Association of Haematological and Haemostatic Parameters with Female Reproductive Hormones: A Systematic Review and Research Synthesis of Mechanisms, Clinical Correlations, and Implications for Practice

Abstract

Background: Female reproductive hormones exert systemic effects extending beyond reproductive physiology to influence hematopoiesis, immune regulation, endothelial integrity, and haemostatic balance. Cyclical and life‑stage hormonal variations significantly alter haematological and coagulation parameters.

Objective: To systematically review and synthesize evidence on the association between female reproductive hormones and haematological and haemostatic indices, including mechanistic pathways and clinical implications.

Methods: A systematic review of peer‑reviewed literature was conducted using electronic databases (PubMed, Scopus, ScienceDirect, and Google Scholar). Studies assessing associations between oestrogen, progesterone, FSH, LH, prolactin and haematological (RBC indices, WBC counts, platelet parameters) and haemostatic variables (coagulation factors, anticoagulant proteins, fibrinolysis markers) were included. Mechanistic, observational, and interventional studies were synthesized narratively.

Results: Oestrogen enhances erythropoiesis through upregulation of erythropoietin gene expression and bone marrow responsiveness, increases hepatic synthesis of coagulation factors, reduces anticoagulant activity, and modulates endothelial nitric oxide pathways. Progesterone influences leukocyte distribution, promotes immune tolerance, and modulates platelet reactivity. Pregnancy induces haemodilution, physiological anaemia, leukocytosis, gestational thrombocytopenia, and marked hypercoagulability. Combined hormonal contraceptives increase thrombotic risk via elevated fibrinogen, factor VII, and activated protein C resistance. Menopause is associated with increased inflammatory markers, altered lipid profile, and prothrombotic tendency.

Conclusion: Female reproductive hormones significantly regulate haematological and haemostatic systems through complex endocrine‑hematologic interactions. Consideration of hormonal status is essential in laboratory interpretation, thrombotic risk assessment, and clinical decision‑making.