Can the menstrual cycle affect exercise performance?

There is speculation that the rise and fall of hormones throughout the menstrual cycle could affect exercise performance. Put very simply, one prevailing theory is that performance may be enhanced during the late follicular phase, when menstruation and its potential accompanying symptoms are gone and estrogen (an anabolic hormone) is high, compared to the luteal phase, when progesterone is elevated, which may counteract the actions of estrogen, increase body temperature, and negatively affect recovery and neuromodulation.^[1] However, whether exercise performance fluctuates alongside these hormonal shifts likely depends on the individual. For example, some people find that the symptoms of menstruation, like cramping and gastrointestinal discomfort, interfere with their ability to engage in athletic pursuits (especially if they suffer from dysmenorrhea or PMS), whereas other people are unaffected by menses.^[2] This heterogeneity makes it difficult to prescribe general guidelines regarding exercise and the menstrual cycle.

In fact, studies on the menstrual cycle and exercise performance have failed to find robust and consistent differences between performance (strength or aerobic) at different phases of the menstrual cycle.^[3] A 2020 meta-analysis reported that in eumenorrheic female athletes, there may be a trivial reduction in exercise performance during the early follicular phase (the time of menses).^[4] Other studies find that muscle recruitment and recovery may be impaired during the luteal phase, when progesterone is at its peak, but that this does not necessarily affect performance.^[3][5] Nonetheless, menstrual-related symptoms can negatively affect a person’s perception of their performance, mental sharpness, and balance.^[6] Studies of higher quality are needed to determine whether training based on menstrual cycle phases provides added benefit over that of a well-structured exercise program.

Similarly, there is insufficient evidence that the risk for exercise-related injuries (particularly ligament injuries) varies across the menstrual cycle, but it is possible that hormonal fluctuations increase the risk for injuries.^[7][8][9]