運動生理學中的女性視角：激素波動對黏膜免疫的影響與驗證月經階段之黃金標準

A female perspective in exercise physiology: The impact of hormonal fluctuations on mucosal immunity and validation of the gold standard for determining menstrual phases

當前運動科學研究中受試者的男女比例約為2:1，這可能反映了研究者對月經週期與激素變化影響的考量，導致多數研究優先招募男性受試者。然而，這種性別不均衡可能影響我們對女性運動生理適應的理解，因為月經週期的激素波動對能量代謝與免疫功能具有明顯影響。特別是黃體期，高孕酮濃度可能抑制骨骼肌葡萄糖吸收，並且與免疫系統調節相關，形成「免疫脆弱窗口」，增加感染風險。此外，高強度運動可能削弱黏膜免疫功能，使女性運動員較男性更易罹患疾病，如呼吸道感染。運動後的免疫抑制效應與開窗假說相關，高訓練負荷可能降低唾液抗菌分子的濃度，提高感染風險。女性的免疫調節受雌激素與孕酮影響，雌激素可促進免疫反應，而孕酮可能抑制免疫功能，這種性別差異也影響女性對自體免疫疾病的易感性。由於月經週期的個體變異性大，傳統研究多依賴自我報告判定月經階段，缺乏標準化驗證方法，影響數據的精確性與可比性。因此，學者們建議應採用三步驟或二步驟驗證法，以激素測量來準確確認月經階段，提高研究品質與再現性。未來女性運動科學研究應更廣泛應用標準化的方法學，以減少月經週期影響測量的不確定性，並加強對運動表現與免疫適應的探討，推動更具性別代表性的運動科學研究，以促進女性運動員的健康與競技表現。

In current sports science research, the ratio of male to female participants is approximately 2:1. This disparity may stem from researchers’concerns about menstrual cycle fluctuations and hormonal changes, resulting in a preference for recruiting male participants. However, this gender imbalance may limit our understanding of female physiological adaptations to exercise, as menstrual cycle hormones significantly affect energy metabolism and immune function. In particular, during the luteal phase, high progesterone levels may suppress glucose uptake, impacting high-intensity exercise performance. Additionally, high progesterone levels regulate the immune system, creating an‘immunological vulnerability window’that raises infection risk. Furthermore, high-intensity exercise may weaken mucosal immune function, making female athletes more susceptible to illnesses such as respiratory infections. The post-exercise immune suppression effect aligns with the open window hypothesis, as high training loads may reduce the concentration of salivary antimicrobial molecules, increasing infection risk. Estrogen and progesterone influence female immune function, with estrogen enhancing immune responses while progesterone may suppress them. These sex differences also contribute to women’s higher susceptibility to autoimmune diseases. Given the significant individual variability in menstrual cycles, traditional studies often rely on self-reported menstrual phases without standardized validation methods, affecting data accuracy and comparability. Therefore, scholars recommend adopting the three-step or two-step verification method, using hormonal measurements to accurately determine menstrual phases and improve research quality and reproducibility. Future research on female athletes should adopt standardized methodologies more broadly to reduce uncertainty in measuring menstrual cycle effects, improve studies on exercise performance and immune adaptation, and promote gender-balanced sports science research. This approach will contribute to enhancing the health and competitive performance of female athletes.