Autonomic Nervous System Regulation in Women: Electrophysiological Signatures of Stress Reactivity across the Female...

Women exhibit distinct stress-response patterns shaped by dynamic interactions between ovarian hormones, the autonomic nervous system (ANS), and cortical stress-processing circuits. Across the female lifespan, hormonal transitions, including the menstrual cycle, pregnancy, postpartum period, perimenopause, and menopause, are associated with heightened vulnerability to mood and anxiety disorders, underscoring the need for sex-specific physiological frameworks. This narrative review synthesizes current evidence on how hormonal fluctuations modulate stress physiology in women, with a particular focus on noninvasive biomarkers derived from heart rate variability (HRV), electrodermal activity (EDA), and electroencephalography (EEG).

HRV emerges as a key marker of female stress reactivity, reflecting shifts in sympathetic-parasympathetic balance that vary across hormonal states and life stages. Estrogen is generally associated with enhanced vagal modulation and higher HRV, whereas progesterone and estrogen withdrawal are linked to reduced vagal modulation and relatively greater sympathetic activation, patterns that are especially pronounced during the luteal phase, pregnancy progression, postpartum, and menopause. Complementary measures provide additional insight: EDA indexes sympathetic arousal and captures hormonally driven changes in emotional reactivity, while EEG reflects cortical dynamics underlying affective style, cognitive control, and stress sensitivity. Current evidence suggests that multimodal HRV-EDA-EEG assessment may provide a more comprehensive physiological characterization of stress-related autonomic and cortical regulation by integrating complementary signals across central and peripheral systems. However, its clinical and predictive utility remains to be established in longitudinal, hormone-informed studies.

By consolidating findings across key female life stages, this review highlights how hormonal modulation of ANS-brain interactions contributes to sex-specific stress profiles and psychiatric risk. We conclude that multimodal physiological assessment represents a promising research framework for characterizing women's stress physiology, while its translation into personalized prevention or intervention strategies requires further validation through standardized, longitudinal, and hormone-informed studies.