Autonomic Nervous System Regulation in Women: Electrophysiological Signatures of Stress Reactivity Across the Female Lifespan.
BACKGROUND 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). SUMMARY HRV emerges as a core biomarker 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 sympathetic dominance and reduced HRV, 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. Evidence indicates that multimodal HRV-EDA-EEG approaches improve detection of stress-related vulnerability by integrating autonomic and cortical signatures rather than relying on a single system. KEY MESSAGES By consolidating findings across key female life stages, this review highlights how hormonal modulation of ANS-brain interactions contribute to sex-specific stress profiles and psychiatric risk. We conclude that multimodal physiological assessment holds substantial promise for advancing personalized prevention and intervention strategies in women's mental health, while emphasizing the need for standardized methodologies, longitudinal designs, and hormone-informed analytic frameworks in future research.