Contents lists available at ScienceDirect Neuroscience and Biobehavioral Reviews journal homepage: www.elsevier.com/locate/neubiorev Do women expose themselves to more health-related risks in certain phases of the menstrual cycle? A meta-analytic review Jordane Boudesseul a, ⁎, Kelly A. Gildersleeve b , Martie G. Haselton c , Laurent Bègue d a Instituto de Investigación Científica, Universidad de Lima, Peru b University of Michigan, Ann Arbor, MI, United States c University of California, Los Angeles, CA, United States d Univ. Grenoble Alpes, France ARTICLE INFO Keywords: Menstrual cycle Risk-taking Sexual behavior Cigarettes Alcohol Evolution ABSTRACT Researchers have increasingly examined the menstrual cycle as a potential source of day-to-day variation in women’s cognitions, motivations, and behavior. Within this literature, several lines of research have examined the impact of the menstrual cycle on women’s engagement in activities that could negatively affect their health (alcohol and tobacco consumption, sexual behavior, risk recognition). However, findings have been mixed, leaving it unclear whether women may expose themselves to more health-related risks during certain phases of the cycle. We conducted a meta-analysis of 22 published and four unpublished studies (N = 7529, https://osf.io/ xr37j/). The meta-analysis revealed shifts across the menstrual cycle in women’s sexual behavior with others and risk recognition (higher in ovulatory phase), whereas there was no consistent pattern of difference for alcohol and cigarette consumption. These findings help to clarify the proximate physiological and evolutionary me- chanisms underlying women’s health-related risk-taking and may inform new interventions. 1. Introduction Over the past three decades, dozens of studies have reported evi- dence that the menstrual cycle influences many aspects of women’s cognition, motivations, and behavior, including, for example, emotion recognition (Sundström Poromaa and Gingnell, 2014), mental rotation abilities (Broverman et al., 1981; Zhu, Kelly, Curry, Lal, & Joseph, 2015), verbal ability (Rosenberg and Park, 2002), mood (Maki, Rich, & Rosenbaum, 2002; Rubinow and Schmidt, 1995), empathy (Derntl, Hack, Kryspin-Exner, & Habel, 2013; Pfaff, 2012) and mate preferences (meta-analyzed by Gildersleeve et al., 2014; reviewed by Thornhill and Gangestad, 2008). Within this broad area of research, a growing lit- erature has examined changes across the menstrual cycle in women’s engagement in behaviors that could expose them to health-related risks, particularly sexual behavior, alcohol and cigarette consumption, and recognition and avoidance of potentially threatening people and dan- gerous situations. However, evidence in this area has been mixed. Furthermore, inconsistencies across study findings have been difficult to understand without a guiding theoretical framework or careful evaluation of differences in study methods (e.g., methods used to assess women’s position within the menstrual cycle; different characterization of hormonal profiles; within vs. between design). In this review, we begin by providing a brief orientation to the physiological changes that occur during the menstrual cycle. Studies of nonhuman animals in neuroendocrinology also point to plausible physiological pathways through which women’s position in the men- strual cycle could influence health behaviors (e.g., through estradiol and progesterone receptors within the amygdala, hippocampus, hy- pothalamus and the frontal cortex, see Guerra-Araiza, Coyoy-Salgado, & Camacho-Arroyo, 2002, Guerra-Araiza, Villamar-Cruz, Gonzalez- Arenas, Chavria, & Camacho-Arroyo, 2003; Kato, Hirata, Nozawa, & Yamada-Mouri, 1994). Next, we propose specific predictions regarding when, how (via what mechanisms), and why different forms of health- related risk-taking may change across the menstrual cycle. These pre- dictions are informed by behavioral neuroendocrinology, studies of nonhuman animal species, and modern evolutionary theory. We then present a meta-analysis of 22 published and four unpublished studies (N = 7529) that examined changes in women’s health-related risk- taking behaviors across the menstrual cycle, followed by a discussion of the implications of our findings for understanding the mechanisms underlying women’s health risk behaviors. Data, analysis and supple- mentary materials are available online (https://osf.io/xr37j/) in ac- cordance with the Open Science movement (Peters, Abraham, & Crutzen, 2012). https://doi.org/10.1016/j.neubiorev.2019.08.016 Received 3 April 2019; Received in revised form 29 July 2019; Accepted 19 August 2019 ⁎ Corresponding author at: Instituto de Investigación Científica, Universidad de Lima, Av. Javier Prado Este 4000, Lima 33, Peru. E-mail address: jmj.boudesseul@gmail.com (J. Boudesseul). Neuroscience and Biobehavioral Reviews 107 (2019) 505–524 Available online 09 September 2019 0149-7634/ © 2019 Elsevier Ltd. All rights reserved. T