What is the clinical evidence from this study?

Study design: Observational. Population: Menstrual cycle (n=11590). Intervention: Naturally cycling vs. Hormonal birth control pills. Primary outcome: Resting heart rate cardiovascular amplitude (RHRamp) (p=<0.001).

December 23, 2024Open Access

A Novel method for quantifying fluctuations in wearable derived daily cardiovascular parameters across the menstrual cycle

Q: What are the key findings of this study?

Naturally cycling females exhibited significantly higher resting heart rate amplitude (2.73 bpm) across the menstrual cycle compared to those using hormonal birth control pills (0.28 bpm).

SJSummer R. JasinskiUniversity of Massachusetts Boston DPDavid M. PresbySIB Swiss Institute of Bioinformatics GGGregory J. GrosickiPreventive Cardiology

Key Result

Naturally cycling females exhibited significantly higher resting heart rate amplitude (2.73 bpm) across the menstrual cycle compared to those using hormonal birth control pills (0.28 bpm).

Study Design

Type

Observational (n=11,590)

Structured PICO

Do resting heart rate and heart rate variability fluctuate across the menstrual cycle, and are these fluctuations affected by age, BMI, and birth control use in adult females?

Population

11,590 females aged 18 or older with an active WHOOP membership who manually logged menstruation, including 9,968 naturally cycling and 1,661 on birth control pills. Multinational cohort (United States 69.9%, Great Britain 8.0%, Australia 4.2%, Germany 4.2%, Ireland 1.4%, Netherlands 1.3%, UAE 1.1%, Switzerland 1.0%, and 92 other countries).

Intervention

Continuous monitoring with a wrist-worn wearable device (WHOOP Strap versions 3.0 or 4.0) to measure resting heart rate (RHR) and heart rate variability (RMSSD) during non-wake periods across the menstrual cycle.

Comparator

Participants using hormonal birth control pills (compared to naturally cycling participants in the sub-analysis).

Outcome

Cardiovascular amplitude (fluctuations in resting heart rate [RHRamp] and heart rate variability [RMSSDamp] across the menstrual cycle).surrogate

Wearable-derived cardiovascular metrics (RHR and RMSSD) show predictable fluctuations across the menstrual cycle that are significantly attenuated by age and hormonal birth control use, offering a potential non-invasive method to monitor female hormonal health.

Main Result

Absolute Event Rate: 2.73% vs 0.28%

p-value: p=<0.001

Limitations

Restricted to regularly menstruating females, limiting generalizability to females with irregular menstrual cycles.
Relied on self-reported data concerning menstruation status and birth control methods, which can be subject to human error.
Lacked access to relevant sociocultural variables such as race/ethnicity and socioeconomic status.
Lacked direct hormonal measurements and detailed information regarding potential reproductive or cardiovascular health conditions and specific birth control details.

Abstract

Abstract Currently, knowledge of changes in cardiovascular function across the menstrual cycle and how these changes may inform upon underlying health is limited. Utilizing wrist-worn biometric data we developed a novel measure to quantify and investigate the cardiovascular fluctuation (i.e. cardiovascular amplitude) within resting heart rate (RHR) and heart rate variability (RMSSD) across 11,590 participants and 45,811 menstrual cycles. Within participants, RHR and RMSSD fluctuated in a regular pattern throughout the menstrual cycle, with population RHR min and RMSSD max at cycle day 5, RHR max at day 26, and RMSSD min at day 27. Cardiovascular amplitude was attenuated ( p < 0.05) in older participants and participants using birth control, suggesting the novel metric may mirror differences in hormonal fluctuations in these cohorts. Longitudinal tracking of cardiovascular amplitude may offer accessible non-invasive monitoring of female physiology and underlying health across the menstrual cycle.

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