The Menstrual Cycle and Exercise Performance

Ovarian hormones oestrogen and progesterone exert their physiological effects by binding to specific receptors, namely, oestrogen receptors and progesterone receptors (Davis & Hackney, 2017). These receptors are found in many tissues, including the musculoskeletal system (bone, ligaments, tendons, muscles), as well as the cardiovascular, respiratory, and central nervous systems. As a result, changes in oestrogen and progesterone across the menstrual cycle can influence multiple physiological systems, all of which are important for exercise performance. Constantini et al. (2005) proposed a framework showing the different components of exercise performance that could be affected by the menstrual cycle. This model helps explain how hormonal fluctuations could impact strength, aerobic, and anaerobic performance. For example, oestrogen is thought to have anabolic effects on skeletal muscle (Alexander et al., 2022; Chidi-Ogbolu & Baar, 2019; Lowe et al., 2010) and is linked to shifts in metabolism, including better muscle glycogen storage and increased fat use during endurance exercise (Boisseau & Isacco, 2022; Hackney et al., 2021). In contrast, progesterone may have anti-oestrogenic effects (Frankovich & Lebrun, 2000). These hormonal changes suggest that performance may vary across the menstrual cycle. Together, these hormonal dynamics suggest that variations in performance across the menstrual cycle are plausible and could be driven by the changing ovarian hormone profiles that characterise each phase.

Although it is possible that changes in ovarian hormones could exert either positive or negative effects on exercise performance, whether these changes lead to measurable differences in exercise performance is unclear. Current evidence is inconsistent and, at times, conflicting. Some studies report improved performance in specific phases, such as the early follicular (Campbell et al., 2001; Pallavi et al., 2017; Tenan et al., 2016), late follicular (Bambaeichi et al., 2004), and mid-luteal phases (Ekenros et al., 2013; Oosthuyse et al., 2005). Other studies found no differences in performance across the cycle (Casazza et al., 2002; De Jonge et al., 2001; Dibrezzo et al., 1988; Elliott et al., 2003; Vaiksaar et al., 2011). Recent narrative (Carmichael et al., 2021) and systematic reviews (Blagrove et al., 2020; McNulty et al., 2020) have aimed to identify, evaluate, and synthesise the available evidence on the effects of menstrual cycle phase on exercise performance. Notably, McNulty et al. (2020) conducted a systematic review and meta-analysis of 78 studies and found that, on average, strength and endurance performance might be slightly lower during the early follicular phase compared to other phases. Focusing exclusively on strength-related outcomes, Blagrove et al. (2020) similarly found only small to trivial effects of hormone fluctuations on strength performance. However, it is important to note that both reviews consistently highlight the low overall quality of evidence in this area and the substantial variability (e.g., methodology, findings etc) between studies. 

From a practical standpoint, current evidence does not justify broad or prescriptive recommendations on modulating exercise performance based on menstrual cycle phase. For instance, at present there is no strong evidence to suggest that performance will be reduced or enhanced during any menstrual cycle phase. Therefore, until more robust, high-quality research becomes available, it is advised that female athletes, and coaches working with them, should be aware of the cycle’s potential effects, but adjustments should be individualised based on each athlete’s experiences and responses.

Other factors might also influence performance, including athletes’ perceptions and cycle-related symptoms. Specifically, it is reported that between 36 to 93% of sportswomen perceive that their menstrual cycle influences their ability to perform (Armour et al., 2020; Bruinvels et al., 2021; Findlay et al., 2020; Heather et al., 2021; Martin et al., 2018; Solli et al., 2020). Supporting this, a narrative review found that approximately 71% of female athletes felt their performance was impaired during specific phases of their menstrual cycle (Carmichael et al., 2021). One possible reason for these perceived effects could be the influence of cycle-related symptoms. For instance, the cyclic fluctuations in ovarian hormones across the menstrual cycle have been associated with a variety of physical (e.g., period pain, breast pain and bloating) and psychological (e.g., mood changes, anxiety and irritability) symptoms (Dickerson et al., 2003; Ferries-Rowe et al., 2020; Yonkers et al., 2008), which are likely to be incompatible with optimal performance in female athletes. 

Existing research indicates that such cycle-related symptoms are common among naturally menstruating, physically active women (Armour et al., 2020; Brown et al., 2021; Bruinvels et al., 2021; Chica-Latorre et al., 2025; Crawford er al., 2025; Findlay et al., 2020; Martin et al., 2018; Nolan et al., 2022) and are often associated with negative perceptions of exercise performance, particularly during the early follicular phase (McNulty et al., 2023). Finally, real world factors such as menstrual stigma, kit/uniform choices, access to toilets, access to period products, and waste disposal can also influence performance as has been observed in recreational settings (Kolić et al., 2024). Furthermore, lifestyle factors including sleep, nutrition, and stress, which share a bi-directional relationship with ovarian hormones, might further modulate performance outcomes throughout the cycle (McNulty et al., 2021). Collectively, these findings underscore the importance of considering all facets of menstrual cycle influences, rather than focusing solely on the physiological effects of ovarian hormones, when aiming to optimise performance in female Rugby players.

Coaching Tips:

• Be aware that hormone changes during the menstrual cycle might influence performance, but this is different for every athlete, so any changes should be looked at and managed for each person individually.
• Pay attention to how each athlete feels about their menstrual cycle and any symptoms they experience, not just the hormone changes, to get a full understanding.
• Address environmental and social barriers, such as access to period products or uniforms (e.g., white shorts), as they can directly impact performance.