Mapping changes in women's visual functions during the menstrual cycle: narrative review

Figueiredo, Bruna Gabrielli Damascena de; Rezende, Maria Thalita Cardoso; Santos, Natanael Antonio dos; Andrade, Michael Jackson Oliveira de

doi:10.1590/1516-3180.2020.0474.R2.03052021

Tabla de contenido Anterior Actual Siguiente

Tabla de contenido

Narrative Review • Sao Paulo Med. J. 139 (6) • 2021 • https://doi.org/10.1590/1516-3180.2020.0474.R2.03052021 linkcopy

Mapping changes in women's visual functions during the menstrual cycle: narrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND: This article systematically updates the literature on changes in visual functions during the phases of the normal menstrual cycle in women.

OBJECTIVES: To update Guttridge's 1994 review of visual structures and functions associated with the menstrual cycle and broaden the search through psychophysical, neuroimaging and neurobehavioral measurements covering 1994-2020.

DESIGN AND SETTING: Narrative review conducted in a neurosciences and behavior laboratory in Brazil.

METHODS: The PubMed, Cochrane Clinical Answers and Google Scholar databases were searched. After screening and applying the eligibility criteria, 32 articles were examined. Through this analysis, the following information was extracted: (1) geographical distribution of the study; (2) sample size (according to age and phase of the menstrual cycle); (3) type of measurements according to psychophysical, neuroimaging and neurobehavioral instruments; (4) vision testing model; (5) visual subcategory evaluated; (6) categories of processed visual stimuli; and (7) main findings.

RESULTS: The menstrual phases give rise to significant changes in visual functions, including in relation to orientation and spatial attention, visual campimetry and visual sensitivity. These relate specifically to the follicular and luteal phases.

CONCLUSIONS: These findings theoretically expand the effects of menstrual cycles on visual functions found by Guttridge (1994). Despite some inconsistencies in the studies analyzed, it was found that visual processing during the follicular and luteal phases of the normal menstrual cycle of healthy women can explain physiological, cognitive, behavioral and social modulations.

KEY WORDS (MeSH terms):
Vision disorders; Menstrual cycle; Progesterone; Narrative review [publication type]

AUTHORS’ KEY WORDS:
Healthy women; Estrogen; Basic visual functions; Visual contrast

Authors (year)	Country	Sample (phases of the cycle)	Method	Testing	Visual task	Stimuli	Results
Darlington, Ross, King & Smith (2001)²⁴	New Zealand	12 women aged 21.9 ± 4.0 years (menstrual, follicular, half-cycle and luteal phases)	P	NS	Eye movement	Oculogram and optokinetic (OKR)	There was no difference in eye movement speed
Apaydin, Akar, Akar, Zorlu & Ozer (2004)³⁴	Turkey	93 eyes of women in the follicular and luteal phases: 45 eyes of women with diabetes mellitus (34.9 ± 4.7 years) and 48 healthy controls (36.2 ± 5.2 years)	P	M (left eye recording)	Visual field	Humphrey Field Analyzer II (upper temporal, lower temporal, upper nasal and lower nasal)	There were no differences between women with and without diabetes. Women with diabetes had lower sensitivity in the visual field in the luteal phase
Eisner, Burke & Toomey (2004)²⁸	United States	4 women aged 21–29 years (menstrual, follicular and luteal phases)	P	M	Visual sensitivity	Temporal stimulus of 1.5 Hz square wave (wavelengths: 440, 460, 490, 510, 540, 580 and 640 nm)	No variation in visual sensitivity
Hausmann (2005)²³	New Zealand	24 women aged 33.93 ± 10.1 years (menstrual, follicular and luteal phases); 14 men aged 26.96 ± 6.19 years	P	NS	Spatial orientation	Line bisection task (17 horizontal lines)	Greater activation of spatial hemispheric asymmetry in the luteal phase
Giuffrè, Rosa & Fiorino (2007)³¹	Italy	15 women aged 25 ± 4.0 years (3 evaluation phases: menstrual, ovulatory and luteal)	P	M (left-eye and right-eye recording)	Visual acuity, luminance contrast and color view	Vertical sine grids; Farnsworth-Munsell 100-hue test	There were no differences in visual acuity or luminance contrast; greater color vision in the ovulatory phase
Akara et al. (2013)¹⁸	Turkey	59 eyes of women (follicular and luteal phases) 54 eyes of men	P	Monocular	Visual field	Humphrey Field Analyzer II (upper temporal, lower temporal, upper nasal and lower nasal); Ishiara's color test	Smaller auto-tinted perimeter in visual field sensitivity in the luteal phase
Kumar, Mufti & Kisan (2013)²¹	India	30 women aged 21.33 ± 2.3 years (menstrual, follicular and luteal phases)	P	NS	Visual (TRV) and auditory (TRA) reaction time	Reaction time after the presentation of stimuli (green light; 4,000 Hz)	TRV and TRA were higher during the luteal phase and lower during the follicular phase
Danilenko & Sergeeva (2015)⁴³	Russia	16 women aged 27.5 ± 1.9 years (follicular and mid-cycle phases)	P	NS	Visual sensitivity	Lumie SADlight with LEDs; light flashes of wavelengths: blue (480 nm) and red (651 nm)	Greater visual sensitivity at 480 nm during the follicular phase
Abdul et al. (2015)¹⁹	United Kingdom	30 women in the follicular phase (19.72 ± 1.20 years); 24 women in the luteal phase; 30 men (20.16 ± 1.02 years)	P	Binocular	Spatial orientation	CRFT system (previous mechanical rod and frame test); line stimuli	Largest error in the spatial orientation of verticality for women in the luteal phase
Sudheer, Jagadeesan & Kammar (2016)³³	India	50 women aged 20-25 years (3 phases of evaluation: menstrual, ovulatory, and luteal)	P	NS	Visual (TRV) and auditory (TRA) reaction time	Reaction time after presentation of stimuli (flash/sound)	TRV and TRA were higher during the menstrual phase and lower during the luteal phase
Sy et al. (2016)¹¹	United States	16 women; mean age 22 years (follicular and luteal phases)	P	M (left/right eye recording)	Binocularity	Psychophysics toolbox; circular sinusoidal grid stimuli (4.5 and 30%; 1.48 in diameter)	There was no significant difference in binocularity or temporal dynamics
Webb, Hibbard & O’Gorman (2018)²⁰	United Kingdom	21 women aged 21.6 ± 3.8 years (menstrual, ovulatory and luteal phases); 14 women who used contraceptives; 14 men	P	NS	Luminance contrast	Stimuli were Gabor's sinusoidal grids with spatial frequencies of 1, 4 and 16 cpd	There was no difference in luminance contrast according to hormonal shifts

Authors (year)	Country	Sample (phases of the cycle)	Method	Testing	Visual task	Test and stimuli	Results
Yılmaz, Erkin, Mavioglu & Sungurtekin (1998)¹⁴	Turkey	30 women aged 29.6 ± 6.4 years (4 evaluation phases: menstrual, follicular, ovulatory and luteal)	N (VEP)	M (left/right eye recording)	Visual electrophysiology	Visual evoked potential (reverse pattern); P100 latency and visual range (Oz)	Higher mean P100 amplitude during the ovulatory phase
Krug et al. (2007)¹³	Germany	11 women (in the menstrual, ovulatory and luteal phases); mean age 25.3 years	N (VEP)	NS	Visual electrophysiology	Social stimuli (sexy man, baby, people, woman); N1, P2, P3, LPC, SW (700-900 ms), LPC	Greater LPC amplitude to stimulate sexy men in the ovulatory phase
Derntl et al. (2008)³⁵	Austria	22 women aged 24.45 ± 3 years (11 in the follicular phase and 11 in the luteal phase)	N (fMRI)	NS	Emotion recognition	3T scanner for amygdala activation (T2 protocol); emotional discrimination task (Vienna Emotion Recognition Tasks (VERT-K)	Greater neural activation for all follicular phase emotions. In particular, negative facial expressions caused greater activation of the amygdala
Zhang, Zhou & Ye (2013)⁴¹	China	29 women (premenstrual, post-menstrual and ovulation phases); aged 20.6 ± 1.5 years	N (VEP)	NS	Visual electrophysiology	Visual evoked potential; visual latency and amplitude components N1, P2, N2 in Fz, Cz, Pz; P3, LPP in Pz, Oz	Late positive potential (LPP) evokes changes in the premenstrual phase for facial expressions: fear (110-130 ms, 150-190 ms and 300-500 ms), sadness (230-300 ms), and anger (750- 1,000 ms.); lower LPP amplitude in the premenstrual phase
Mareckova et al. (2014)²⁵	United Kingdom	20 women (10 in the regular cycle and 10 who used oral contraceptives (menstrual, follicular, mid-cycle and luteal phases); aged 20.44 ± 2.69 years	N (fMRI)	NS	Recognition of emotions	T1-weighted images (T1W), magnetic transfer rate (MTR) and diffusion tensor image (DTI)	Higher level of blood oxygenation (BOLD) in the fusiform area during the mid-cycle phase
Lusk et al. (2015)³⁷	Australia	28 women in the follicular phase (23.54 ± 6.6 years); 29 women in the luteal phase (24.41 ± 7.1 years); 27 men	N (VEP)	B	Visual electrophysiology	Visual evoked potential; latency and visual range of P100, P300, N200, N300 and LPP	Early latency in the luteal phase (P1, N1). Early latency for unpleasant images in the menstrual phase in P3 and LPP

Authors (year)	Country	Sample (phases of the cycle)	Method	Testing	Visual task	Test / Stimuli	Results
Penton-Voak & Perrett (1999)³⁰	United Kingdom	139 women; mean age 20 years (menstrual, follicular and luteal phases)	B	NS	Facial attractiveness	Emotional attractiveness task (female and male face stimuli)	Women showed greater facial attractiveness as facial stimuli in the follicular phase
Penton-Voak et al. (1999)³⁰	United Kingdom and Japan	20 women; mean age 21 years (follicular phase and luteal phase)	B	NS	Facial attractiveness	Visual stimuli consisting of male faces	Greater attractiveness to male faces of Caucasians in the follicular phase
Roberts et al. (2004)⁴⁷	United Kingdom and Czech Republic	130 men; 131 women; mean age 25 years	B	NS	Facial attractiveness	Emotional attractiveness task (female face stimuli in the follicular and luteal phases)	Women showed greater facial attractiveness in the menstrual cycle, and higher in the periovulatory than in the luteal phase
Pearson & Lewis (2005)²⁶	United Kingdom	50 women of mean age 20 years (12 in the menstrual phase; 13 in the preovulatory phase; 11 in the ovulatory phase; and 14 in the luteal phase)	B	NS	Emotion recognition	Emotion recognition task (Face Bank; Paul Ekman)	Greater accuracy of the fear face in the menstrual phase
Little, Jones, Burt & Perrett (2007)³⁶	United Kingdom	31 women aged 20-25 years (in the follicular and luteal phases)	B	NS	Facial attractiveness	Male and female facial stimuli in 2D symmetry	Greater facial attractiveness of symmetrical faces in the follicular phase
Roney & Simmons (2008)²⁷	United States	43 women aged 18.36 ± 0.10 years (menstrual phases: follicular, mid-cycle and luteal phases)	B	NS	Facial attractiveness	Visual stimuli consisting of male faces	Greater facial attractiveness of more masculine features in the late follicular phase
Rubinow et al. (2007)¹⁷	United States	28 women with PMDD (37.9 ± 5.0 years); 27 women without PMDD (33.5 ± 7.0); evaluated in both the follicular and the luteal phases	B	NS	Emotion recognition	Emotional discrimination task	Better discrimination of sad face in the luteal phase for PMDD. Women with PMDD differed significantly from women without PMDD in the luteal phase regarding sad faces
Derntl et al. (2008)³⁵	Austria	32 women aged 23.84 ± 3 years (15 in the follicular phase and 17 in the luteal phase)	B	NS	Emotion recognition	Emotional discrimination task (Vienna Emotion Recognition Tasks, VERT-K)	Better performance in the follicular phase; greater confusion in discrimination of negative emotions (anger and disgust) in the luteal phase
Guapo et al. (2009)³²	Brazil	30 women aged 22.1 ± 2.9 years (11 women in the follicular phase; 9 women in the ovulatory phase; and 10 women in the luteal phase); 10 healthy men	B	NS	Emotion recognition	Prototypes of emotional facial stimuli	Recognition of negative emotions, such as sadness, anger and fear in the follicular phase
Konishi et al. (2009)²⁹	Japan	12 women in the menstrual, follicular and luteal phases; aged 22.4 ± 1.1 years	B	NS	Visuospatial memory	Visual memory task using the Baddely model	Higher mental load performance in the luteal phase.
Oberzaucher et al. (2012)⁴⁰	Austria, Czech Republic and Slovakia	10 women and 15 men; aged 23.35 ± 3.1 years)	B	NS	Facial attractiveness	Female facial stimuli in the ovulatory and luteal phases	Greater facial attractiveness of female stimuli in the ovulatory phase. There was no difference regarding the other phases of the menstrual cycle
Puts et al. (2013)¹⁵	United States	202 women aged 19.6 ± 1.6 years (late follicular and middle luteal phases)	B	NS	Facial attractiveness	Visual stimuli consisting of male faces	Greater facial attractiveness of more masculine features in the late follicular phase (increased estradiol)
Lobmaier, Bobst & Probst (2016)³⁸	Switzerland	60 women aged 25.16 ± 5.1 years (2 evaluation phases: ovulatory and luteal)	B	NS	Facial attractiveness	Facial stimuli prototypes	Higher rate of facial recognition during the ovulatory phase
Marcinkowska & Holzleitner (2020)³⁹	Poland	102 women aged 28.8 ± 4.6 years	B	NS	Facial attractiveness	Female facial stimuli in the ovulatory and luteal phases	Greater facial attractiveness of female stimuli in the ovulatory phase. There was no difference regarding facial symmetry and sexual dimorphism during the phases of the cycle

location_on

Associação Paulista de Medicina - APM APM / Publicações Científicas, Av. Brigadeiro Luís Antonio, 278 - 7º and., 01318-901 São Paulo SP - Brazil, Tel.: +55 11 3188-4310 / 3188-4311, Fax: +55 11 3188-4255 - São Paulo - SP - Brazil
E-mail: revistas@apm.org.br

rss_feed Acompañe los números de esta revista en su lector de RSS

[TFN1] P = psychophysical; NS = not specified; M = monocular; cpd = cycles per degree.