The Menstrual Cycle:

Female sex hormone levels at various phases of the menstrual cycle (MC) must be considered in order to improve female athletes' performance and well-being. According to Costello et al. (2014) the majority of research has been centred around the male population.

Eumenorrheic menstruation lasts 21–35 days and helps the uterus prepare for pregnancy. A standard MC has a pair of distinct phases known as the luteal and follicular phase. These steps are controlled by menstruation, ovary growth, ovulation, and the production of corpus luteum (Reed & Carr, 2000). There are distinct phases of the MC outlined in figure 1.

Figure 1: Represents the hormonal phases of a 28-day eumenorrheic cycle McNulty et al. (2020) and Farage et al. (2009) are among the sources.

The MC normally begins at the age of thirteen and lasts until perimenopause, which occurs around the age of 45, with the exception of pregnancy, hormonal contraception (HC), or menstrual disorders (Morabia & Costanza, 1998). It has been stated that 67%-91% of competitive female athletes are eumenorrheic, with approximately fifty percent not using HC (Verrilli et al., 2018). This demonstrates that many female athletes may have hormonal alterations.

 

Mechanisms for Performance Fluctuations?

MCs can impact athletic ability through a variety of mechanisms which will be covered in this blog, including thermoregulation, body composition, substrate metabolism and stimulation of muscles. Female sex hormones have the potential to affect peak force force and force development rates.

 

Thermoregulation:

Studies have indicated that the thermoregulatory set point shift produced by increased progesterone during the luteal phase may affect sprint performance under heat stress, depending on exercise length Girard et al. (2015). Increased muscular contractility and force production during short-duration activities are facilitated by a higher body temperature (Girard et al., 2015).

According to Somboonwong et al. (2015), a sufficient and vigorous warm-up could mitigate the elevated luteal phase baseline body temperature while having no effect on subsequent performance. Increased thermoregulatory and cardiovascular strain following prolonged exercise can result in elevated baseline body temperature, limiting endurance abilities throughout the luteal phase (Janse de Jonge, 2003; Marshall, 1963). Giersch et al. (2020) identified before and after exercise, the luteal phase displays an ongoing rise in the body's internal temperature, although a fact that cooling mechanisms such as skin temperature and sweat rate remain constant.

Tendon Stiffness:

Some researchers examined tendon and muscle stiffness to determine whether the MC phase is a contributory contributor to soft tissue injuries. Several investigations have demonstrated that the MC phase affects tendon stiffness (Sung & Kim, 2018; Yim et al., 2018). Abdelsattar et al. (2018) suggested that lower limb muscle and tendon stiffness influences jumping, hopping and sprinting.

Elevated oestrogen during the MC stages is believed to reduce stiffness by diminishing connective tissue and muscle synthesis of collagen and density (Yim et al., 2018). However, research on tissue stiffness across the MC has shown inconsistent findings (Campbell et al., 2001).

 

Neural Discharge Rate:

According to Gordon et al. (2013), progesterone and oestrogen impact the generation of force in a positive as well as negative manner due to their neuroexcitatory and inhibitory effects on cortical excitability. Del Vecchio et al. (2019) hypothesise that low progesterone during follicular phase improves strength, especially when oestrogen peaks late. A high amount of progesterone diminishes luteal strength. The pace of force development may be affected by the MC phase. Explosive force production is influenced by muscle activation, particularly the rate of discharge of early motor units. A Study by Tenan et al. (2013) found that late luteal phase exhibited greater vastus medialis and oblique initial motor unit firing rates than early follicular phase in the general female population.

ELLIOTT et al. (2003) discovered no differences in strength between the early follicular and mid-luteal phases, despite MC-based testosterone reductions. Athlete performance is enhanced by increased testosterone because it increases motor system function, cognitive activity, and muscular contractility  (Crewther et al., 2011). According to Cook et al. (2018), basal salivary and plasma testosterone levels peak during ovulation. Following exercise, salivary and free testosterone levels rise during the ovulatory and mid-luteal phases. In the ovulatory phase, salivary and plasma testosterone levels rise, which may be greater than in previous MC phases, hence having an impact on strength (Dougherty et al., 1997).

 

Metabolism:

Variations in substrate accessibility and metabolism could impact endurance performance at various stages of the MC. According to research Oosthuyse and Bosch (2010), oestrogen enhances the supply of liberated fatty acids for energy during exercise and promotes lipid oxidation in muscle tissue, while progesterone decreases the oxidation of fat.

In a brief study of recreational athletes, it was discovered that vigorous exercise reduced the oxidation of glucose whilst boosting the oxidation of fat in the mid to late luteal phase relative to the early follicular phase (Zderic et al., 2001). Early follicular phase, when oestrogen is lowest, is connected with metabolic changes. It was documented that submaximal physical activity preserved glucose and lipid oxidation throughout the mid-luteal and late follicular stages (Hackney et al., 1994).

 

Body Composition:

Body composition and mass has been investigated extensively with respect to running performance and can be deemed to have a significant impact on running economy (Maciejczyk et al., 2014). The impact of the MC phases on body composition remains undetermined. Stachoń (2016) found no difference in female athletes' body composition over different MC stages.

According to Stachoń (2016), transitioning from follicular to luteal phase can cause changes in body composition, including increased mass and hydration. This has been highlighted in healthy, non-athletic females; increased total body water (Fruzzetti et al., 2007) and body mass (McKee & Cameron, 1997). It has been proposed that is likely due to reduced insulin in response to progesterone, which amplifies appetite and food consumption (Dye & Blundell, 1997). It has also been suggested that increased levels of aldosterone result in fluid retention, hence impacting performance (Szmuilowicz et al., 2006).

 

Apps to monitor the Menstrual Cycle in Sport:

In professional sports, regular MC phase monitoring is becoming more and more common. Applications allow players to track the start of their periods and other menstrual symptoms. Individual strategies for dealing with cyclic changes in recuperation, sleep, and performance have been continually evolving. These strategies include changing an athlete's  recovery, training, nutrition, sleep, or lifestyle factors depending on recommendations.

 

Athletes Perception of performance during the Menstrual Cycle

Armour et al. (2020) found between 50-71% and 49-65% of respondents claimed that specific MC phases had an impact on their ability to athletically perform. At key MC phases, perceptions of speed, strength, and power altered. Menstrual symptoms are connected with perceived performance reductions in the early follicular and late luteal phases, which are frequently caused by being drained (Armour et al., 2020). Findlay et al. (2020) identified Elite rugby players are concerned about flooding and menstrual pain during the early follicular cycle.

Figure 2. Strength, anaerobic and aerobic performance differed during the MC in the trials included (Carmichael et al., 2021)

Impact of the Menstrual Cycle on Physical Performance

In an in-depth investigation 20 of 35 relevant studies demonstrated that MC did neither help or harm athlete performance, whereas Fifteen concluded that the MC phase impacted at least one result (Carmichael et al., 2021). This clarifies why the MC phase has a little impact upon performance in prior systematic reviews (Blagrove et al., 2020; McNulty et al., 2020). Early follicular performance declined in seven of 24 studies (Forouzandeh Shahraki et al., 2020; Gordon et al., 2013; Graja et al., 2022) and late luteal performance declined in two studies (Rodrigues et al., 2019; Shakhlina et al., 2016). In Figure 2, late luteal phase performance was lowest of all MC phases. reduce female sex hormones, premenstrual condition, or menstrual symptoms before menstruation may reduce performance (Carmichael et al., 2021).

 

This defies the claim made by McNulty et al. (2020) that the performance of the early follicular phase was inferior to that of the later stages. The amount of between-phase performance decreases is not evaluated by the chart; rather, it merely evaluates the rate of performance outcomes being decreased. The effects of the MC phase and the ensuing disparities are illustrated in Figure 2. It is anticipated that in the early follicular phase, aerobic performance would increase but strength performance will decline, just as endurance drops throughout the ovulatory phase while strength and anaerobic performance increases.

The outcomes differ in a multitude of ways. With the exception of one strength outcome that was greater than in the early follicular phase, almost all of the results in the late luteal phase were lower than in the other MC phases. The highest anaerobic and strength performance may be found in the ovulatory phase, the best endurance performance may be found in the early MC, and the lowest strength and aerobic performance may be found in the late luteal phase.

Where do we go from here?

Although there is no conclusive evidence linking the MC phase to performance in eumenorrheic athletes, many female athletes believe it does. Numerous research show that MC stage performance is reliable. Strength and aerobic performance were impacted by MC in the late luteal phase, whereas anaerobic performance was reduced in the late follicular phase. These impacts on performance were not uniform. When customising training to the MC phase, it is necessary to evaluate session objectives and critical performance criteria. The effects of MC phase on athletes are a subject of debate. More research is needed since mechanistic outcomes, such as substrate metabolism and the stiffness of muscles and tendons, differ across the MC.

Larger sample sizes for longitudinal or observational designs allow for an in-depth examination of how athletes perceive performance differences during the MC. These types of studies can look at perceived performance, pain, fatigue and motivation. To ascertain if athletes are prepared to train and compete during the MC, which influences training adaptability and overtraining, research is crucial (Julian et al., 2017; Julian et al., 2021; Statham, 2020).

Thanks for reading....Chris

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