Impact of endogenous and exogenous progesterone exposure on stress biomarkers: a systematic review

Abstract

Stress activates the autonomic nervous system (ANS) and the hypothalamic–pituitary–adrenal axis (HPAA). Based on a systematic literature review of the impact of endogenous and exogenous exposure with natural progesterone on the stress response in healthy premenopausal and postmenopausal women, the following conclusions can be drawn: the HPAA activity was not relevantly affected by endogenous progesterone exposure across the menstrual cycle, but might be reduced by exogenous micronized progesterone application; in contrast, the ANS has a sympathetic predominance in the (progesterone-dominated) luteal phase of the menstrual cycle. Future studies should assess various stress biomarkers under various hormonal conditions to, for example, allow for cardiovascular risk stratification in hormone users.

Chinese abstract

应激激活自主神经系统(ANS)和下丘脑-垂体-肾上腺轴(HPAA)。根据对内源性和外源性接触天然黄体酮对健康绝经前和绝经后女性应激反应影响的一项系统性文献综述, 可以得出以下结论：在整个月经周期内, 内源性孕酮暴露对HPAA活性没有相关影响, 但外源性微粒化孕酮的应用可能会降低HPAA活性；相反, ANS在月经周期的黄体期(以黄体酮为主)具有交感优势。未来的研究应评估不同激素条件下的各种应激生物标志物, 例如, 允许激素使用者进行心血管风险分层。

Keywords:

• Heart rate variability
• hypothalamic–pituitary–adrenal axis
• cortisol
• progesterone
• menstrual cycle
• menopause
• menopausal hormone therapy

Acknowledgements

The authors are grateful for the administrative support of J. Wilhem, secretary at the Department of Obstetrics and Gynecology, Inselspital, Bern.

Potential conflict of interest

P. Stute has been part of a German-speaking expert board funded by DR. KADE/BESINS Pharma GmbH. A. Stadler and S. Weidlinger do not have any conflict of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

The publication was not funded.