**Special topics**

[2] Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, Pinsky MR, Hofer CK, Teboul JL, de Boode WP, Scolletta S, Vieillard-Baron A, De Backer D, Walley KR,

[4] Peeters Y, Bernards J, Mekeirele M, Hoffmann B, De Raes M, Malbrain ML. Hemodynamic

[5] Bernards J, Mekeirele M, Hoffmann B, Peeters Y, De Raes M, Malbrain ML. Hemodynamic

[6] Ramsingh D, Alexander B, Cannesson M. Clinical review: Does it matter which hemodynamic monitoring system is used? Critical Care. 2013;17(2):208. DOI: 10.1186/cc11814 [7] Ho KM. Pitfalls of hemodynamic monitoring in postoperative and critical setting. Anaes-

[8] Junttila EK, Koskenkari JK, Ohtonen PP, Ala-Kokko TI. Uncalibrated arterial pressure waveform analysis for cardiac output monitoring is biased by low peripheral resistance in patients with intracranial haemorrhage. British Journal of Anaesthesia. 2011;107:581-586.

[9] Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of intensive care medicine.

Intensive Care Medicine. 2014;40(12):1795-1815. DOI: 10.1007/s00134-014-3525-z

[10] Cecconi M, Arulkumaran N, Kilic J, Ebm C, Rhodes A. Update on hemodynamic monitoring and management in septic patients. Minerva Anestesiologica. 2014;80(6):701-711

[11] Hofer CK, Rex S, Ganter MT. Update on minimally invasive hemodynamic monitoring in thoracic anesthesia. Current Opinion in Anaesthesiology. 2014;27(1):28-35. DOI: 10.1097/

[12] Su LX, Liu DW. Personalized hemodynamic therapy concept for shock resuscitation. Chinese Medical Journal. 2018;131:1240-1243. DOI: 10.4103/0366-6999.231511

[13] Saugel B, Vincent JL, Wagner JY. Personalized hemodynamic management. Current Opin-

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ACO.0000000000000034

[3] Chan YK, Khan ZH. Hemodynamic monitoring

6 Highlights on Hemodynamics

**Chapter 2**

**Provisional chapter**

**Functioning of the Cardiovascular System of Women in**

Seventy seven women with 17–19 years of age examined central hemodynamics and its wave structure at rest, with orthopedic and psychoemotional load in different phases of the ovarian cycle (OC). It was established that in the luteal phase of the OC in the lying position, the blood pressure was higher than in other phases. In orthoprost in the luteal phase, in comparison with other phases, the growth of cardiac rhythm wave strength in the range of 0.04–0.15 Hz is observed, their concentration and connection with oscillations of the shock volume of blood, and the leveling of differences in blood pressure levels. The involvement of spontaneous baro-reflex sensitivity of the studied states and

**Keywords:** central hemodynamics, variability of the cardiac rhythm, women,

The basis of modern human physiology is the systematic approach, the synthesis of the theory of functional systems and the theory of adaptation, which allows us to obtain meaningful information about the functional state of the organism during ontogenesis and use the

Heart rate variability (HRV) is a fundamental physiological property of the human body, which reflects the state of regulatory mechanisms of homeostasis, in particular, the tone of the autonomic nervous system [4]. Therefore, the study of HRV has become important for

qualitative diagnosis, prediction, and prevention of various diseases [5, 6].

**Functioning of the Cardiovascular System of Women** 

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.79633

**Different Phases of the Ovarian-Menstrual Cycle**

**in Different Phases of the Ovarian-Menstrual Cycle**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79633

Olena Lutsenko

Olena Lutsenko

**Abstract**

reactions is discussed.

ovarian-menstrual cycle

obtained data for practical actions [1–3].

**1. Introduction**

#### **Functioning of the Cardiovascular System of Women in Different Phases of the Ovarian-Menstrual Cycle Functioning of the Cardiovascular System of Women in Different Phases of the Ovarian-Menstrual Cycle**

DOI: 10.5772/intechopen.79633

#### Olena Lutsenko Olena Lutsenko

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79633

#### **Abstract**

Seventy seven women with 17–19 years of age examined central hemodynamics and its wave structure at rest, with orthopedic and psychoemotional load in different phases of the ovarian cycle (OC). It was established that in the luteal phase of the OC in the lying position, the blood pressure was higher than in other phases. In orthoprost in the luteal phase, in comparison with other phases, the growth of cardiac rhythm wave strength in the range of 0.04–0.15 Hz is observed, their concentration and connection with oscillations of the shock volume of blood, and the leveling of differences in blood pressure levels. The involvement of spontaneous baro-reflex sensitivity of the studied states and reactions is discussed.

**Keywords:** central hemodynamics, variability of the cardiac rhythm, women, ovarian-menstrual cycle

### **1. Introduction**

The basis of modern human physiology is the systematic approach, the synthesis of the theory of functional systems and the theory of adaptation, which allows us to obtain meaningful information about the functional state of the organism during ontogenesis and use the obtained data for practical actions [1–3].

Heart rate variability (HRV) is a fundamental physiological property of the human body, which reflects the state of regulatory mechanisms of homeostasis, in particular, the tone of the autonomic nervous system [4]. Therefore, the study of HRV has become important for qualitative diagnosis, prediction, and prevention of various diseases [5, 6].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

At the beginning of the twenty-first century, the attention of researchers is drawn to the study of the variability of the duration of the interval R-R [7–10], blood pressure [11–13], shock volume [14], respiratory arrhythmia [15–17], and the relationship of wave changes in various hemodynamic parameters. This is due to the wide introduction of information technology to the theory and practice of medicine and physiology, high diagnostic value of parameters of regulatory rhythms of hemodynamics.

In this case, the power in the ranges of low and high frequencies was negatively correlated with age. The total power of the spectrum was relatively reduced between 20–29 years and

Functioning of the Cardiovascular System of Women in Different Phases of the Ovarian…

http://dx.doi.org/10.5772/intechopen.79633

11

The same gender and age characteristics of the wave structure of the heart rate were also confirmed in measurements of 302 men and 312 women conducted by Bai et al., for 653 persons performed by Aubert et al. [7], and on 276 persons conducted by Barrett et al. The gender differences in HRV are measured at the sixth decade of the human life cycle. Changes in the cardiac rhythm and its spectral components during orthopedic trial at this age did not have

There are significant differences in the reactivity of fluctuations in the interval of R-R and the peripheral pressure of men and women on physical, mental, and cold loads. So in the research of Peshakova [32] shows that women under these conditions have a greater centralization of the mechanisms of regulation of the cardiovascular system, and for men, an increase in the

Many researchers [33–36] point out that cardiovascular analysis is more appropriate to detect minor fluctuations of the VNS activity during the menstrual cycle than the use of traditional indicators such as heart rate and arterial pressure. However, the results of studies of changes in the heart rate in different phases of the menstrual cycle are still controversial. It should be noted that significant changes in HRV in women of reproductive age, both at rest and during psychoemotional stresses, may be due to the phase of the ovarian cycle [37–42]. SDNN in young women was the highest during the follicular phase of the menstrual cycle [43]. According to Koening and co-authors [44], in women during the luteal phase compared with the follicular showed an increase in the activity of the sympathetic department of the autonomic autonomy of the autonomy according to the HRV indices. However, a group of researchers, Grossman et al. [45], insists on the absence of differences in the parameters of the wave structure of blood pressure and heart rate when performing orthopedic and stimulating

Japanese scientists [43] demonstrate a significant increase in sympathetic and decreased parasympathetic activity in the lutein phase compared to follicular, as evidenced by an increase in the values of LF/HF and LF, as well as a decrease in HF in the luteal phase. The facts of the increase in the level of LF/HF in the early and middle luteal phase are given in Holzen et al. [46], with the late luteal phase showing a tendency to decrease the level of LF/HF. At the same time, some researchers, Princi et al. [47] and Sato et al. [39] refute this assumption, indicating

Although some researchers point to an increase in the level of HF in the follicular phase compared with the luteal and menstrual phase, measurements were made only one [48–50] or twice a week [51] during the cycle. Since hormonal and physiological changes during the menstrual cycle are complex and complex, they can not be characterized by two measure-

In studies [52], in 10 completely healthy women, it was found that spontaneous baroreflectory sensitivity increases during the luteal phase compared to the follicular phase. It was stated

activity of the sympathetic link of the autonomic nervous system.

carotid sinus in women in different phases of the ovarian cycle.

ments, which indicate the need for long-term research.

that there is no significant change.

60–69 years by 30%.

sexual differences.

Of all the physiological systems of humans, the most important and little studied is reproductive [18–22]. In particular, insufficient research on the chronostructure of physiological systems in women suggests that the productivity and stability of body systems, in addition to the annual seasonal changes in various physiological functions and the seasonal exacerbation of some diseases, significantly affect the ovarian-menstrual cycle [23, 24].

An analysis of the above-mentioned developments of scientists and practitioners shows that the preservation and strengthening of health significantly depends on the further study of adaptive reactions of the female body, taking into account the ovarian-menstrual cycle, the individual annual, and the seasonal period of physiological functions.

On the adaptive trophic role of the sympathetic department of the VNS, including the reproduction, one of the first pointed academician Orbeli [15]. However, to date, the question of the state of the autonomic nervous system, including the activity of the cardiac rhythm, in women during the menstrual cycle is inadequate. A series of review papers [25–27] provides data on age and gender changes in some HRV indicators. However, these data relate, preferably, to short (2–5 min.) Records of R-R intervals are performed on contingents of persons with different pathologies [28–30]. At the same time, the characteristics of the wave structure of the vibrations of hemodynamic indices in healthy women in different physiological conditions and loads in the process of ontogenesis are insufficiently analyzed.

It should be emphasized the existence of certain contradictions in the results of various studies of the variability of the cardiac rhythm in women in different phases of the ovarian-menstrual cycle and the treatment of their mechanisms.

There remains an inadequate study of the problem associated with the influence of the ovarian-menstrual cycle on the indicators of central hemodynamics and cardiac rhythm variability under different physiological conditions. In particular, studies of changes in the oscillations of the shock volume of blood, spontaneous baro-reflex sensitivity in women under different stresses.

In Ketel et al. conducted in randomized tubes for 149 men and 137 middle-aged women, revealed that HRV levels were inversely related to age and heart rate in both sexes. The level of LF in men is significantly higher than in women and is negatively related to the level of triglycerides, insulin. The power of the R-R interval for women is higher than that of men.

The widespread introduction of the ECG holter monitoring method into clinical practice allowed the evaluation of HRV in the course of the day and at certain intervals, and also used this method for studying the state of autonomic regulation of the heart rate. Extreme values of total spectrum power and power in the very low and low frequency range under holter monitoring of women in comparison with men were also recorded in Fluckiger et al. [31]. In this case, the power in the ranges of low and high frequencies was negatively correlated with age. The total power of the spectrum was relatively reduced between 20–29 years and 60–69 years by 30%.

At the beginning of the twenty-first century, the attention of researchers is drawn to the study of the variability of the duration of the interval R-R [7–10], blood pressure [11–13], shock volume [14], respiratory arrhythmia [15–17], and the relationship of wave changes in various hemodynamic parameters. This is due to the wide introduction of information technology to the theory and practice of medicine and physiology, high diagnostic value of parameters of

Of all the physiological systems of humans, the most important and little studied is reproductive [18–22]. In particular, insufficient research on the chronostructure of physiological systems in women suggests that the productivity and stability of body systems, in addition to the annual seasonal changes in various physiological functions and the seasonal exacerbation

An analysis of the above-mentioned developments of scientists and practitioners shows that the preservation and strengthening of health significantly depends on the further study of adaptive reactions of the female body, taking into account the ovarian-menstrual cycle, the

On the adaptive trophic role of the sympathetic department of the VNS, including the reproduction, one of the first pointed academician Orbeli [15]. However, to date, the question of the state of the autonomic nervous system, including the activity of the cardiac rhythm, in women during the menstrual cycle is inadequate. A series of review papers [25–27] provides data on age and gender changes in some HRV indicators. However, these data relate, preferably, to short (2–5 min.) Records of R-R intervals are performed on contingents of persons with different pathologies [28–30]. At the same time, the characteristics of the wave structure of the vibrations of hemodynamic indices in healthy women in different physiological conditions

It should be emphasized the existence of certain contradictions in the results of various studies of the variability of the cardiac rhythm in women in different phases of the ovarian-menstrual

There remains an inadequate study of the problem associated with the influence of the ovarian-menstrual cycle on the indicators of central hemodynamics and cardiac rhythm variability under different physiological conditions. In particular, studies of changes in the oscillations of the shock volume of blood, spontaneous baro-reflex sensitivity in women under

In Ketel et al. conducted in randomized tubes for 149 men and 137 middle-aged women, revealed that HRV levels were inversely related to age and heart rate in both sexes. The level of LF in men is significantly higher than in women and is negatively related to the level of triglycerides, insulin. The power of the R-R interval for women is higher than that of men.

The widespread introduction of the ECG holter monitoring method into clinical practice allowed the evaluation of HRV in the course of the day and at certain intervals, and also used this method for studying the state of autonomic regulation of the heart rate. Extreme values of total spectrum power and power in the very low and low frequency range under holter monitoring of women in comparison with men were also recorded in Fluckiger et al. [31].

of some diseases, significantly affect the ovarian-menstrual cycle [23, 24].

individual annual, and the seasonal period of physiological functions.

and loads in the process of ontogenesis are insufficiently analyzed.

cycle and the treatment of their mechanisms.

different stresses.

regulatory rhythms of hemodynamics.

10 Highlights on Hemodynamics

The same gender and age characteristics of the wave structure of the heart rate were also confirmed in measurements of 302 men and 312 women conducted by Bai et al., for 653 persons performed by Aubert et al. [7], and on 276 persons conducted by Barrett et al. The gender differences in HRV are measured at the sixth decade of the human life cycle. Changes in the cardiac rhythm and its spectral components during orthopedic trial at this age did not have sexual differences.

There are significant differences in the reactivity of fluctuations in the interval of R-R and the peripheral pressure of men and women on physical, mental, and cold loads. So in the research of Peshakova [32] shows that women under these conditions have a greater centralization of the mechanisms of regulation of the cardiovascular system, and for men, an increase in the activity of the sympathetic link of the autonomic nervous system.

Many researchers [33–36] point out that cardiovascular analysis is more appropriate to detect minor fluctuations of the VNS activity during the menstrual cycle than the use of traditional indicators such as heart rate and arterial pressure. However, the results of studies of changes in the heart rate in different phases of the menstrual cycle are still controversial. It should be noted that significant changes in HRV in women of reproductive age, both at rest and during psychoemotional stresses, may be due to the phase of the ovarian cycle [37–42]. SDNN in young women was the highest during the follicular phase of the menstrual cycle [43]. According to Koening and co-authors [44], in women during the luteal phase compared with the follicular showed an increase in the activity of the sympathetic department of the autonomic autonomy of the autonomy according to the HRV indices. However, a group of researchers, Grossman et al. [45], insists on the absence of differences in the parameters of the wave structure of blood pressure and heart rate when performing orthopedic and stimulating carotid sinus in women in different phases of the ovarian cycle.

Japanese scientists [43] demonstrate a significant increase in sympathetic and decreased parasympathetic activity in the lutein phase compared to follicular, as evidenced by an increase in the values of LF/HF and LF, as well as a decrease in HF in the luteal phase. The facts of the increase in the level of LF/HF in the early and middle luteal phase are given in Holzen et al. [46], with the late luteal phase showing a tendency to decrease the level of LF/HF. At the same time, some researchers, Princi et al. [47] and Sato et al. [39] refute this assumption, indicating that there is no significant change.

Although some researchers point to an increase in the level of HF in the follicular phase compared with the luteal and menstrual phase, measurements were made only one [48–50] or twice a week [51] during the cycle. Since hormonal and physiological changes during the menstrual cycle are complex and complex, they can not be characterized by two measurements, which indicate the need for long-term research.

In studies [52], in 10 completely healthy women, it was found that spontaneous baroreflectory sensitivity increases during the luteal phase compared to the follicular phase. It was stated that there were certain differences in the logRSA fluctuations during the menstrual cycle, which were related to the average NSC indexes.

to anamnesis, taking basal body temperature, and using a set of inkjet ovulation tests "Solo"

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13

The main method for determining the phases of the CMC was the collection of anamnesis. Using the test-microscope "Arbor" in the studied group of students examined the presence of ovulation by the nature of the crystallization of saliva. The method is based on the fact that during ovulation, when the concentration of estrogen in the blood of a woman becomes maximal, in saliva, the concentration of salts increases, which is manifested in the maximum crystallization of saliva. Thus, a graphic image on a glass under a microscope was called a "leaf of ferns" (**Figure 1**).

Confirmation of reliability of phase change of the cycle (selectively) was carried out by means of ultrasound diagnostics, the apparatus, HDI 1500, as well as the set of jet tests SoloTM (company "Pharmaco", the registration certificate of the Ministry of Health of Ukraine NO 1856/2003 of 16.05.2008, the international certificate of quality ISO 9001/ISO 13485, and

The confirmation of the MC phase was also carried out using the technique of basal body temperature measurement Krupko-Bolshova (1986). During the ripening of the egg in the follicular phase of the cycle, against the background of increased estrogen BBT is low (36–37°C), after ovulation, in the lutein phase, begins the temperature increase (37.2–38°C), which is due to the low estrogen levels in the background of increased progesterone in the blood of women. BBT was measured every morning, at the same time, from 600 to 800 hours (depending on the time of year), not getting out of bed for 5 minutes, mercury thermometer in the rectum at a depth of about 5 cm. Rozultaty entered into the table: date, day of the cycle, BT, and special

The difference between the mean values of the second and first phase of the CTD can be 0.5–0.8°C, but it should not be less than 0.4–0.50°C. This is evidence of the normal course of CMC. If during the whole cycle the temperature on the graph is kept, for example, on the same level, or the graph looks like "tyna" (when the low temperature constantly changes

high), rather than biphasic, this is due to the fact that ovulation was not (**Figure 2**).

Manufacturer of IND Canada) to determine the ovulation.

**Figure 1.** Photo of smear of saliva of student L. (during ovulation).

(IND Diagnostic, Inc., Canada).

circumstances.

According to Weisman, there are significant changes in both the wave structure of the cardiac rhythm and its reactivity to the burden on women in the first 20 weeks of pregnancy. So, normally in this period, the power of OT components increases, often the synchronization of respiratory and baroreflector waves is observed. In pathological development of pregnancy, there is an inversion of such regulatory relations.

The variability of the cardiac rhythm during the physiological course of pregnancy is reduced, which indicates an increase in the activity of the sympathetic department of the autonomic nervous system [21, 53]. In women with gestosis, HRV is more pronounced. Revealed by scientists, the facts of changes in HRV with other hypertensive states in pregnant women, as well as in normal and complicated childbirth are few and controversial. The emphasis is placed on the prospect of further study of sympathetic activity in relation to changes in HRV in pregnant and childbearing, as well as on the need for widespread introduction of cardiointervalography in obstetrics.

The process of reproduction in humans regulates complex neuroendocrine mechanisms, so the normal functioning of the reproductive system is possible only with the integrated control of the nervous and humoral signals. One of the manifestations of complex changes in the body of a woman is the menstrual cycle: cyclic changes in the hypothalamus, pituitary gland, and ovaries; cyclic changes in the target organs (uterus, fallopian tubes, vagina, and mammary glands); cyclic changes in the endocrine, nervous, and other systems of the organism. The most pronounced changes occur in the ovaries (ripening of the follicles, ovulation, and development of the yellow body) and the uterus (desquamation of the endometrium is actually menstruation, regeneration and proliferation of the functional layer, secretory changes in it, and again desquamation). Due to these changes, the reproductive function of the woman is carried out: ovulation, fertilization, implantation, and development of the embryo in the uterus. If implantation does not occur, pregnancy does not occur, and the functional layer of the endometrium is exfoliated, from the genital tract, there is a spotting (menstruation). The appearance of menstrual discharge indicates the completion of cyclical changes in the body and the absence of pregnancy. The main symptom of normal functioning of the reproductive system of a woman is a normal menstrual cycle. This biorhythm is genetically determined in a healthy woman, and it is stable throughout the generative age according to its parameters.
