Minute ventilation (V̇E) may vary across the menstrual cycle due to cyclical changes in sex hormones, potentially exerting an exercise intensity dependent effect. This systematic review and meta-analysis aimed to quantify differences in V̇E, respiratory frequency (RF), and tidal volume (VT) between the follicular and luteal phases at rest, during submaximal exercise (≤90 %V̇O_2max), and at incremental maximum (100 %V̇O_2max). The systematic review adhered to PRISMA guidelines for conducting and reporting systematic reviews. Studies included healthy eumenorrheic females (≥18 years) not using hormonal contraceptives. Studies that reported V̇E in the follicular and luteal phases were included. RF and VT were extracted as secondary outcome measures. Searches were conducted in Cochrane, PubMed, and EBSCO databases in January 2025. Study quality was assessed using the modified Downs and Black checklist for menstrual cycle research. Data were extracted and analysed using maximum likelihood random-effect meta-analyses followed with meta-regressions with intensity and duration as a moderator in submaximal exercise. Publication bias was assessed using Egger's test. Meta-regressions were also conducted for resting and submaximal datasets using change in progesterone as a moderator. A total of 35 studies inclusive of 743 participants and 64 paired datasets were included. V̇E was lower in the follicular phase than the luteal phase at rest (ES = -0.64, p < 0.001, I² = 75.74 %) and during submaximal exercise (ES = -0.89, p < 0.001, I² = 76.58 %), with no effect of study quality. Meta-regression revealed that duration and intensity did not influence menstrual cycle effect on V̇E in submaximal exercise. At incremental maximum, a small but significant effect was observed towards higher V̇E in the luteal phase than the follicular phase (ES = -0.33, p = 0.03, I² = 61.5 %) however this effect was no longer observed after removal of low-quality studies. All analyses were coupled with significant heterogeneity. Meta-regression demonstrated that change in progesterone significantly predicted V̇E changes during submaximal exercise (p = 0.02), but not at rest (p = 0.07). RF and VT analyses suggested minimal menstrual cycle effect, with only VT reductions at rest contributing to V̇E differences, this was likely related to the low number of studies included. The menstrual cycle significantly influences V̇E, with lower values in the follicular phase at rest and during submaximal exercise. Changes in progesterone partially explain the differences in V̇E between menstrual phases during exercise but not at rest. At maximal intensities, hormonal influence on V̇E is minimal which corroborates the hypothesis that physiological mechanisms override hormonal mediation of ventilatory responses at high intensities. These findings suggest potential implications for exercise performance, particularly endurance activities in the luteal phase due to the increased likelihood of hyperventilation.

Background: Oestradiol has been implicated as a factor in substrate utilisation in male and mouse studies but the effect of acute changes during the menstrual cycle is yet to be fully understood. Objective: To determine the role of oestradiol in respiratory exchange ratio (RER) during exercise at various intensities. Methods: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From inception to November 2023, four online databases (Cochrane, SPORTDiscus, MEDline and Web of Science) were searched for relevant articles. Studies that reported a resting oestradiol measurement in naturally menstruating women with exercise at a percentage of maximal aerobic capacity (%V˙O_2max) were included. Mean and standard deviation for oestradiol, RER and exercise intensity were extracted and study quality assessed using a modified Downs and Black checklist. Risk of bias was assessed using I₂ measure of heterogeneity and Egger’s regression test, assessment of bias from methodological quality was identified by sensitivity analysis. Eligible datasets were extracted for pairwise comparisons within a meta-analysis and correlation between change in oestradiol and change in RER. Data were also pooled to produce a mean and standard deviation for RER for menstrual stage and for low and high oestradiol groups. Results: Twenty-four articles were identified, over 50% were identified as high quality. Sixteen articles included datasets eligible for meta-analysis. Eleven articles utilised a submaximal constant-load exercise intensity, finding a standardised mean difference of − 0.09 ([CI: −0.35–0.17], p = 0.5) suggesting no effect of menstrual phase on constant-load exercise RER. In six articles using incremental exercise tests to exhaustion, a standardised mean difference of 0.60 ([CI 0.00–1.19], p = 0.05) was identified towards a higher maximal RER attained in follicular compared to luteal phase. There was no correlation (R = −0.26, p = 0.2) between change in oestradiol and change in RER between phases. All 24 articles, totalling 650 participants, were included in pooled analysis. When grouped by menstrual cycle phase or when grouped by oestradiol levels, RER was higher in the follicular phase than the luteal phase at low and high constant load exercise intensities. Discussion: Findings from the pooled-analysis and meta-analysis suggest that there may be menstrual cycle phase differences in RER that are intensity dependent. These differences may be related to sex hormone levels, but this was not supported by evidence of correlation between differences in RER and differences in oestradiol. At present, it remains best practice to assess performance in the same menstrual cycle phase if seeking to assess change from baseline.

Menopause may contribute to declining aerobic capacity alongside aging; whether this is related to declines in physical activity or alterations in physiology is unclear. This study examined the effect of menopause on maximal and submaximal cardiopulmonary variables in an incremental aerobic capacity assessment in active women. Sixty‐nine women, aged between 18 and 60 years, categorized as premenopausal (PRE), late premenopausal (LPRE), perimenopausal (PERI), and postmenopausal (POST) completed a cycle ergometer ramp aerobic capacity test, body composition analysis, and blood hormone testing. Naturally menstruating women were tested in the early follicular phase of the menstrual cycle. One‐way ANOVAs were utilized to analyze the effect of menopause phase on outcome variables. Participant groups had similar V̇O_2peak, physical activity levels, and endogenous sex hormone profiles (p > 0.05), but POST had lower muscle mass than PRE, LPRE, and PERI (p < 0.05). There were no differences in maximal or submaximal cardiopulmonary variables (p > 0.05). Age and V̇O_2peak were not correlated (r = −0.23, p = 0.06). Contrary to prior reports, maintenance of aerobic capacity is possible throughout midlife and menopause in women with high activity levels. Compared to premenopausal and late premenopausal women, perimenopausal and postmenopausal women demonstrated minimal changes in maximal and submaximal cardiopulmonary variables.

Aim: This study aimed to investigate the differences in metabolism and ventilation between women before, during, and after menopause during rest and to varying steady-state exercise intensities. Method: 74 female participants (18–60 years; premenopausal [PRE], perimenopausal [PERI], and postmenopausal [POST]) completed four laboratory visits; one maximal exercise test, resting data collection, and body composition assessment followed by three steady-state submaximal exercise tests at 40% (low), 60% (moderate), and 80% (high) V̇O _2peak in a randomised order with subgroup analysis for hormonal contraceptive or hormone therapy use. Results: There was an effect of menopause stage on exercise energy expenditure but no interaction effect with intensity. There were no differences in substrate utilisation or ventilation across any of the exercise intensities. Subgroup analysis revealed that HT and HC use did not impact EE, substrate oxidation, or ventilation. Conclusions: Menopause stage is influential upon exercise energy expenditure but more research in perimenopause is required to confirm the effect, future studies should explore the broader implications of the menopausal transition on exercise physiology.