Switzerland.
Arch Gynecol Obstet. 2024 Jan;309(1):37-46. doi: 10.1007/s00404-023-06996-9. Epub 2023 Mar 18.
The immune system is influenced by many factors, including female sex hormones. The extent of this influence, however, is not completely understood so far. This systematic literature review aims at giving an overview of the existing concepts on how endogenous progesterone influences the female immune system along the menstrual cycle.
The inclusion criteria were healthy female subjects in their reproductive age with a regular menstrual cycle. The exclusion criteria were exogenous progesterone, animal models, nonhealthy study populations and pregnancy. This led to 18 papers covered in this review. The search was performed using the databases EMBASE, Ovid MEDLINE and Epub, and the last search was conducted on September 18, 2020. Our findings were analyzed in four categories: cellular immune defense, humoral immune defense, objective and subjective clinical parameters.
We demonstrated that progesterone acts in an immunosuppressive way, favoring a Th-2-like cytokine profile. Further, we showed that progesterone inhibits mast cell degranulation and relaxes smooth muscle cells. Furthermore, we found supporting evidence for a so-called window of vulnerability after ovulation, where immune functions are lowered and mediated through progesterone.
The clinical relevance of these findings is not completely understood yet. As the sample sizes of included studies were rather small and the content of them was broad, further investigations are needed to define to which extent the described changes actually clinically meaningful, whether they are capable of influencing the female health and how these findings can be used to increase well-being.
免疫系统受到许多因素的影响，包括女性性激素。然而，到目前为止，这种影响的程度还不完全清楚。本系统文献综述旨在概述内源性孕酮如何影响女性免疫系统沿着月经周期的现有概念。
纳入标准为生殖年龄、月经周期正常的健康女性。排除标准为外源性孕酮、动物模型、非健康研究人群和妊娠。这导致了本综述涵盖的 18 篇论文。检索使用了 EMBASE、Ovid MEDLINE 和 Epub 数据库，最后一次检索于 2020 年 9 月 18 日进行。我们的发现分为四个类别进行分析：细胞免疫防御、体液免疫防御、客观和主观临床参数。
我们表明孕酮具有免疫抑制作用，有利于 Th2 样细胞因子谱。此外，我们还表明孕酮抑制肥大细胞脱颗粒并使平滑肌松弛。此外，我们还发现了排卵后所谓的脆弱窗口的支持证据，在此期间免疫功能降低，这是通过孕酮介导的。
这些发现的临床相关性尚未完全理解。由于纳入研究的样本量较小，内容广泛，需要进一步的研究来确定所描述的变化在多大程度上具有实际临床意义，它们是否能够影响女性健康，以及如何利用这些发现来提高幸福感。
