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Menstrual cycle influence on cognitive function and emotion processing—from a reproductive perspective
Open accessAbstract
The menstrual cycle has attracted research interest ever since the 1930s. For many researchers the menstrual cycle is an excellent model of ovarian steroid influence on emotion, behavior, and cognition. Over the past years methodological improvements in menstrual cycle studies have been noted, and this review summarizes the findings of methodologically sound menstrual cycle studies in healthy women. Whereas the predominant hypotheses of the cognitive field state that sexually dimorphic cognitive skills that favor men are improved during menstrual cycle phases with low estrogen and that cognitive skills that favor women are improved during cycle phases with increased estrogen and/or progesterone, this review has not found sufficient evidence to support any of these hypotheses. Mental rotation has gained specific interest in this aspect, but a meta-analysis yielded a standardized mean difference in error rate of 1.61 (95% CI -0.35 to 3.57), suggesting, at present, no favor of an early follicular phase improvement in mental rotation performance. Besides the sexually dimorphic cognitive skills, studies exploring menstrual cycle effects on tasks that probe prefrontal cortex function, for instance verbal or spatial working memory, have also been reviewed. While studies thus far are few, results at hand suggest improved performance at times of high estradiol levels. Menstrual cycle studies on emotional processing, on the other hand, tap into the emotional disorders of the luteal phase, and may be of relevance for women with premenstrual disorders. Although evidence at present is limited, it is suggested that emotion recognition, consolidation of emotional memories, and fear extinction is modulated by the menstrual cycle in women. With the use of functional magnetic resonance imaging, several studies report changes in brain reactivity across the menstrual cycle, most notably increased amygdala reactivity in the luteal phase. Thus, to the extent that behavioral changes have been demonstrated over the course of the menstrual cycle, the best evidence suggests that differences in sexually dimorphic tasks are small and difficult to replicate. However, emotion-related changes are more consistently found, and are better associated with progesterone than with estradiol such that high progesterone levels are associated with increased amygdala reactivity and increased emotional memory.
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“The results are in line with the conclusions of researchers who argued that cognitive performance does not change throughout the cycle [10,28–32,34].”
From Menstrual cycle effects on cognitive performance: A meta-analysis (2025) · cites this paper as [34]
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“one prior meta-analysis that examined a narrow set of cognitions using similar methods (mental rotation tasks) also did not find significant cycle differences [34].”
From Menstrual cycle effects on cognitive performance: A meta-analysis (2025) · cites this paper as [34]
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“Sample sizes are typically small [27,34], which limits generalizability of any one study.”
From Menstrual cycle effects on cognitive performance: A meta-analysis (2025) · cites this paper as [34]
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Mineralocorticoid receptor haplotype, estradiol, progesterone and emotional information processing
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“Better performance on verbal memory, associative learning and spatial attention tasks was observed in OC-users (Gogos et al., 2014; Sundstrom Poromaa and Gingnell, 2014).”
Design and methods of the Apple Women’s Health Study: a digital longitudinal cohort study
Mahalingaiah, S., Fruh, V., Rodriguez, E., Konanki, S. C., Onnela, J.-P. “., Veiga, A. D. F., Lyons, G. R., Ahmed, R., Li, H., Gallagher, N. J., et al. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.09.041 · Cited by 42
Reactivity of alpha rhythms to eyes opening (the Berger effect) during menstrual cycle phases
Bazanova, O. M., Nikolenko, E. D., & Barry, R. J. (2017) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2017.05.001 · Cited by 40
“Hormonal variations occur to a great extent during the menstrual cycle (MC), and these variations can influence emotion, behavior and cognition (see for review Sundström-Poromaa and Gingnell, 2014).”
BackgroundEffects of sex, menstrual cycle phase, and endogenous hormones on cognition in schizophrenia
Rubin, L. H., Carter, C. S., Drogos, L. L., Pournajafi‐Nazarloo, H., Sweeney, J. A., & Maki, P. M. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.04.039 · Cited by 39
Sex Hormones, Sleep, and Memory: Interrelationships Across the Adult Female Lifespan
Harrington, Y. A., Parisi, J. M., Duan, D., Rojo‐Wissar, D. M., Holingue, C., & Spira, A. P. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.800278 · Cited by 42
Menopause, cognition and dementia – A review
Pertesi, S., Coughlan, G., Puthusseryppady, V., Morris, E., & Hornberger, M. (2019) · Post Reproductive Health · doi:10.1177/2053369119883485 · Cited by 39
“high estrogens associated with better performance.(57) • Estrogen therapy increased prefron-”
BackgroundCauchoix, M., Chaine, A. S., & Barragan‐Jason, G. (2020) · Frontiers in Ecology and Evolution · doi:10.3389/fevo.2020.00106 · Cited by 42
Brain Structure and Function in Women with Comorbid Bipolar and Premenstrual Dysphoric Disorder
Syan, S. K., Minuzzi, L., Smith, M., Costescu, D., Allega, O. R., Hall, G. B., & Frey, B. N. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00301 · Cited by 35
“Interestingly, there is considerable overlap between regions implicated in the neurobiology of BD, those affected by PMDD (25–27) and by female sex hormones (28, 29).”
BackgroundThe Specificities of Elite Female Athletes: A Multidisciplinary Approach
Castanier, C., Bougault, V., Teulier, C., Jaffré, C., Schiano-Lomoriello, S., Vibarel-Rebot, N., Villemain, A., Rieth, N., Scanff, C. L., Buisson, C., et al. (2021) · Life · doi:10.3390/life11070622 · Cited by 44
Paulukat, L., Frintrop, L., Liesbrock, J., Heussen, N. M., Johann, S., Exner, C., Kas, M. J., Tolba, R. H., Neulen, J., Konrad, K., et al. (2016) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2016.1173725 · Cited by 37
“…trading as Taylor & Francis Group been associated with improved cognitive performance in recognition and spatial memory tasks linked to hippocampus and prefrontal cortex, and has been shown to enhance spine density in the hippocampus (Luine & Frankfurt 2012; Sundstr€om Poromaa & Gingnell 2014).”
BackgroundPregnancy and brain architecture: Associations with hormones, cognition and affect
Rehbein, E., Kogler, L., Kotikalapudi, R., Sattler, A., Krylova, M., Kagan, K. O., Poromaa, I. S., & Derntl, B. (2021) · Journal of Neuroendocrinology · doi:10.1111/jne.13066 · Cited by 35
“50,51 In the present study, we observed significantly higher positive affect ratings in the pregnant compared to naturally cycling women.”
Impact of gender and genetics on emotion processing in Parkinson's disease - A multimodal study
Heller, J., Mirzazade, S., Romanzetti, S., Habel, U., Derntl, B., Freitag, N. M., Schulz, J. B., Dogan, I., & Reetz, K. (2018) · NeuroImage Clinical · doi:10.1016/j.nicl.2018.01.034 · Cited by 37
Ponce, P., Arco, A. D., & Loprinzi, P. D. (2019) · Medicina · doi:10.3390/medicina55050119 · Cited by 35
Judkins, T. C., Dennis-Wall, J. C., Sims, S. M., Colee, J., & Langkamp‐Henken, B. (2020) · BMC Women s Health · doi:10.1186/s12905-020-01000-x · Cited by 35
“Hormone fluctuations from the menstrual cycle influence a multitude of processes, including sensory perception [11–13], sexual desire [14], cognitive function [15], and emotional processing [15]; however, few studies have examined the relationship these hormones have with the GI system.”
BackgroundEstrogen-dependent hippocampal wiring as a risk factor for age-related dementia in women
Torromino, G., Maggi, A. C., & Leonibus, E. D. (2020) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2020.101895 · Cited by 35
Sex hormones and human brain function
Hornung, J., Lewis, C. A., & Derntl, B. (2020) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64123-6.00014-x · Cited by 37
GABAA Receptor-Modulating Steroids in Relation to Women’s Behavioral Health
Bäckström, T. C., Bixo, M., & Strömberg, J. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0627-4 · Cited by 34
van Zutphen, L., Siep, N., Jacob, G. A., Domes, G., Sprenger, A., Willenborg, B., Goebel, R., Tüscher, O., & Arntz, A. R. (2019) · Brain Imaging and Behavior · doi:10.1007/s11682-019-00161-0 · Cited by 36
Hidalgo‐Lopez, E., & Pletzer, B. A. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.105108 · Cited by 34
“For the final sample, hormone levels followed the expected pattern (Table 1) (Fehring et al., 2006; Poromaa and Gingnell, 2014).”
BackgroundThe regional effect of serum hormone levels on cerebral blood flow in healthy nonpregnant women
Cote, S. R., Butler, R., Michaud, V., Lavallée, É., Croteau, É., Mendrek, A., Lepage, J., & Whittingstall, K. (2021) · Human Brain Mapping · doi:10.1002/hbm.25646 · Cited by 35
“Serum hormones were within normal ranges in all participants (Poromaa & Gingnell, 2014).”
BackgroundInfluentialHengartner, M. P., Krüger, T. H. C., Geraedts, K., Tronci, E., Mancini, T., Ille, F., Egli, M., Röblitz, S., Ehrig, R. M., Saleh, L., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.05.018 · Cited by 36
“Secondly, though our sample was considerably larger than those commonly applied in neuroendocrinological research, a sample size of n > 100 would be preferable due to the substantial variance in hormone levels at given cycle phases [64].”
BackgroundThe Menstrual Cycle Alters Resting-State Cortical Activity: A Magnetoencephalography Study
Haraguchi, R., Hoshi, H., Ichikawa, S., Hanyu, M., Nakamura, K., Fukasawa, K., Poza, J., Rodríguez-González, V., Gómez, C., & Shigihara, Y. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.652789 · Cited by 33
“The first parameter, MF, refers to the median of the distribution represented by the PSDn (i.e., the frequency that splits the PSDn into two halves of equal power) (Poza et al., 2007).”
BackgroundMethodInfluentialCook, R. L., O’Dwyer, N., Parker, H. M., Donges, C. E., Cheng, H. L., Steinbeck, K. S., Cox, E. P., Franklin, J., Garg, M. L., Rooney, K. B., et al. (2017) · Nutrients · doi:10.3390/nu9111216 · Cited by 33
Oral contraceptives and cognition: A systematic review
Gurvich, C., Nicholls, I., Lavale, A., & Kulkarni, J. (2022) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2022.101052 · Cited by 38
Meeker, T. J., Veldhuijzen, D. S., Keaser, M. L., Gullapalli, R. P., & Greenspan, J. D. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.594588 · Cited by 31
“…would not only affect potential mechanisms of mate selection, but would extend to influences on cognition, emotion processing, motivation and sensitivity to disease (Kibler et al., 2005; Sundstrom Poromaa and Gingnell, 2014; Albert et al., 2015; Herzog et al., 2015; Pilarczyk et al., 2019).”
BackgroundPrado, R. C. R., Silveira, R., Kilpatrick, M. W., Pires, F. O., & Asano, R. Y. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.525943 · Cited by 32
“The MC is frequently related to a negative change in the psychological status (Costello et al., 2014; Steel et al., 2014; Sundström Poromaa and Gingnell, 2014; Sundstrom-Poromaa, 2018), mainly during the LP (Ossewaarde et al., 2010; van Wingen et al., 2011).”
BackgroundLiparoti, M., Lopez, E. T., Sarno, L., Rucco, R., Minino, R., Pesoli, M., Perruolo, G., Formisano, P., Lucidi, F., Sorrentino, G., et al. (2021) · Journal of Neuroscience Research · doi:10.1002/jnr.24898 · Cited by 28
“However, a single hormone measurement may not be sufficient to accurately determine the phase of the cycle (Becker et al., 2005; Sundström Poromaa & Gingnell, 2014).”
BackgroundSlyepchenko, A., Lokuge, S., Nicholls, B., Steiner, M. S., Hall, G. B., Soares, C. N., & Frey, B. N. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.031 · Cited by 31
Lusk, B. R., Carr, A. R., Ranson, V. A., & Felmingham, K. L. (2017) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-017-0520-1 · Cited by 32
“Despite growing evidence regarding the relevance of sex hormones for emotional processing (for a review, see Toffoletto, Lanzenberger, Gingell, Sunderstom-Poromaa, & Comasco, 2014), previous sex differences and emotion regulation studies have typically failed to control for the influence of menstrual cycle phase.”
BackgroundInfluentialExercise and Executive Function during Follicular and Luteal Menstrual Cycle Phases
Dirk, K., Belfry, G. R., & Heath, M. D. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002192 · Cited by 30
“Bannbers E, Gingnell M, Engman J, et al. The effect of premenstrual dysphoric disorder andmenstrual cycle phase on brain activity during response inhibition.”
BackgroundMethodInfluentialAmbrasė, A., Lewis, C. A., Barth, C., & Derntl, B. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2020.100873 · Cited by 33
Regulation of cognitive function by androgens and estrogens
Hampson, E. (2018) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2018.03.002 · Cited by 33
Becegato, M. S., Meurer, Y. D. S. R., Paiva-Santos, M. A., Lima, A. C., Marinho, G. F., Bioni, V. S., Soares, M. B. L., Leão, A. H. F. F., Suchecki, D., & Silva, R. H. (2021) · Physiology & Behavior · doi:10.1016/j.physbeh.2021.113343 · Cited by 30
Gatta, E., Camussi, D., Auta, J., Guidotti, A., & Pandey, S. C. (2022) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2022.108299 · Cited by 28
Hao, Z., Feng, S., Zhu, Y., Yang, J., Chen, M., Hu, D., Liu, H., & Liu, H. (2020) · Acta Astronautica · doi:10.1016/j.actaastro.2020.04.058 · Cited by 27
Progress in the Pathogenesis of Diabetic Encephalopathy: The Key Role of Neuroinflammation
Luo, Y., Zhu, J., Hu, Z., Luo, W., Du, X., Hu, H., & Peng, S. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3841 · Cited by 29
“The research by Sundström Poromaa and Gingnell suggests that insufficient oestrogen may lead to a decrease in women's cognitive function [186, 187].”
Metadata
- Authors
- Sundström Poromaa, I., & Gingnell, M.
- Affiliations
- Uppsala University (SE)
- ORCID
- Gingnell, Malin
- Venue
- Frontiers in Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2014-11-24
- Volume
- 8
- Pages
- 380-380
- ISSN
- 1662-453X (ISSN-L)
- PMC
- PMC4241821
- OpenAlex
- W2019634736
- Cited by
- 291
- References
- 132
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 18 · 2023: 18 · 2022: 18 · 2021: 30 · 2020: 34 · 2019: 32 · 2018: 30 · 2017: 28 · 2016: 17 · 2015: 19 · 2014: 1
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
- Keywords
- menstrual cycle, cognitive function, emotional processing, ovarian steroids, estradiol, progesterone, sexual dimorphism, mental rotation, working memory, prefrontal cortex, luteal phase, premenstrual disorders, amygdala reactivity, emotional memory, fear extinction, emotion recognition
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