Jul 2026· Neuropsychobiology· pp.
1-20
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Medicine
TL;DR
It is concluded that multimodal physiological assessment holds substantial promise for advancing personalized prevention and intervention strategies in women's mental health, while emphasizing the need for standardized methodologies, longitudinal designs, and hormone-informed analytic frameworks in future research.
Abstract
BACKGROUND
Women exhibit distinct stress-response patterns shaped by dynamic interactions between ovarian hormones, the autonomic nervous system (ANS), and cortical stress-processing circuits. Across the female lifespan, hormonal transitions, including the menstrual cycle, pregnancy, postpartum period, perimenopause, and menopause, are associated with heightened vulnerability to mood and anxiety disorders, underscoring the need for sex-specific physiological frameworks. This narrative review synthesizes current evidence on how hormonal fluctuations modulate stress physiology in women, with a particular focus on noninvasive biomarkers derived from heart rate variability (HRV), electrodermal activity (EDA), and electroencephalography (EEG).
SUMMARY
HRV emerges as a core biomarker of female stress reactivity, reflecting shifts in sympathetic-parasympathetic balance that vary across hormonal states and life stages. Estrogen is generally associated with enhanced vagal modulation and higher HRV, whereas progesterone and estrogen withdrawal are linked to sympathetic dominance and reduced HRV, patterns that are especially pronounced during the luteal phase, pregnancy progression, postpartum, and menopause. Complementary measures provide additional insight: EDA indexes sympathetic arousal and captures hormonally driven changes in emotional reactivity, while EEG reflects cortical dynamics underlying affective style, cognitive control, and stress sensitivity. Evidence indicates that multimodal HRV-EDA-EEG approaches improve detection of stress-related vulnerability by integrating autonomic and cortical signatures rather than relying on a single system.
KEY MESSAGES
By consolidating findings across key female life stages, this review highlights how hormonal modulation of ANS-brain interactions contribute to sex-specific stress profiles and psychiatric risk. We conclude that multimodal physiological assessment holds substantial promise for advancing personalized prevention and intervention strategies in women's mental health, while emphasizing the need for standardized methodologies, longitudinal designs, and hormone-informed analytic frameworks in future research.
Background: The menstrual cycle, a reproductive rhythm marked by bleeding and ovulation, is a dynamic biological process where hormones quietly reshape multiple systems in the body with their fluctuations. Cardiovascular control, emotional reactivity and stress responsiveness are the changes which become relevant in young women. Objectives were to measure heart rate variability (HRV) and anxiety sensitivity in different phases of menstrual cycle and establish their correlation.
Methods: This study was a comparative (observational) consisting of 48 healthy females’ participants aged 18-32 years. Cardiac autonomic function was assessed using HRV analysis on day 2, day 10, and day 21 of the menstrual cycle While anxiety sensitivity was assessed using the anxiety sensitivity index-3 (ASI-3), an 18-item scale, containing items specifying different concerns someone could have regarding their anxiety. The total ASI-3 score was analysed and compared across the menstrual phases to observe variations in anxiety sensitivity. Correlation between HRV parameters and anxiety sensitivity scores was also assessed to study the relationship between cardiac autonomic function and anxiety sensitive.
Results: Both time-domain and frequency-domain HRV parameters, remained largely stable across follicular, and luteal phases. No statistically significant phase-wise differences were observed. In contrast, anxiety sensitivity exhibited a statistically significant variation across menstrual cycle phases, reflecting meaningful phase-related psychological fluctuation. However, this variation in anxiety sensitivity was not accompanied by corresponding changes in resting HRV parameters, and no consistent association was identified between anxiety sensitivity categories and cardiac autonomic indices across phases.
Gulnaaz Khanam, Shraddha Singh, Mohammed Ubaidullah et al.· International Journal of Res...· 0 citations
Ramadan fasting is a unique form of intermittent fasting characterized by abstinence from food and fluids from dawn to sunset for approximately one lunar month. This practice induces alterations in circadian rhythm, metabolism, hemodynamics, and neurohumoral regulation, all of which may influence cardiovascular (CV) physiology and autonomic nervous system (ANS) function. To synthesize evidence published between 2015 and 2025 on CV and ANS remodeling during Ramadan fasting, a narrative review of PubMed-indexed human studies (2015–2025) was conducted, focusing on CV outcomes, blood pressure, lipid metabolism, heart rate variability (HRV), and autonomic regulation during Ramadan fasting. Most studies report no increase in acute CV events during Ramadan in healthy individuals or stable cardiac patients. Modest improvements in blood pressure, lipid profile, body weight, and insulin sensitivity are frequently observed. Autonomic adaptations assessed through HRV demonstrate heterogeneous findings, with transient sympathetic predominance in some cohorts and preserved or enhanced parasympathetic activity in others. Ramadan fasting induces short-term CV and autonomic remodeling that is generally adaptive and clinically safe in stable individuals. However, methodological heterogeneity, limited long-term data, and underrepresentation of high-risk populations remain important gaps in current evidence.
Shakib Shahab, Tahzeeb Fatima, Ansari Rehan et al.· Asian Journal of Medical Sci...· 0 citations
Introduction Pregnancy induces profound cardiovascular adaptations, including changes in vascular resistance, cardiac output, and heart rate, which are partly regulated by the autonomic nervous system. Although a shift toward reduced parasympathetic activity has been reported, the longitudinal evolution of autonomic function and its responsiveness to physiological stressors across gestation remain incompletely defined. This study aimed to characterize trimester-specific changes in autonomic regulation and reactivity. Methods In this prospective longitudinal cohort, 67 healthy pregnant women were evaluated during the first (T1), second (T2), and third (T3) trimesters. Continuous cardiovascular monitoring was performed during a standardized protocol including rest, paced breathing, and a cognitive task. Heart rate variability, blood pressure, and phase synchronization indices were analysed using two-way repeated-measures ANOVA (Time × Phase). Results Heart rate increased across gestation, while blood pressure showed a mid-pregnancy nadir. Indices of vagal modulation declined from T1 to T3, whereas overall variability remained unchanged. No effect of gestational age was observed for sympathovagal balance, but significant Time × Phase interactions indicated attenuation of autonomic reactivity. Both vagal responses to paced breathing and sympathetic responses to cognitive stress were reduced in late pregnancy. Similarly, indices of cardio-respiratory and cardiovascular coupling showed phase-dependent changes, with reduced synchronization during paced breathing in T3. Discussion Our findings suggest that autonomic regulation during pregnancy is characterized by preserved responsiveness but reduced modulation. The decline in vagal activity, together with attenuated reactivity and reduced cardio-respiratory coupling, suggests reduced autonomic flexibility. These findings outline autonomic trajectories in healthy pregnancy that may serve as a normative reference against which early deviations could be examined in future studies on pregnancy-associated cardiovascular complications.
M. Moertl, F. Piani, H. Lackner et al.· Frontiers in Physiology· 0 citations
Background.
Blood cortisol is a key biomarker of hypothalamic-pituitary-adrenal (HPA) axis activity and is widely used in sports science to assess physiological and psychological stress.However, its interpretation is limited by considerable biological variability and multiple influencing factors.
Aim.
To summarize current evidence on the physiological role of blood cortisol in endurance exercise and its usefulness for monitoring training load, recovery, and adaptation.
Material and methods.
A narrative review of peer-reviewed studies, systematic reviews,meta-analyses, and guidelines on cortisol physiology, exercise endocrinology, and athlete monitoring was conducted.
Results.
Blood cortisol reflects the physiological stress response and supports metabolic andimmune regulation during endurance exercise. Acute increases are a normal adaptive response, whereas persistent alterations may indicate excessive training stress when interpreted in context. Due to circadian variation and other confounding factors, single measurements have limited value. Current evidence favors longitudinal within-athlete monitoring combined with physiological, psychometric, hormonal, and performance measures.Conclusions.
Blood cortisol is a useful component of endurance athlete monitoring butshould not be used as a stand-alone marker. Its greatest value lies in repeated standardized assessments interpreted within a multimodal monitoring approach.
Key words:
cortisol, endurance training, exercise physiology, training monitoring, trainingload, physiological stress, overtraining syndrome, athlete monitoring, Hypothalamic-Pituitary-Adrenal Axis
Luiza Stadnik, Alicja Kozłowska, Karolina Przybysz et al.· Quality in Sport· 0 citations
Background Adolescence is a critical window for autonomic and limbic development and a period of elevated risk for depression. Although autonomic and limbic system function have, independently, been linked to depression, they are coupled and both influenced by early life stress (ELS). We do not yet know, however, whether the association of autonomic activity and limbic connectivity with depressive symptoms differs across dimensions of ELS. Methods Participants were 93 youth (Mage = 12.3) who completed the Trier Social Stress Test (TSST) with continuous electrocardiogram (ECG) recording. ECG-derived high-frequency heart rate variability (RespHRV) was assessed across the baseline, reactivity, and recovery phases of the TSST. Hippocampal-amygdala connectivity was estimated from resting-state data acquired just before the TSST using the Tian atlas. We tested whether RespHRV recovery and connectivity were jointly associated with depressive symptoms and whether ELS dimensions of threat, unpredictability, and deprivation moderated this association. Results Greater RespHRV during recovery was associated with more negative right hippocampal tail-left lateral amygdala connectivity (β = −0.42, q = 0.002). In a joint model, threat (β = −0.34, p = .007) and deprivation (β = −0.36, p = .009 independently moderated this association. Specifically, more negative connectivity predicted fewer symptoms when paired with weaker RespHRV recovery in high-ELS youth, but with stronger RespHRV recovery in low-ELS youth. Conclusions Whether autonomic-limbic coupling buffers or confers risk for depression depends on the early environment in which it developed.
Eugenia Giampetruzzi, C. Antonacci, Jean Rachel Bahk et al.· Neurobiology of Stress· 0 citations
Abstract Objective NeoNatal Neurobehavioral Scale (NNNS-II) measures behavioral signs of stress according to systems, including the autonomic and central nervous systems. These systems influence heart rate variability (HRV), which is a biomarker for regulatory capacity. The present study aims to investigate whether patterns of autonomic dysregulation are evident in both behavioral and physiological measures. Study Design HRV metrics—short- and long-term fractal scaling exponents (α1, α2) and root mean square fluctuations (RMS1, RMS2)—were calculated from the heart rates of 51 preterm infants at 33 weeks postmenstrual age. The NNNS-II assessments were conducted at term-equivalent age. Results Linear regression revealed that higher total stress signs were associated with increased α2 ( β = 0.366, p = 0.006), indicating reduced long-scale autonomic complexity. Autonomic and central nervous systems–specific stress signs were significantly associated with elevated α2 ( β = 0.349, p = 0.022). Individual items such as high-frequency tremors were also associated with increased α2 ( β = 0.303, p = 0.018) whereas startles were not ( p = 0.096). Conclusion Neurobehavioral stress signs, particularly those associated with the central nervous system (CNS), are linked to early diminished autonomic variation in infants. These findings can help researchers and clinicians interpret the significance of neurobehavioral stress signs to autonomic tone in preterm infants. Key Points Neurobehavioral stress is linked to HRV. CNS stress predicts reduced autonomic complexity. Tremors were most strongly related to HRV.
Elan L Donnellan, J. Ngwa, N. Andescavage et al.· American Journal of Perinato...· 0 citations
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