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For research design, this supports the need to systematically verify cycle phase with hormonal or ovulatory markers, explicitly report cycle characteristics, and—where feasible—stratify or adjust for phase, rather than excluding women or treating the menstrual cycle as statistical “noise.” It also highlights the need for multi-system study designs that incorporate endocrine, immune, microbiome, and behavioral readouts, and for sex-specific analyses that recognize that “female vs
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