Accumulating evidence suggests that the menstrual cycle is underpinned by inflammatory patterns that change in a way that enables maternal control over the selection of viable embryos.
In humans, although results are mixed due to methodological issues, naturally cycling females exhibit menstrual variation in immune function and nonreproductive health.
Female cyclical immunity ought to be considered for understanding phenotypic diversity in female behavioural immunity and reproductive behaviour, male immunity, and the evolution of sex-specific pathogen virulence.
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Why do some females menstruate at all? Answering this question has implications for understanding the tight links between reproductive function and organismal immunity. Here we build on the growing evidence that menstruation is the byproduct of a ‘choosy uterus’ to: (i) make the theoretical case for the idea that female immunity is cyclical in menstruating species, (ii) evaluate the evidence for the menstrual modulation of immunity and health in humans, and (iii) speculate on the implications of cyclical female health for female behaviour, male immunity, and host–pathogen interactions. We argue that an understanding of females’ evolved reproductive system is foundational for both tackling the future challenges of the global women’s health agenda and predicting eco-evolutionary dynamics in cyclically reproducing species.