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The menstrual cycle is an important biological rhythm, whereby large cyclic fluctuations in endogenous sex hormones, such as estrogen and progesterone, are observed, which can affect performance. Evidence shows that endogenous and exogenous changes in hormone concentrations during the menstrual cycle exert many effects on the nervous and endocrine systems, in addition to the connective tissue, with consequences for the movement system. Pre-clinical studies (i.e., in animal models) show an estrogen association with the structural and mechanical properties of tendons and ligaments. Several elegant studies performed with female participants have tried to establish the mechanism underlying the effect of estrogen on collagen synthesis and its effects on exercise and functionality. Their findings suggest that the tendon properties may be affected when exposed to varying concentrations of estrogen. The largest tendon in humans, the Achilles tendon, has a direct role in functional capacity, activities of daily living, and locomotion. Studies show that the triceps surae's structural and mechanical properties may change throughout the menstrual cycle, and that these changes are related to endogenous and exogenous fluctuations in estrogen and progesterone. Musculotendinous stiffness, which is dependent on the collagen content, has been seen to vary considerably over the course of the menstrual cycle. In addition, it has been reported that females who have been taking the contraceptive pill for at least a year demonstrate lower levels of tendon strain compared to non-pill taking females, indicating a possible influence of hormonal state on tendon mechanical properties. However, the different experimental designs, the varied approaches to the evaluations and the lack of studies with high methodological quality limit our understanding of the effects of the different phases of the menstrual cycle on the triceps surae's neuromechanical properties. The aim of this observational study will be to investigate whether the morphological, mechanical (active and passive), material, and functional properties of the plantar flexor muscles and of the Achilles tendon, as well as functional parameters, change during voluntary contractions throughout the phases of the menstrual cycle in eumenorrheic women and in users of hormonal contraception. Understanding the acute effects of these properties in eumenorrheic women and users of hormonal contraception is essential so that we can adequately plan interventions and prescriptions of physical exercise and rehabilitation aimed for women.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Physically active eumenorrheic women with regular menstrual cycle | Women who practice physical exercise and have regular menstruation ranging from 25 to 38 days. |
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| Sedentary eumenorrheic women with regular menstrual cycle | Women who do not practice physical exercise and have regular menstruation ranging from 25 to 38 days. |
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| Physically active women using hormonal contraceptives | Physically active women using oral hormonal contraception combined with estrogen and progesterone within the last six months. |
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| Sedentary women who use hormonal contraception | Sedentary women using oral hormonal contraception combined with estrogen and progesterone within the last six months. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Evaluations of the mechanical properties of the achilles tendon in different phases of the menstrual cycle | Other | Monitoring assessments to verify the effect of different phases of the menstrual cycle on the neuromechanical properties of the Achilles tendon. |
| Measure | Description | Time Frame |
|---|---|---|
| Maximal voluntary isometric contraction (Nm) | Maximal voluntary isometric contraction (MVIC) of the plantar flexor muscles, i.e., largest plantar flexor torque generated in different phases of menstrual cycle and different moments of contraception use | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Achilles tendon stiffness (N/mm) | Achilles tendon stiffness will be calculated during maximal voluntary contraction in different phases of menstrual cycle and contraception users | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Measure | Description | Time Frame |
|---|---|---|
| Cross-sectional area (mm²) | The evaluation of the cross-sectional area will be carried out using ultrasound, evaluating proximal, medial and distal portions from the calcaneus bone. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
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Inclusion Criteria:
Inclusion criteria for the group of eumenorrheic women
Inclusion criteria for the group users of hormonal oral contraception:
Exclusion Criteria:
Exclusion Criteria for eumenorrheic and contraception hormonal groups:
Health problems - contraindication to maximal effort exercise. Additionally, the following subjects will be excluded:
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Over the last three decades, there has been a rise in the number of women participating in exercise, from physical activity to elite sports. However, the number of studies regarding female participants' performance is still small compared to male participants. The menstrual cycle is an important biological rhythm, whereby large cyclic fluctuations in endogenous sex hormones, such as estrogen and progesterone, are observed, which can affect performance.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marco Vaz | Contact | 5551993851188 | marco.vaz@ufrgs.br |
| Name | Affiliation | Role |
|---|---|---|
| Marco Vaz | Federal University of Rio Grande do Sul | Study Chair |
| Marco Vaz | Federal University of Rio Grande do Sul | Study Director |
| Marco Vaz |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Marco Aurelio Vaz | Recruiting | Porto Alegre | Brazil |
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| tendon stress (MPa) during maximal voluntary contractions | The stress will be obtained by taking the ratio between Achilles tendon strength and tendon cross sectional area, and tension taking the relationship between tendon elongation and tendon length at rest | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Myotendinous junction displacement (mm) | The displacement of the myotendinous junction of the medial gastrocnemius muscle (DTJM) will be evaluated during passive torque assessment.The analysis will be carried out in three core cycles of the five passive torque cycles. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Ankle functionality (cm) | Ankle functionality and ankle dorsiflexion range of motion assessed through functional heel raise theses. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Blood concentrations (pg/ml) | Blood concentrations of estrogen and progesterone in different phases of menstrual cycle | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Transvaginal ultrasound (cm) | Transvaginal ultrasound will be evaluated to control the menstrual cycle and take measurements of the ovary and uterus in the different phases of the menstrual cycle. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Tendon length (mm²) | The length of the tendon will be assessed using ultrasound, starting from the myotendinous junction to the calcaneus bone. The measurement will be carried out with a measuring tape. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Strain (%) during maximal voluntary contractions | strain will be evaluated through the relationship relationship between tendon deformation and tendon length at rest. ratio between tendon elongation and TL at rest. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Hysteresis (%) | Hysteresis measurements will be obtained from five cycles, but they will begin at 30° of plantar flexion, and the ankle will be passively moved until maximum dorsal flexion that is achieved. Both passive torque and hysteresis will be evaluated at a constant angular velocity of 5°.s | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Passive torque (Nm) | Passive torque will be evaluated with the isokinetic method dynamometer moving the ankle passively for five cycles, from 0° (i.e. 90° angle between foot and leg) to the maximum ROM previously determined for each participant. | The assessment will be performed at the beginning (1-4 days), middle (10-14 days), and end (22-26 days) of Cycle 1 (each menstrual cycle is between 28-30 days). |
| Federal University of Rio Grande do Sul |
| Principal Investigator |