Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis

Abstract

Although results of animal research show that interactions between stress and sex hormones are implicated in the development of affective disorders in women, translation of these findings to patients has been scarce. As a basic step toward advancing this field of research, we analyzed findings of studies which reported circulating cortisol levels in healthy women in the follicular vs. luteal phase of the menstrual cycle. We deemed this analysis critical not only to advance our understanding of basic physiology, but also as an important contrast to the findings of future studies evaluating stress and sex hormones in women with affective disorders. We hypothesized that cortisol levels would be lower in the follicular phase based on the proposition that changes in levels of potent GABAergic neurosteroids, including allopregnanolone, during the menstrual cycle dynamically change in the opposite direction relative to cortisol levels. Implementing strict inclusion criteria, we compiled results of high-quality studies involving 778 study participants to derive a standardized mean difference between circulating cortisol levels in the follicular vs. luteal phase of the menstrual cycle. In line with our hypothesis, our meta-analysis found that women in the follicular phase had higher cortisol levels than women in the luteal phase, with an overall Hedges' g of 0.13 (p < 0.01) for the random effects model. No significant between-study difference was detected, with the level of heterogeneity in the small range. Furthermore, there was no evidence of publication bias. As cortisol regulation is a delicate process, we review some of the basic mechanisms by which progesterone, its potent metabolites, and estradiol regulate cortisol output and circulation to contribute to the net effect of higher cortisol in the follicular phase.

Audio Described vs. Audiovisual Porn: Cortisol, Heart Rate and Engagement in Visually Impaired vs. Sighted Participants

“…Information on the general characteristics of the sample was collected prior to the experiment (see Table 1 below). Data were also collected on health factors likely to influence participants’ physiological response, such as the day of the menstrual cycle ( Hamidovic et al, 2020 ). This information was nevertheless not included in our analyses, since most participants admitted not being sure of their answers.…”

Endocrine and Electrolyte Balances during Periovulatory Period in Cycling Mares

“…In women, while ACTH secretion shows a cyclic pattern, with low levels during the late follicular phase (days −3 and −2), peak values at days −1 and 0, and a relatively high level during the luteal phase, CORT increases during preovulatory period [ 30 ]. Ovulatory peak of CORT in other species, as human [ 31 ], sheep [ 32 ] and elephant [ 33 ] has been documented. In addition, in female dogs, the highest ACTH and CORT concentrations, during proestrus and estrus, were respectively shown [ 34 ].…”

Steroid stress hormone changes throughout the menstrual cycle: A rise in evening aldosterone concentration in early luteal phase precedes the symptoms of premenstrual syndrome

“…29,30 More recent literature on cortisol in this context has yielded mixed results. Hamidovic et al 31 performed a meta-analysis on circulating cortisol during the menstrual cycle supporting higher cortisol concentrations in the follicular vs luteal phase. However, as acknowledged by Hamidovic et al 31 , many questions remain largely unanswered.…”

“…Hamidovic et al 31 performed a meta‐analysis on circulating cortisol during the menstrual cycle supporting higher cortisol concentrations in the follicular vs luteal phase. However, as acknowledged by Hamidovic et al 31 , many questions remain largely unanswered. In the case of aldosterone, the changes across the menstrual cycle are much better described.…”