Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

RESEARCH ARTICLE

Female reproductive health in long-duration space

missions: a narrative review of current challenges

José Santos Herrada-Torres1,2

Lizbeth Kely Castro-Gaona3

Lynn A. Quintana-García4

Dayana Kelly Reyes-Lezama5

Magdalena Michely Vargas-Maucaylle6

Fabrizio Manuel Sanchez-Medina6

Jhareth Ariana Perez-Velasquez3

Angie Shirley Mendoza Pariona7

1Universidad de Huánuco. Huánuco, Perú

2Universidad Nacional de Ucayali. Ucayali, Perú

3Universidad Cientíﬁca del Sur. Lima, Perú

4Instituto de Ciencias Biomédicas de la Universidad Ricardo Palma. Lima, Perú

5National University of San Marcos. Lima, Perú

6Universidad de San Martín de Porres (USMP). Lima, Perú

7Universidad Peruana de Ciencias Aplicadas. Lima, Perú

Email: herradatorresjosesantos@gmail.com

Received: 23/04/2026 •Revised: 14/05/2026 •Accepted: 07/06/2026

Abstract

Female reproductive health represents a critical dimension of long-duration spaceﬂight.

This narrative review examined the impacts of space exposure, prolonged micro-

gravity, cosmic radiation, and circadian rhythm disruption on female fertility and

maternal–fetal health during space missions. A search was conducted in high-impact

databases, and gray literature was also considered. The available evidence suggests

that microgravity and radiation could suppress progesterone levels, reduce the ovarian

reserve, or induce a nonreceptive endometrial phenotype. Furthermore, dysregulation

of the hypothalamic–pituitary–gonadal (HPG) axis and gamete degradation could pose

critical threats to conception and fetal development. Current mitigation strategies re-

main insuﬃcient; hormonal contraception and assisted reproductive technologies have

been explored, but they lack validation under real-world spaceﬂight conditions. These

ﬁndings underscore the urgent need for biomedical protocols, regulatory frameworks,

and ethical standards that enable safe and inclusive space missions.

Keywords: Cosmic radiation, female reproductive health, microgravity, spaceﬂight,

space medicine

Cite:

Herrada-Torres, JS., Castro-Gaona, LK., Quintana-García, LA., Reyes-Lezama, DK.,

Vargas-Maucaylle, MM., Sanchez-Medina, FM., Perez-Velasquez, JA., Mendoza Pariona,

AS. (2026). Female reproductive health in long-duration space missions: a narrative review

of current challenges. Revista Cientíﬁca de Astrobiología,3(1), 1–11.

https://doi.org/

10.69976/aspast.v3n1.1

Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

1. Introduction

The advance towards longer-duration space missions and the eventual colonization

of other planets position reproductive health as a fundamental pillar for the survival of

humanity beyond our planet’s atmosphere (Edelbroek, 2019; Sharma et al., 2024). However,

current knowledge about the impact of the spatial environment on the reproductive system,

especially the female reproductive system, is remarkably scarce.

Astronauts face the so-called ”space exposome,”a combination of unique risk factors

that include ionizing radiation, alterations in gravitational forces, and changes in circadian

rhythms (Williams et al., 2009) and temperature variation (Bailey et al., 2025; Williams et

al., 2009), which are diﬃcult to counteract with any conventional shielding model. These

factors can cause physiological, genetic, and epigenetic alterations (Bonanni et al., 2023),

potentially aﬀecting every stage of reproduction, from gametogenesis to the moment of

labor (Jain et al., 2023; Mathyk et al., 2024). In addition, eﬀects such as gravity-induced

muscle atrophy, bone loss, and longer healing times for wounds and fractures have been

described, with repercussions on the human body’s immune response, as well as anorexia

and electrolyte imbalances (Bonanni et al., 2023; Da Silva et al., 2002; Laurens et al.,

2019).

In female reproductive organs, ionizing radiation compromises the integrity of the endo-

metrium and ovarian reserve, whereas microgravity alters the HHG axis, with consequences

for folliculogenesis, ovulation and potentially early embryonic development described in

animal models (Cutigni et al., 2025; Jain et al., 2023; Marin et al., 2025; Mathyk et al.,

2024). Hese eﬀects could not only compromise the individual fertility of astronauts but

also raise questions about possible transgenerational risks not yet quantiﬁed in humans

(Jain et al., 2023; Mathyk et al., 2024).

The lack of immediate access to specialized medical care, coupled with limitations in

the supply of pharmaceuticals and biotechnology, necessitates the development of strategies

capable of addressing reproductive health demands during long-duration space missions.

Analysing these challenges is a crucial step toward ensuring that humanity can become a

safe and sustainable interplanetary species (Edelbroek, 2019; Jain et al., 2023; Mathyk et

al., 2024).

Likewise, despite the increasing participation of women in long-term missions, there is

no up-to-date synthesis with methodological rigor that integrates, with solid statistical

support, the physiological, technological, and ethical challenges of female reproductive

health in deep space. This analysis aims to ﬁll this knowledge gap and examine these

challenges and the strategies available to address them.

2. Body

A narrative review was conducted via a structured search of the scientiﬁc and gray

literature. Search terms in Spanish and English were used to identify scientiﬁc articles, re-

views, and other relevant documents, including “female reproductive health,” “spaceﬂight,

microgravity,” “cosmic radiation,” “ovarian reserve,” “fertility,” “pregnancy in space,”

“menstrual suppression,” and “space medicine.” The search encompassed all literature

published up to March 2026 in the following databases: Scopus, PubMed, and Web of

Science. The gray literature was also identiﬁed via Google Scholar. Documents without an

identiﬁed author or publication date, as well as articles that did not meet the search crite-

ria, were excluded. No restrictions were applied on the basis of language or publication year.

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2.1. Eﬀects of radiation and microgravity on the ovarian reserve

and endometrium

Ovarian tissue is highly radiosensitive (Hughes-Fulford et al., 2024; Mathyk et al.,

2024); a dose of approximately 2 Gy can destroy up to 50% of the primary follicular

reserve, with primordial follicles being the most sensitive (Mishra et al., 2016, 2017).

Studies in animal models have demonstrated that exposure to high-energy particles (HZE)

and neutrons induces oxidative damage, double-strand DNA breaks, and apoptosis in

oocytes and granulosa cells, resulting in dose-dependent depletion of the ovarian reserve,

a greater incidence of ovarian tumors (Magni et al., 2025) and infertility (Mishra et al.,

2017). These results should be interpreted with scientiﬁc caution, given that they come

predominantly from murine models and in vitro platforms whose direct extrapolation to

human reproductive physiology is limited (Hughes-Fulford et al., 2024; Marin et al., 2025;

Mathyk et al., 2024).

It is postulated that, during long-term missions, the female ovarian reserve could

be reduced by up to 50%, which would be associated with a greater risk of primary

ovarian insuﬃciency and premature menopause (Gimunová et al., 2024; Rose, 2022). At

the molecular level, a signiﬁcant decrease in the proliferation and migration of uterine

stromal cells is documented due to a reduction in the activity of the Akt pathway and the

expression of FOXO3a, alterations that converge in a nonreceptive endometrial phenotype

that could interfere with decidualization (Gimunová et al., 2024; Mathyk et al., 2024). This

is compounded by a reduction in the blastocyst formation rate and quality, with DNA

damage and alterations in epigenetic methylation proﬁles (Mathyk et al., 2024; Steller et

al., 2020), as well as interference with meiotic spindle organization and oocyte maturation,

which compromises chromosome segregation (Mathyk et al., 2024). In this context, space

missions involve probable pathophysiological eﬀects on women’s reproductive health, as

described in (Figure 1).

Figure 1

Main risks to female reproductive health

Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

2.2. Hormonal changes and menstrual cycle alterations in exten-

ded missions

The reproductive capacity of females on Earth depends on ﬁnely coordinated neuroen-

docrine regulation via the hypothalamic–pituitary–gonadal axis (see Figure 2). However, a

speciﬁc biological model has not been eﬀectively described in humans; therefore, further

in-depth studies and contributions are needed, as are potential synergies in the space

exposome (Cutigni et al., 2025).

Figure 2

Physiology of the hypothalamic–pituitary–gonadal axis and normal menstrual cycle

It has been proposed that, under microgravity conditions, there is an approximately

12% decrease in luteinizing hormone (LH) levels, a 52 % decrease in progesterone, and

a reduction in the regulation of estrogen receptors in uterine tissue, compromising im-

plantation and pregnancy viability in astronauts (Cutigni et al., 2025; Gimunová et al.,

2024). The environmental stress caused by microgravity and/or ionizing radiation could

substantially impact embryonic and fetal development (Cutigni et al., 2025; Demir et al.,

2025; Holden, 2025). Taken together, these ﬁndings increase myometrial excitability and

intrauterine growth restriction, the likelihood of preterm labor, pregnancy loss, potential

transgenerational eﬀects (Jain et al., 2023), and teratogenesis (Demir et al., 2025).

On the other hand, the reduction in pulsatile oxytocin waves associated with spaceﬂight

(Ronca et al., 2014) is a physiological compensation in response to stress stimuli. Attempts

have been made to link increased psychosocial stress resulting from isolation with circadian

dysregulation, which aﬀects menstrual cycle patterns (Chaloulakou et al., 2022; Cutigni

Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

et al., 2025). Therefore, mental health assessments should not be limited to psychosocial

stress or isolation: factors such as genetic predisposition, prior experience, and emotional

capacity (Chaloulakou et al., 2022), as well as environmental interventions such as the

use of natural landscapes and artiﬁcial windows to simulate the terrestrial environment

(Sanchez Delgado et al., 2025), should be considered.

2.3. Assisted reproduction and reproductive control

Microgravity increases the risk of venous thromboembolism in astronauts undergoing

menstrual suppression treatment with combined oral contraceptives (COCs), a common

practice on space missions (Gimunová et al., 2024). This risk is exacerbated by changes

in blood stasis and plasma viscosity, which are characteristic of spaceﬂight, and by space

adaptation syndrome, which compromises gastrointestinal absorption, reducing the eﬃcacy

of oral contraceptives (Mathyk et al., 2024; Steller et al., 2020). Furthermore, the shift of

ﬂuids toward the head associated with microgravity increases the risk of potentially lethal

clot formation (Steller et al., 2020). This scenario highlights an unresolved paradox: the only

contraceptive methods with evidence of use in space inherently introduce cardiovascular

risks that are ampliﬁed by microgravity.

In the ﬁeld of assisted reproductive technology (ART), space embryo incubators desig-

ned to operate in low Earth orbit are already being developed, which integrate IVF/ART

in an automated manner (Chaplia et al., 2024; Edelbroek, 2019). The use of artiﬁcial

wombs would allow for more eﬀective shielding of fetal development from ionizing radiation

than the maternal body does, eliminating the complications of extreme gravitational

transitions during launch and reentry (Edelbroek, 2019; Mathyk et al., 2024). However,

the automation of IVF via microﬂuidics remains in the experimental phase, without

optimized protocols for chronic exposure to galactic radiation (GCR) or solar particle

events (SPE) (Chaplia et al., 2024; Wu et al., 2024). Spontaneous reproduction during

active missions is considered contraindicated given the physiological stress generated by

radiation, microgravity and pressure variations (Cole et al., 2025; Palmer et al., 2026;

Reguera et al., 2023; Shahbazi, 2020), and space agencies have established operational

policies to prevent mission pregnancy (Gimunová et al., 2024; Jennings & Santy, 1990).

2.4. Scientiﬁc and technological mitigation strategies

The most ambitious proposed mitigation strategies include habitats with artiﬁcial

gravity created by rotation (Jones, 2023); radiation shields based on aluminum, water, or

polyethylene (Steller et al., 2020); molecular-based radioprotectors with gene expression

platforms (Chaplia et al., 2024); and AI-assisted real-time genetic monitoring systems

(Rojas Barnett et al., 2024; Vilhekar et al., 2024). However, none have been validated

in an integrated manner or under real microgravity conditions, which keeps them at the

operational and implementable proposal stage.

In the ﬁeld of in vitro experimental platforms, ovarian organoids and 3D follicular

models have demonstrated the ability to reproduce cellular heterogeneity and basic endo-

crine function and have been proposed for studying radiation damage to human ovarian

tissue (Del Valle & Chuva de Sousa Lopes, 2023; Francés-Herrero et al., 2022; Mathyk et

al., 2024). Microﬂuidic organ-on-a-chip systems ”manage to mimic”a complete 28-day

menstrual cycle, allowing the study of endocrine cross-signalling (Francés-Herrero et al.,

2022; Heidari-Khoei et al., 2020); bioprinted ovary-on-a-chip models using theca and

Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

granulosa cells show sustained estradiol and progesterone production for nearly three weeks

under perfusion, with cell viability exceeding 78% at 27 days (Healy et al., 2021). However,

none of these platforms have been evaluated under actual microgravity or full-spectrum

space radiation (see Figure 3).

Figure 3

Scientiﬁc and technological mitigation strategies

The immediate priority, consistently highlighted in peer reviews, is to transfer these

platforms to simulated microgravity systems and, in a second phase, to the International

Space Station to establish dose–response curves in human ovarian tissue (Gimunová et

al., 2024; Marin et al., 2025; Mathyk et al., 2024). The absence of a longitudinal clinical-

hormonal database of female astronauts prevents any in vitro model from being validated

as representative of the real space environment (Gimunová et al., 2024; Mathyk et al., 2024).

2.5. Management of gynecological emergencies in long-duration

missions

The management of acute gynecological emergencies—ovarian torsion, ectopic preg-

nancy and hemorrhage—represents the scenario of greatest immediate life risk in long-

duration missions and the area where the gap between clinical need and technological

capacity is most pronounced. Unlike missions in low Earth orbit, where medical evacuation

can be carried out in hours, a mission to Mars imposes a structural impossibility of

evacuation, with a communication latency of up to approximately 24 minutes per direction

(Mathyk et al., 2024; Pantalone et al., 2021; Rajput, 2021). Robotic telesurgery, which

is viable in terrestrial contexts (Macias et al., 2025; Rahmah et al., 2025), is technically

unfeasible under that latency for direct control from Earth, which forces a rethinking

of the paradigm toward surgical robots with partial autonomy assisted by AI, delayed

teleassistance and reality (de’Angelis et al., 2022; Macias et al., 2025; Pantalone et al.,

2021). Unresolved issues persist regarding volume, energy, reliability, and crew training,

and there are few speciﬁc data on experimental and analogous surgeries (Mathyk et al.,

2024; Pantalone et al., 2021; Rajput, 2021).

Revista Cientíﬁca de Astrobiología, 3 (1), 1-11 doi: 10.69976/aspast.v3n1.1

2.6. Ethical, social, and legal dimensions

The ethical, legal, and reproductive autonomy dimensions add a layer of complexity

that cannot be resolved solely through technological advancements. Currently, there are

no international treaties regulating human reproduction in space or the legal status of

embryos conceived oﬀ-Earth (Balistreri & Umbrello, 2022; Kendal, 2021). Any assisted

reproductive intervention in space requires the informed consent of the parties involved and

a care infrastructure that includes equipment, trained personnel, and AI integration (Cole

et al., 2025; Mathyk et al., 2024; Waisberg et al., 2023). The possibility of a pregnancy on

mission, whether spontaneous or through ART, including ectogenesis, raises ethical, legal,

and reproductive autonomy questions that remain unanswered (Cole et al., 2025; De Bie

et al., 2023; Horn, 2021).

3. Conclusions

The reproductive health of females on long-duration space missions is a relatively

unexplored and challenging ﬁeld. The eﬀects of the space exposome on the ovarian re-

serve, the hypothalamic–pituitary–gonadal axis, and human embryonic development are

insuﬃciently documented, with evidence largely derived from animal models and in vitro

platforms not validated under real-space conditions. The eﬀects reported in this research

not only compromise fertility viability but also raise questions about the feasibility and

safety of human reproduction during long-duration space exploration. While mitigation

strategies such as artiﬁcial gravity, radiation protection, robotic telesurgery, and organ-

on-a-chip methods are plausible, none have achieved operational validation. Therefore,

more methodologically rigorous research is needed, with a focus on longitudinal human

evidence, experimental validation in real microgravity, emergency surgical protocols, and

international legal regulation.

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