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Cold Exposure for Women Is Safe, but Has a Few Caveats

Cold Exposure Therapy Is as Beneficial for Women as It Is for Men, but With Some Added Precautions

Key Takeaways:

  • Both men and women experience myriad health benefits from cold exposure therapy, including increased longevity, better sleep quality, reduced inflammation, and much more.
  • The marginal difference in benefits between the two sexes isn’t all that important in the aggregate when considering the marked benefit to both.
  • Due to fluctuations in the sex hormones estrogen and progesterone, menstruating women may experience slightly more benefit from cold exposure during the late first half of their cycle when estrogen is at its highest and progesterone at its lowest.
  • Women who should exercise caution or temporarily avoid cold exposure include pregnant women, women with painful menstrual cramping (especially when worsened by cold), and women with significant cardiovascular disease.
  • A cold rinse at the end of a regular shower is a great place to start in the world of cold exposure therapy, rather than doing a whole-body immersion in a freezing body of water.

So you’ve jumped onto the cold plunge train. You’ve started adding 30 seconds of cold water to the tail end of your showers, maybe started doing some cold water swims in the morning, or placing the wrist that ails you in a quick ice bath. You know the drill.

But you may have heard that a lot of the cold therapy research — like many of other fields of health and medical study — has focused a lot on men and assumed they applied to women. 

Even in the studies looking at a more holistic approach to medicine, a focus on men often comes before a focus on women — research on health-optimizing strategies almost always starts with men. Luckily, there’s been some improvement in this area in the last couple of decades, and the body of research that looks at women-specific responses to medicine, diets, and behavioral protocols is growing. There are still some gaps, though.

While there are studies looking at the health benefits of cold stress for both men and women, a precious few look specifically at how a woman’s biochemistry — hormonal fluctuations in menstruating women, in particular — can alter (positively or negatively) the effects of cold exposure or cryotherapy.

Is cold therapy as beneficial for women as it is for men? (yes it can be, and sometimes more so!) What do we know so far, and what still needs examining? The short answer is that we do believe that cold water immersion and other forms of cold exposure therapy can benefit women (as long as you’re not pregnant, which is an important caveat we’ll expand on). Let’s dig into the details.

What the Research Says about Cold Exposure for Women and Female Hormones

Aside from a very small amount of evidence for symptom reduction in menopause, there is no body of research on the benefits of cold water immersion or cold exposure specifically for women’s health issues. However, there are unique hormonal features of female physiology that may change how cold exposure affects women.

If you’ve ever tracked your menstrual cycle, you know that your core temperature varies throughout the month, based on where your body is in its cycle. During the luteal phase (the second half of the menstrual cycle, beginning right after ovulation), a woman’s core body temperature rises by about 0.5-1℉, largely due to the thermogenic effect of the hormone progesterone (it makes you warmer by increasing blood flow to the skin) [1]. 

Once a woman has ovulated, temperatures rise and she is more likely to be able to conceive. If pregnancy occurs, a woman’s temperature remains elevated. If not, progesterone levels decline and cause the core body temperature to decrease again, triggering menses and the start of her next cycle.

A literature review found that, due to the higher resting core body temperature at the luteal phase, a woman’s cold response was more protective during that phase. When the air temperature was rapidly decreased from 32°C to 12°C, women in their luteal phase (and those on oral contraceptives) started shivering at higher core body temperatures indicating an increased sensitivity to the cold [1]. 

Since shivering can cut short the effects of brown fat activation with cold exposure, this loosely suggests that women might experience less benefit when progesterone levels are high.

The same review referenced a study that showed that women who were exposed to decreasing air temp (from 30°C to 15°C) put on protective clothes (sweaters, etc) more quickly in their luteal phase compared to their follicular phase [1]. 

However, in the other two weeks of a woman’s cycle, estrogen levels are higher, and cold-induced thermogenesis was significantly increased in women when compared to men. In week two, when estrogen levels peak, this difference was most significant. We can speculate from these findings that during the first half of a woman’s monthly cycle, she may have an edge over men when it comes to cold exposure benefits [1].

It appears that women may be uniquely sensitive to a decrease in temperature, due to natural thermogenesis during the second half of her menses, which likely plays a role in cold exposure benefits. But is this role a benefit or a hindrance?

Benefits of Cold Exposure for Women AND Men

While there is a very small amount of research suggesting that hormonal fluctuations may alter a woman’s response to cold exposure, it’s likely that most women can still benefit from cold exposure (and I work with women who do report benefits in my clinic).

I personally have experienced positive changes to my T3 levels after cold exposure. 

The physical benefits may include [2]: 

  • Improved immune system function/reduced autoimmunity
  • Reduced inflammation
  • Better sleep quality
  • Improved energy 
  • Improved body composition/weight loss (reduction in obesity/white fat) due to increased production of adiponectin (a protein that increases fat burn)
  • Increased brown adipose tissue (brown fat) activation, and nonshivering thermogenesis (which increases calorie expenditure as your body tries to warm up)
  • Increased longevity/lifespan
  • Reduced blood lipids
  • Increased glucose uptake/insulin response
  • Better temperature regulation
  • Reduced pain levels
  • Reduced muscle soreness when practiced post-exercise

The emotional/psychological/spiritual benefits may include [2]: 

  • Better mood/decreased depressive symptoms
  • Improved cognitive/nervous system function (due in part to an increase in norepinephrine)
  • Reduced anxiety
  • Improved sexual desire
  • Increased gratitude/sense of well-being
  • Decreased stress/cortisol (also due in part to norepinephrine release)

These benefits have been born out in the research on both men and women, although the findings vary when it comes to which of the sexes benefits most. A deep dive into the research comparing the effects of men and women shows that we still don’t know conclusively if cold exposure therapy is more beneficial for either sex.

In two studies, cold-induced thermogenesis (metabolic rate) and rate of fat burn were actually improved by a greater margin in women than men [3, 4]. In two others, women seemed to show greater cognitive resilience to the cold and showed promising benefits for concentration and mood [5, 6]. However, there are also studies that showed that men had a greater metabolic, fat-burning, hormonal, and immune response than women [2, 7].

These mixed findings do beg the question, does it really matter if there’s a marginal difference between cold therapy benefits on men vs women if we know that, in general, both experience measurable benefit? I’ll venture to say no, and that the most important takeaway is that cold exposure therapy is likely beneficial to all the sexes. That being said, there are still a few caveats to consider for women specifically: pregnancy, menstrual cramps, and cardiovascular health.

Cold Therapy and Pregnancy

All the benefits of cold exposure notwithstanding, pregnant women — especially those who don’t already have experience with cold therapy — should not practice extreme cold water immersion, as it can significantly alter blood flow to the fetus [8]. 

There is no evidence supporting that cold water immersion is safe in either practiced or unpracticed pregnant women, but a 2020 literature review found that cold water swimming/winter swimming prior to pregnancy may lead to better outcomes for pregnancy when compared to those who didn’t engage in that activity prior to pregnancy [9]. These potential benefits are likely due to the positive effects cold water immersion has on stress response.

Once you become pregnant, consider swapping out your cold plunges with other methods that are much safer for pregnancy and proven to help with a healthy stress response. Consider mindfulness meditation, gentle exercise, and good nutrition as a functional health approach during pregnancy.

It’s well-known that hot tubs and extreme heat exposure during pregnancy are potentially harmful to the fetus. However, the internet offers mixed advice on the topic of cold exposure with so-called “experts” making assumptions that if hot is bad, cold must be good. There’s no evidence to support this. On the contrary, there is evidence to support that too much cold exposure may lead to preterm birth [8]. Despite misinformation on the internet, we cannot extrapolate these findings to say that ice plunges are beneficial — or even remotely safe — during pregnancy. 

Ending your shower with a cold rinse is a significantly safer option than whole-body cold water immersion, as it administers less of a shock to the system with the easy ability to adjust the temperature handle to less extreme temperatures. However, you should always check with your doctor before introducing any type of cold exposure (even a cold rinse) in pregnancy if your body is not used to it. A “cooler” rinse with a less extreme decrease in temperature is probably better than a “cold shower”, but should still be used with caution — especially in women with elevated blood pressure or diagnosed with preeclampsia.

The Caveats of Cold Exposure for Women

Aside from pregnancy, there are a few other circumstances in which avoiding cold exposure is a good idea for women.

A Potential Increase in Menstrual Cramps

The other main concern regarding cold exposure in women that seemed to pop up in the literature was an increased risk of menstrual cramping. A 2022 meta-analysis with 78,068 female students found that primary dysmenorrhea — menstrual cramps with no known underlying condition — may sometimes result from cold exposure during menses (period). Cold exposure during menses, along with eating cold foods during menses, was listed among 10 other unrelated potential risk factors [10].

The risk here is discomfort, which isn’t life-threatening. But it’s worth taking notice to avoid accidentally worsening your cramps. The best advice I can give would be to pay attention to your body if you’re practicing cold therapy on or around your period. If you notice that you’re experiencing unusual or worsening cramps, take a break from the cold therapy next month, and then feel free to resume once your period is complete. There’s no evidence that practicing cold exposure during the other days of the month has any impact on menstrual cramps.

Cold Exposure and Cardiovascular Health Risks

As I mentioned up top in the list of benefits of cold exposure, there are some cardiovascular health-adjacent advantages: reduced blood lipids, reduced inflammation, and reduced stress and anxiety. These are all great things, however, extreme temperatures (in either direction, actually) may pose a cardiovascular risk for those who already have a heart-related condition. And for women, cold exposure may be more risky than for men.

We do need more research in this area to confirm the findings of a small 2022 study of 14 people. This study of 7 men and 7 women introduced participants to cool (16°C), neutral (23°C), or hot (34°C) air temperatures while submersing their left hand and foot first in warm water (35°C) for 5 min. followed by cold water (8°C) for 40 min [11].

After the submersion of their hands and feet in cold water, women experienced greater cardiovascular strain than men, detected by increased heart rate, blood pressure, and cold-induced vasodilation reaction (CIVD) in the fingers and toes. These reactions were worse in the cold environment.

Despite the limitations of this small study, it’s probably wise for women with a history of heart disease to proceed with caution when practicing cold exposure therapy, and it’s probably best avoided for those who have vascular conditions that affect the digits, like Raynaud’s disease. I’d give the same advice as I would to pregnant women. Talk to your doctor first, and if you do want to proceed, end your shower with a cold rinse instead of immersion in cold temperatures.

Quick Note about Hormone Replacement Therapy and Birth Control

So far, I’ve really only focused on women of reproductive age experiencing the natural fluctuations of hormones throughout the month, but many women (across the age spectrum) use hormonal interventions, whether it’s hormonal birth control (HBC) or hormone replacement therapy (HRT).

Progestin (synthetic progesterone) in some HRT regimens and most hormonal birth control may increase core body temperature, while estradiol (synthetic estrogen) in some HRT protocols corresponds with a lower body temperature. These differences will likely create differences in how a woman’s body responds to cold exposure [1]. That being said, it doesn’t mean that cold therapy isn’t worth a try for women on hormonal therapies. The benefits will still be there, even if slightly blunted.

I mentioned at the beginning of this article that, in the luteal phase of a woman’s natural cycle, her core body temperature rises. Unintuitively, this rise makes her more sensitive to cold and more likely to shiver or reach for a sweater at a higher ambient temperature [1]. You might think of the addition of progestin as an artificial luteal phase. And the reverse is true as well, a lowered body temperature created by estradiol (or a drop in progesterone in the case of untreated menopause) leads to less sensitivity to cold—and potentially increased benefits of cold exposure, although more work needs to be done in this area [12].

Importantly, cold exposure may also be quite beneficial for menopausal and post-menopausal women. For menopausal women, the increased temperature regulation benefit may be particularly helpful when it comes to mitigating hot flashes, for example. It’s the rapidly swinging levels of both estrogen and progesterone that account for the vasomotor symptoms (hot flashes and night sweats) in perimenopausal and menopausal women [13].

Should Women Practice Cold Exposure?

The short answer is yes, unless you’re pregnant, experiencing worsened menstrual cramps, or have a heart condition. There’s still work to be done to better understand how monthly hormonal fluctuations may impact the experience of cold exposure for women, but there’s no reason to believe that it’s harmful or not helpful.

Women in the second week of their cycle seem to have a measurable edge over men in the energy expenditure that takes place during thermogenesis (giving them greater metabolic benefit). And in the luteal phase, when progesterone rises, the differences somewhat even out.

Ultimately, the comparisons don’t feel tremendously important when all signs point to a benefit across the sexes. As with anything new, if you’d like to start experimenting with cold therapy, it’s a good idea to talk to a medical professional beforehand, and it’s a good idea to start small. The 30-second cold rinse at the end of your shower is a great place to start.

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➕ References
  1. Baker FC, Siboza F, Fuller A. Temperature regulation in women: Effects of the menstrual cycle. Temperature (Austin). 2020 Mar 22;7(3):226–62. DOI: 10.1080/23328940.2020.1735927. PMID: 33123618. PMCID: PMC7575238.
  2. Esperland D, de Weerd L, Mercer JB. Health effects of voluntary exposure to cold water – a continuing subject of debate. Int J Circumpolar Health. 2022 Dec;81(1):2111789. DOI: 10.1080/22423982.2022.2111789. PMID: 36137565. PMCID: PMC9518606.
  3. Herz CT, Kulterer OC, Prager M, Marculescu R, Langer FB, Prager G, et al. Sex differences in brown adipose tissue activity and cold-induced thermogenesis. Mol Cell Endocrinol. 2021 Aug 20;534:111365. DOI: 10.1016/j.mce.2021.111365. PMID: 34126190.
  4. Niu X, Han P, Tang Z, Huang J, Li L, He H, et al. Cold stress induced a higher level of fat oxidation in women. J Strength Cond Res. 2023 Jan 1;37(1):114–22. DOI: 10.1519/JSC.0000000000004160. PMID: 34711769.
  5. Solianik R, Skurvydas A, Urboniene D, Eimantas N, Daniuseviciute L, Brazaitis M. Similar cold stress induces sex-specific neuroendocrine and working memory responses. Cryo Letters. 2015;36(2):120–7. PMID: 26017291.
  6. Leppäluoto J, Westerlund T, Huttunen P, Oksa J, Smolander J, Dugué B, et al. Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females. Scand J Clin Lab Invest. 2008;68(2):145–53. DOI: 10.1080/00365510701516350. PMID: 18382932.
  7. Néma J, Zdara J, Lašák P, Bavlovič J, Bureš M, Pejchal J, et al. Impact of cold exposure on life satisfaction and physical composition of soldiers. BMJ Mil Health. 2023 Jan 4; DOI: 10.1136/military-2022-002237. PMID: 36599485.
  8. Khodadadi N, Dastoorpoor M, Khanjani N, Ghasemi A. Universal Thermal Climate Index (UTCI) and adverse pregnancy outcomes in Ahvaz, Iran. Reprod Health. 2022 Feb 2;19(1):33. DOI: 10.1186/s12978-022-01344-7. PMID: 35109854. PMCID: PMC8811963.
  9. Gundle L, Atkinson A. Pregnancy, cold water swimming and cortisol: The effect of cold water swimming on obstetric outcomes. Med Hypotheses. 2020 Nov;144:109977. DOI: 10.1016/j.mehy.2020.109977. PMID: 32570161.
  10. Wang L, Yan Y, Qiu H, Xu D, Zhu J, Liu J, et al. Prevalence and Risk Factors of Primary Dysmenorrhea in Students: A Meta-Analysis. Value Health. 2022 Oct;25(10):1678–84. DOI: 10.1016/j.jval.2022.03.023. PMID: 35523614.
  11. Tsoutsoubi L, Ioannou LG, Mantzios K, Ziaka S, Nybo L, Flouris AD. Cardiovascular Stress and Characteristics of Cold-Induced Vasodilation in Women and Men during Cold-Water Immersion: A Randomized Control Study. Biology (Basel). 2022 Jul 13;11(7). DOI: 10.3390/biology11071054. PMID: 36101432. PMCID: PMC9312820.
  12. Metz L, Isacco L, Beaulieu K, Fearnbach SN, Pereira B, Thivel D, et al. Cold-Water Effects on Energy Balance in Healthy Women During Aqua-Cycling. Int J Sport Nutr Exerc Metab. 2021 May 1;31(3):236–43. DOI: 10.1123/ijsnem.2020-0177. PMID: 33588379
  13. 13. Baker FC, de Zambotti M, Chiappetta L, Nofzinger EA. Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes and menopausal symptoms: a pilot study. Behav Sleep Med. 2021;19(5):615–28. DOI: 10.1080/15402002.2020.1826484. PMID: 33040586.

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