“From Periods to Peak Performance: How Your Cycle Can Guide Smarter Workouts”

Fitness tips for women at various stages of the menstrual cycle

Society is becoming increasingly open to discussing the menstrual cycle as a natural and essential aspect of women’s health. It can provide information on one’s health status, but did you know it can also guide our exercise and training? 

For the past 50 years, the amount of female collegiate athletes has been increasing. During this time, it has been noted that women tend to experience more injuries compared to their male counterparts. ¹ Various studies have attempted to find correlations in the menstrual cycle and physiological measures to best prevent injury and improve performance. 

First let's do a simple review of the menstrual cycle. 

The menstrual cycle consists of two general phases - Follicular and Luteal phases separated by Ovulation and Menstruation. 

https://www.everydayhealth.com/womens-health/understanding-your-menstrual-cycle/

The follicular phase consists of an increase in follicle stimulating hormone (FSH) then gradual increases in estrogen, promoting ovulation and preparing the uterus for implantation.

Ovulation occurs between the follicular and luteal phases. If the egg (ovum) isn’t fertilized and there is no pregnancy, the luteal phase begins. 

In the luteal phase progesterone levels increase, further preparing the uterus for implantation of the fertilized egg. If there is no pregnancy, progesterone levels significantly drop leading to the sloughing off of the uterine lining, which is menstruation. 

Do these hormonal changes affect a woman’s exercise/athletic performance? Can we use this information to better train? 

Several studies have worked on answering this question resulting in a variety of conclusions. 

One study looked at whether the menstrual cycle affected the rating of perceived exertion (RPE). The RPE is the self perceived rating of exertion with exercise. It has been shown to be correlated with physiological parameters of exercise and is simple to measure as one simply asks the person how hard they feel they are working, typically on a scale of 1-10. This study determined that the stage of the menstrual cycle doesn’t affect the rating of perceived exertion (RPE) in endurance exercises, however in some cases it did affect RPE in hotter and more humid temperatures, specifically in the luteal phase. ²

Another study with a small sample of women looked at their athletic performance (sprint or distance run) during the follicular and luteal phases, as well as non-menstruating vs menstruating days. Although performance times changed slightly (by seconds) for individuals, there were no significant trends in performance when comparing the different phases.¹

Other studies both support and refute these findings. One study of female soccer players found that endurance was better in the follicular stage, but sprinting was unaffected.³

Another study showed that muscle force and fatiguability were better during the follicular phase, likely due to the protective properties of estrogen. ⁴  Better muscle endurance (fatigues less quickly) was noted in both non-menstruating phases compared to the menstruating phase.⁵

Other studies have looked at different hormones or different types of exercise demands. 

Relaxin is a hormone we generally consider more during pregnancy. Relaxin helps increase laxity in the ligaments necessary during pregnancy, however it is present during the menstrual cycle and assists with controlling (minimizing) uterine contractions to build the uterine lining in preparation for pregnancy. It is elevated during the mid-luteal phase and until menstruation begins (approximately day 21-28). It is thought that because of this rise in relaxin, ligaments and muscle may be more prone to injury at this stage of the menstrual cycle.¹

Premenstrual and menstrual symptoms of water retention, bloating, sleep disturbance, mood alterations may all affect training and/or athletic performance along with amount of menstrual bleeding. 

So, how might we apply this knowledge into our workouts? Generally speaking we could train harder and more intensely (HIIT, plyometrics, increases in speed or mileage) after our period or right after ovulation instead of the premenstrual time when we might be more prone to injury due to increases in relaxin and water retention.  Depending on the amount of blood loss and menstrual symptoms such as cramping or sleep pattern changes, one might choose lighter more restorative exercise during the menstrual phase like yoga, pilates, light strength training and stretching. 

✨Foothill Physical Therapy knows that everyone’s experience with exercise is different as well as constantly evolving throughout the lifespan. If you need guidance on how to start exercising anew or return to exercise after pregnancy, injury or it’s just “been a long time” we can help guide you to a healthier, stronger YOU. 

REFERENCES:

1. Tremback-Ball, Amy PT, PhD; Fulton, Kaitlin DPT; Giampietro, Nicole DPT; Gibbons, Megan DPT; Kneller, Arielle DPT; Zelinka, Hayley DPT. Effect of the Menstrual Cycle on Athletic Performance in NCAA Division III Collegiate Athletes. Journal of Women's Health Physical Therapy 45(1):p 20-26, January/March 2021. | DOI: 10.1097/JWH.0000000000000188 

2. Prado, Raul Cosme Ramos MSc1,2; Hackney, Anthony C. PhD, DSc3; Silveira, Rodrigo MSc1; Kilpatrick, Marcus W. PhD4; Takito, Monica Yuri PhD1; Asano, Ricardo Yukio PhD1. Effect of Menstrual Cycle Phase on Perceived Exertion During Aerobic Exercise in Eumenorrheic Women: A Systematic Review and Meta-analysis. Journal of Women’s & Pelvic Health Physical Therapy 48(2):p 91-102, April/June 2024. | DOI: 10.1097/JWH.0000000000000283 

3. Julian, R., Hecksteden, A., Fullagar, H. H., & Meyer, T. (2017). The effects of menstrual cycle phase on physical performance in female soccer players. PloS one, 12(3), e0173951. 

4. Pallavi, L. C., SoUza, U. J. D., & Shivaprakash, G. (2017). Assessment of musculoskeletal strength and levels of fatigue during different phases of menstrual cycle in young adults. Journal of clinical and diagnostic research: JCDR, 11(2), CC11.

5. Fullagar, H. H., Skorski, S., Duffield, R., Hammes, D., Coutts, A. J., & Meyer, T. (2015). Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports medicine, 45(2), 161-186.