Training performance variations across menstrual cycle phases in female athletes and current approaches

Acta Scientiae et Intellectus Volume: 10, No: 1, Year: 2024, pp.: 75-91 E-ISSN: 2519-1896 URL: https://actaint.com/ Acta Scientiae et Intellectus, 10 (1), 75-91 ASI Training performance variations across menstrual cycle phases in female athletes and current approaches Esin Çağla ÇAĞLAR1 1Hitit University, Faculty of Sport Sciences, Çorum, Türkiye Review Article DOI: 10.5281/zenodo.17464411 Received: 20.01.2024 Accepted: 19.03.2024 Published: 21.03.2024 Abstract This review examines variations in training performance across menstrual cycle phases in female athletes in light of current evidence and offers practice-oriented recommendations. Fluctuations in estrogen and progesterone during the menstrual, follicular, ovulatory, and luteal phases may influence energy metabolism, neuromuscular control, thermoregulation, pain perception, and recovery processes; however, performance outcomes appear heterogeneous due to individual differences and methodological variability. Evidence suggests greater readiness for strength, power, and technical skills in the follicular phase; short-term advantages in coordination and speed around ovulation; and increased thermal strain, perceived exertion, and hydration demands in the luteal phase. Major sources of inconsistency in the literature include differences in phase verification methods, limited sample sizes, insufficient control of contraceptive use, and heterogeneity in testing schedules and environmental conditions. From an applied standpoint, integrating phase-aware and individualized load–recovery planning with nutrition and hydration strategies and symptom management protocols is recommended. Future research should prioritize standardized phase verification, sport-specific comparative designs, longitudinal monitoring, and multimodal data integration via wearable technologies to advance hormone-informed personalized periodization approaches Keywords: Menstrual cycle; female athletes; training performance INTRODUCTION The increase in the number of female athletes has reopened debate in sports science on a long-neglected topic: the determinant role of female physiology in training planning. Most existing models of athletic performance have historically been based on male physiology; consequently, biological variables specific to the hormonal cycles of female athletes have often been adapted to generic training regimens. However, the menstrual cycle is a multidimensional process that influences a broad biological spectrum, ranging from energy production and muscle tissue adaptation to neuromuscular coordination and thermoregulation (Oosthuyse et al., 2022). Therefore, the physiological response to training loads in female athletes may differ significantly depending on the phase of hormonal changes. The menstrual cycle is typically conceptualized in four main phases: menstrual, follicular, ovulatory, and luteal. During these phases, estrogen and progesterone levels are secreted at varying rates, shaping the organism's metabolic, neuromuscular, and psychological responses. While positive stimuli for muscle strength, endurance, and neuromuscular coordination emerge during the follicular phase, characterized by rising estrogen, the luteal phase, dominated by progesterone, may negatively impact performance due to increased body temperature, impaired hydration balance, and heightened perceived exertion (Bruinvels et al., 2022). These Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 76 ASI distinctions manifest not only at the level of energy metabolism but also in post-training recovery processes. Factors such as muscle glycogen replenishment, pain threshold, and sleep quality are also suggested to be closely associated with hormonal fluctuations (Kissow et al., 2022). However, research on the effects of menstrual cycle phases on performance has not yielded consistent results. Some studies have reported that phase-based training planning provides positive effects on muscle strength and hypertrophy (Kissow et al., 2022), whereas other studies have shown that training performed in different phases does not create a significant difference in performance determinants (Taylor et al., 2024). One of the main reasons for these inconsistencies lies in the variation of phase verification methods used across studies. While some studies determine the phase based on participant self-report using the calendar method, others employ luteinizing hormone tests or serum hormone measurements. This methodological heterogeneity limits the generalizability of results and may lead to misinterpretations in phasebased comparisons (Meignié et al., 2021). Furthermore, differences in sample characteristics and sport-specific training structures also contribute to the variability of outcomes. Physiological responses of elite endurance athletes cannot be evaluated in the same manner as those of female team sport athletes. Additionally, uncontrolled variables such as contraceptive use, training intensity, sleep, and nutrition make it difficult to directly observe hormonal effects. Therefore, understanding the relationship between the menstrual cycle and performance requires not only analyzing hormonal fluctuations but also holistically evaluating their interaction with training load, recovery capacity, and psychophysiological responses. This study aims to systematically examine the growing body of literature in recent years and to reveal, in light of current evidence, the variations in training performance of female athletes across the phases of the menstrual cycle. By addressing methodological discrepancies and inconsistencies among findings in the literature, it seeks to develop a comprehensive understanding of how hormonal fluctuations influence athletic performance and to provide practice-oriented recommendations based on this integrative perspective. METHOD Research group (population-sample) Since this study is a narrative literature review, no human participants were involved. Accordingly, ethical approval was not required. The review was conducted by examining peerreviewed articles focusing on the effects of menstrual cycle phases on athletic performance in female athletes. Data collection tools Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 77 ASI The data collection tools consisted of electronic databases and digital scientific repositories. The primary databases searched were PubMed, Scopus, Web of Science, Google Scholar, and ResearchGate. Search terms included “menstrual cycle,” “female athletes,” “training performance,” “hormonal fluctuation,” “estrogen,” “progesterone,” “periodization,” and “recovery.” Boolean operators (AND, OR) were used to refine and combine keywords. Data collection/processing method Articles published between 2015 and 2025 were systematically screened. Only peer reviewed journal papers written in English were included. Inclusion criteria were: 1. Studies examining menstrual cycle phase–based variations in performance or physiology, 2. Studies involving healthy, eumenorrheic female participants or athletes, and 3. Reviews or experimental studies addressing hormonal mechanisms, performance metrics, or applied training recommendations. Data analysis A descriptive synthesis approach was adopted. Findings from the selected studies were compared in terms of performance domains (strength, endurance, coordination, recovery) and analyzed across menstrual cycle phases (menstrual, follicular, ovulatory, luteal). Methodological variables—such as phase verification methods, sample characteristics, contraceptive control, and sport type—were extracted and summarized in Table 1. The analysis emphasized the identification of common patterns, methodological inconsistencies, and applied recommendations rather than statistical aggregation, consistent with the narrative review framework. FINDINGS Physiology of the menstrual cycle and hormonal mechanisms The menstrual cycle is one of the fundamental biological processes that regulates the physiological rhythm of female athletes. Lasting approximately 28 days, this cycle is controlled by the hypothalamic–pituitary–ovarian axis, whose hormonal feedback mechanisms trigger a series of physiological changes that can directly influence athletic performance. Throughout the cycle, fluctuations in estrogen and progesterone levels play a decisive role in various parameters—from muscle tissue energy utilization and body temperature to pain threshold and recovery processes (Oosthuyse et al., 2022). Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 78 ASI In the early days of the follicular phase, estrogen levels are relatively low; during this period, menstrual bleeding continues, and the body primarily relies on carbohydrate-based energy metabolism. As the cycle progresses and estrogen levels rise, protein synthesis in muscle tissue is stimulated, neuromuscular efficiency increases, and there is a shift toward greater lipid oxidation for energy utilization (Kissow et al., 2022). This process also helps preserve intramuscular glycogen stores and supports a more sustainable balance in energy production. Elevated estrogen levels improve blood flow within muscle tissue, facilitating oxygen transport and accelerating post-exercise microtissue repair. Consequently, performance during strength and power training may be expressed more efficiently (McNulty et al., 2020). Moreover, the increase in estrogen contributes to protecting the muscle membrane from damage, thereby enhancing recovery potential. During the ovulatory phase, estrogen reaches its peak level, followed shortly by a rise in progesterone. This transitional period represents a critical stage for thermoregulation; body temperature slightly increases, fluid and electrolyte balance shifts, and heat tolerance may decrease. As a result, performance reductions can be observed during high-intensity exercise in hot environments (Bruinvels et al., 2022). Additionally, heart rate variability may decrease, and the cardiovascular load can increase, requiring careful attention to aerobic endurance capacity. However, the surge in neuromuscular activation associated with elevated estrogen contributes to improved reflex speed and muscle contraction efficiency. Consequently, this phase may provide an advantage in activities demanding short bursts of power and agility. Therefore, it can be regarded as a dual-faceted period for performance—one that carries both potential risks and opportunities. With the transition to the luteal phase, progesterone becomes the dominant hormone, leading to notable shifts in metabolic processes. The body increasingly relies on fat oxidation for energy production; however, basal body temperature and heart rate also rise during this period. The elevated thermal load causes the cardiovascular system to expend more energy and increases oxygen consumption during exercise. This can result in an earlier onset of fatigue, particularly during prolonged endurance activities. As thermal stress intensifies, endurance performance may decline, hydration balance may be disrupted, and perceived exertion tends to increase (Taylor et al., 2024). Moreover, the sedative effect of progesterone on the central nervous system can slightly delay motivation and reaction times. Progesterone also contributes to ligament laxity, which may elevate the risk of injury in joints such as the knees and ankles (Antero et al., 2023). Therefore, managing training intensity, maintaining proper hydration Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 79 ASI strategies, and incorporating proprioceptive exercises during the luteal phase may help sustain performance continuity and reduce injury risk. At the biological level, estrogen enhances mitochondrial function in muscle cells, increases oxidative capacity, and supports antioxidant defense, whereas progesterone can suppress some of these effects. The opposing actions of these two hormones form the fundamental mechanism underlying performance variations across the menstrual cycle. From a neuromuscular perspective, estrogen facilitates synaptic transmission, thereby improving reflex speed and muscle activation, while progesterone’s inhibitory influence may slow motor responses (Oosthuyse et al., 2022). The physiology of the menstrual cycle determines performance fluctuations not merely through the absolute levels of hormones but through the dynamic interaction between them. Differences in performance observed between cycle phases stem from shifts in energy substrate utilization, variations in neuromuscular excitability, changes in pain threshold, and alterations in thermoregulation. Therefore, considering menstrual cycle phases in training design for female athletes should be viewed as an essential strategy for enhancing physiological adaptation and minimizing injury risk. Figure 1. Menstrual cycle phases and performance mechanisms in female athletes Effects across performance domains Hormonal fluctuations observed throughout the menstrual cycle can influence female athletes’ performance not only in terms of energy production or strength output but also with respect to neuromuscular coordination, recovery, and psychophysiological responses. However, these effects vary depending on the phase of the cycle, individual hormonal responsiveness, and training intensity (McNulty et al., 2020). The following sections outline the key aspects of these variations across different performance components. Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 80 ASI The follicular phase of the menstrual cycle is characterized by a gradual increase in estrogen levels, which supports protein synthesis within muscle tissue and enhances mitochondrial energy production. Several studies have reported that strength training performed during this phase leads to more pronounced muscle hypertrophy and improved neuromuscular efficiency (Kissow et al., 2022). Electromyographic data indicate that motor unit activation is higher, muscle contraction velocity is increased, and fatigue threshold occurs later in the follicular phase (Moore et al., 2024). These outcomes can be attributed to estrogen’s facilitative effect on synaptic transmission and its role in enhancing oxidative capacity. In contrast, as progesterone becomes dominant during the luteal phase, alterations in intracellular calcium regulation may disrupt the coordination of muscle activation. Consequently, high-intensity strength training conducted during the luteal phase may yield lower efficiency and performance outcomes (Antero et al., 2023). Findings related to endurance performance present a more inconsistent picture. Due to estrogen’s glycogen-sparing effect, studies have reported that during the follicular phase, energy efficiency improves, and oxidative metabolism operates more effectively in prolonged aerobic exercise (Oosthuyse et al., 2022). However, some controlled studies have found no significant differences in endurance performance across menstrual phases (Taylor et al., 2024). Such discrepancies may stem from variations in hormonal levels, environmental conditions, temperature, hydration status, and individual hormonal thresholds. During the luteal phase, increased body temperature and thermoregulatory strain may contribute to decreased performance in endurance activities performed in hot environments. Conversely, enhanced cardiovascular efficiency in the follicular phase can positively influence heart rate stability and oxygen utilization during prolonged exercise (Bruinvels et al., 2022). Therefore, phase-based variations in endurance performance should be understood as a multilayered process shaped by the interplay of biological, environmental, and psychological factors. From the perspective of skill, coordination, and motor control, subtle yet distinct differences can be observed across the phases of the menstrual cycle. During the ovulatory phase, the stimulatory effects of estrogen on the central nervous system may enhance reflex speed and sensory perception. This can create a short-term performance advantage in sports where technical precision, balance, and reaction time play a critical role (Domínguez-Muñoz et al., 2024). Estrogen’s facilitative effect on synaptic transmission improves the rate of muscle activation and motor unit synchronization, resulting in smoother motor control, particularly in coordination-dependent tasks. Athletes have been reported to exhibit higher accuracy scores in Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 81 ASI balance assessments and reaction time tests during this phase. In contrast, the elevated progesterone levels of the luteal phase exert an inhibitory influence on the central nervous system, which can slow motor conduction velocity and reduce proprioceptive sensitivity. This period may be characterized by delayed reflex responses, reduced movement accuracy, and minor disruptions in muscle contraction timing. Such neuromotor delays may lead to performance instability, especially during movements involving rapid direction changes or sudden stops. Studies have shown increased error rates and prolonged reflex response times in motor accuracy tests during this phase (Arslan & Ercan, 2025). Moreover, progesterone’s relaxing effect on ligament tissue can negatively affect joint stability, increasing susceptibility to knee and ankle injuries (Antero et al., 2023). These findings indicate that the menstrual cycle represents a complex neurophysiological mechanism influencing not only energy metabolism but also neuromuscular communication. Therefore, when designing training programs according to menstrual phases, it is crucial to consider not only physiological parameters but also the phase-specific sensitivity of motor skill and coordination components to ensure performance consistency. Recovery, sleep quality, and perceived exertion (RPE) levels are also closely associated with the menstrual cycle. The antioxidant and membrane-protective properties of estrogen contribute to accelerated post-exercise recovery during the follicular phase. In this phase, inflammatory responses within muscle tissue are reduced, muscle damage repair occurs more rapidly, and energy stores are replenished more efficiently. In contrast, the rise of progesterone during the luteal phase exerts a sedative effect on the central nervous system, which may reduce sleep depth and lead to decreased morning heart rate variability (HRV) values (Seddik et al., 2025). These physiological changes can increase fatigue perception and prolong the duration of muscle damage. Some studies have reported higher delayed-onset muscle soreness (DOMS) scores and elevated RPE values during the luteal phase (Solli et al., 2020). Therefore, reducing training load or prioritizing recovery-focused sessions during this period may be beneficial for maintaining performance continuity. Overall, the effects of menstrual cycle phases on performance are not unidirectional. Even within the same phase, individual hormone levels, lifestyle factors, training history, and psychological state play a decisive role in determining performance outcomes. The primary reason for the inconsistencies observed in the literature lies in this individual and methodological variability. Therefore, when developing a phase-based training approach for Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 82 ASI female athletes, it is essential to consider not only the biological phase itself but also the athlete’s unique physiological response profile. Figure 2. Summary of menstrual cycle phase-specific effects on athletic performance Methodological differences and limitations in the literature Studies examining the effects of menstrual cycle phases on athletic performance are notable not only for the diversity of their findings but also for their methodological discrepancies. A substantial portion of the conflicting results in the literature arises from inconsistencies in phase verification techniques. In some studies, menstrual phases have been determined solely through the calendar method, relying on participants’ self-reports. While this approach is practical, its reliability is limited due to the natural interindividual variability in hormonal fluctuations. In contrast, objective methods such as luteinizing hormone (LH) testing, basal body temperature (BBT) tracking, or serum hormone assays enhance phase accuracy but are more difficult to implement (Meignié et al., 2021). Particularly in field-based studies or those with large sample sizes, the use of such biochemical verification tools remains limited. This leads to ambiguity in phase classification and, consequently, significant constraints on the comparability of results (McNulty et al., 2020). These methodological challenges affect not only measurement reliability but also raise questions about how findings may vary according to participant characteristics. Indeed, participant profiles represent another crucial factor influencing the consistency of outcomes. Participant profiles constitute another critical variable influencing the consistency of results. Some studies have included elite-level athletes, while others have examined recreational or amateur female participants. Elite athletes may possess a higher adaptive capacity to hormonal fluctuations due to their consistent training histories, whereas individuals with lower Cited in: Caglar, E. C. (2024). Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 83 ASI training experience tend to exhibit more pronounced performance variations (Antero et al., 2023). Consequently, even tests conducted within the same menstrual phase may yield differing outcomes depending on the participant group. Moreover, certain studies have focused exclusively on endurance athletes, while others have evaluated strength-based, aesthetic, or team sports collectively. This heterogeneity makes it difficult to clearly distinguish the sportspecific effects of menstrual phases (Meignié et al., 2021). Therefore, participant diversity not only limits the generalizability of findings but also directly affects methodological consistency in phase-based comparisons. Another critical variable is the use of hormonal contraceptives. Combined oral contraceptives suppress estrogen and progesterone levels, thereby largely eliminating hormonal fluctuations. However, in some studies, participants using contraceptives were included in analyses without proper control or separation. This has led to the evaluation of naturally cycling women and contraceptive users within the same category, effectively masking the impact of hormonal differences (Antero et al., 2023). Moreover, athletes using contraceptives may exhibit distinct physiological responses in terms of muscle hypertrophy, recovery processes, or pain perception, further limiting the generalizability of findings (Oosthuyse et al., 2022). At this stage, it is also essential to consider not only hormonal factors but the influence of measurement conditions on outcomes. Indeed, the timing of performance assessments and environmental conditions represent additional determining factors that can significantly affect results. Conducting exercise tests at different times of day can lead to deviations in parameters such as heart rate variability (HRV) and body temperature. When diurnal hormonal fluctuations are not accounted for particularly during the luteal phase, where thermoregulation plays a significant role endurance data may become misleading (Seddik et al., 2025). Similarly, studies that fail to control for environmental variables such as ambient temperature, humidity, and altitude tend to exhibit weaker internal validity when evaluating phase differences. Sample size and statistical power also represent key limitations within the literature. Most existing studies have been conducted with small samples ranging from 15 to 30 participants, making it difficult to detect statistically significant differences between menstrual phases (Taylor et al., 2024). 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Training performance variations across menstrual cycle phases in female athletes and current approaches. Acta Scientiae et Intellectus, 10 (1), 75-91. 91 ASI CONTRIBUTION RATE EXPLANATION CONTRIBUTORS Idea or Notion Form the research hypothesis or idea Esin Çağla ÇAĞLAR Design To design the method and research design. Esin Çağla ÇAĞLAR Literature Review Review the literature required for the study Esin Çağla ÇAĞLAR Data Collecting and Processing Collecting, organizing and reporting data Esin Çağla ÇAĞLAR Discussion and Commentary Evaluation of the obtained finding Esin Çağla ÇAĞLAR Statement of Support and Acknowledgment No contribution and/or support was received during the writing process of this study. Statement of Conflict Researchers do not have any personal or financial conflicts of interest with other people and institutions related to the research. Statement of Ethics Committee Ethical approval was not required for this study as it is a narrative review that involved no human participants or animal subjects. This study is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY 4.0).