How to study the menstrual cycle: Practical tools and recommendations

Abstract

Despite decades of research on the physiological and psychological effects of the menstrual cycle, studies have not sufficiently adopted consistent methods for operationalizing the menstrual cycle. This has resulted in substantial confusion in the literature and limited possibilities to conduct systematic reviews and meta-analyses. In order to facilitate more rapid accumulation of knowledge on cycle effects, the present paper offers a set of integrative guidelines and standardized tools for studying the menstrual cycle as an independent variable. We begin with (1) an overview of the menstrual cycle and (2) premenstrual disorders, followed by (3) recommendations and tools regarding data collection in cycle studies. These recommendations address selecting the appropriate study design and sampling strategy, managing demand characteristics, identifying a sample of naturally-cycling individuals, and measuring menstrual bleeding dates, ovarian hormones, and ovulation. We proceed with suggestions for (4) data preparation and coding of cycle day and phases, as well as (5) data visualization, statistical modeling, and interpretation of menstrual cycle associations. We also provide (6) recommendations for using menses start day and ovulation testing to schedule visits in laboratory studies and end with a (7) comprehensive summary and conclusion. Regardless of whether the influence of the menstrual cycle is of central interest in a study or should be controlled to accurately assess the effects of another variable, the use of these recommendations and tools will help make study results more meaningful and replicable.

Keywords: Estrogen; Menstrual cycle; Methods; Progesterone; Recommendations; Review.

Figure 1.

An idealized 28-day cycle with the characteristic fluctuations of the ovarian hormones estradiol (E2) and progesterone (P4) in the follicular and luteal menstrual cycle phase.

Figure 2.

Graphical overview of the menstrual cycle and its phases.

Figure 3.

Recommended graphing method for visualizing menstrual cycle effects on person-centered outcomes across the full span of the cycle day variable (from −15 to +10, where menstrual onset is day +1 and there is no day 0).