As women’s participation in sport continues to rise, so does the need for tailored research to understand women’s unique physiological needs. Women’s health physiotherapist Kym Toller and personal trainer and endurance athlete Samantha Chan highlight how hormonal fluctuations throughout the menstrual cycle can influence performance and recovery—and how to harness their power
The Paris Olympics 2024 became the first Games in history to achieve gender parity with near-equal representation of both women and men competing. Whilst this milestone deserves celebration, there is still a significant gender gap in terms of research into women’s sports performance, training and recovery. More importantly, the challenge remains in studying the unique physiological differences that exist between the sexes and how we can use this knowledge to form guidelines and exercise recommendations for women. These will help not only elite athletes, but recreational ones as well. After all, “women are not just small men”.
An area of research that has gained recent attention is how the menstrual cycle can affect sports performance, training and recovery. Whilst the research in this area is sparse, and at times conflicting, there are some common patterns that correspond to the hormonal fluctuations in both oestrogen and progesterone that occur across a natural menstrual cycle. Aside from their role in reproduction, these hormones can influence many other body systems such as the cardiovascular, respiratory, metabolic and neuromuscular systems, which in turn can affect performance, training and recovery. In order to better understand the effect of these hormones it is recommended to track your cycle. Gathering information about your cycle and noting factors such as, but not limited to, level of energy, sleep, diet, mood, stress and exercise, will help you to build up your own data bank. This knowledge becomes a powerful tool to help guide and plan your exercise routine.
What are the key patterns from the different phases of the menstrual cycle?
Starting with menstruation, this phase is characterised by the period. At this point, both oestrogen and progesterone hormone levels are low. This can cause a variety of symptoms, such as period pain, nausea and low mood. If you are experiencing these symptoms you may not feel up for a big training session. However, on the contrary, a training session may help to release endorphins, which may improve your sense of well-being and reduce symptoms. There is no right or wrong way to exercise while on your period and key is to listen to your body.
The next milestone in the menstrual cycle is ovulation, prior to which is the follicular phase, where oestrogen rises. The peak of oestrogen exerts an anabolic effect and muscle building effect on the body system. It also provides a protective effect against muscle damage by reducing muscle soreness and swelling. This in turn can improve the recovery time between sessions and increase your ability to train at an intense level and strength capacity. Oestrogen is known to be a “feel good” hormone and in turn can improve the motivation to train. There is some weak evidence that links the surge in oestrogen to ligament laxity and increased risk of injury. As the research remains inconclusive, if you participate in activities that require a change in direction or pace, such as netball, football or hockey, and you notice niggles and a tendency for injury, then it makes sense to adequately prepare or warm-up, or alternatively to modify your training sessions.
In the luteal phase, which occurs after ovulation, progesterone is the dominant hormone, although oestrogen still experiences a mini peak. Progesterone is thought to promote good mood, reduce anxiety and improve sleep. It has a thermogenic effect on the body which may mean you need to pay extra attention to cooling and hydration strategies. During this phase, it is thought the body can utilise fats as fuel more efficiently thereby leading to improved performance in endurance training. Now might be the time to plan long steady-state runs or cycles. Recovery strategies may also be key in this phase and optimising sleep, nutrition and rest days may be beneficial.
In the last phase of the cycle, levels of both hormone begin to drop and this can cause various premenstrual symptoms such as headaches, breast tenderness, anxiety and bloating. These symptoms can affect training and lead to lower levels of motivation or even altered perceptions of how difficult exercise sessions feel. Again, similar to menstruation, recognising and acknowledging these patterns and allowing greater flexibility in training sessions may be beneficial.
Athlete Samantha Chan offers personal insights into how the menstrual cycle affects her training, performance and recovery
Endurance athlete and running coach Samantha Chan on the Hong Kong trails
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Do you train around your menstrual cycle, and if so how?
In general I try to remain flexible in my training schedule around my menstrual cycle. It is important for me to know I can perform in any race at any phase of my cycle. By listening to my body I am able to understand any problems that arise during my cycle and then I can act accordingly and change my training routine if needed.
When planning my hard training sessions I try and avoid the time just prior to menstruation and then the first couple of days during. I normally experience water retention, lower back pain and headaches during this time. To ease these symptoms I do an easy training session, such as a 60-minute run at a pace where I can hold a conversation. If these symptoms happen on an intense training day, I reduce the volume or intensity by 5 to 10 percent. If I have a high intensity workout, strength session or hard run, I will pay particular attention to my hydration, nutrition and sleep before and after the sessions.
How do the different phases of your cycle affect your performance?
Normally, two days prior to my first day of menstruation, I mentally feel less motivated to train and perform therefore, I have to use strategies to stay positive and change this mindset. I also have to manage my hydration before/during/after training sessions as I am usually more thirsty. I also tend to experience more fatigue and I need to pay particular attention to nutrition replenishment.
During the follicular phase I plan speed and strength sessions, as my body feels and responds well to this type of high intensity exercise. I have extra capacity to lift heavier weights and recover quickly. My body seems to be able to use sugars effectively during this time, and as such I have high levels of energy.
Finally, in the luteal phase I schedule sub-threshold runs and longer training sessions. I feel able and motivated to increase my weekly mileage at a lower intensity pace. I tend to crave more calories in this phase, and make sure to adequately fuel.
Do you have any tips for general training, particularly for running events such as half and full marathons?
- Set goals within an achievable time frame. Give yourself enough time to adequately prepare and train. This will allow you to gradually increase your training mileage and intensity and reduce potential risk of injury. Injury can occur when you “do too much too quickly”.
- Periodisation (training that progressively loads stress but also allows for rest periods, which for running might include base, build, peak and tapering phases) is also crucial to prevent injury and allows you to safely progress mileage. Try to stay at the same mileage/intensity for a few weeks—this allows your body, muscles and tendons to adapt—before increasing mileage and intensity.
- Incorporate strength training into your schedule, as it can reduce the chance of injury. Perform training that is specific to your chosen activity or goal, such as single leg strength and balance drills to improve running performance.
- Understand your menstrual cycle, your symptoms and how to manage them. Even if race day coincides with the menstrual phase you will be prepared and know what your body needs, so you remain confident in your abilities.
- It may be appropriate to share information with your coach or personal trainer about your menstrual cycle so they know how to adapt training sessions accordingly. Having conversations about your cycle helps to normalise the topic and break the “taboo” associated with menstruation.
Although the literature notes common threads across the menstrual cycle, the lack of evidence on sports performance leads us to recommend a personalised approach to training. Listen to your body, stay flexible in your training routine and look for opportunities to optimise it.
As the participation of women in all areas of sport and physical activity increases, the demand for female-specific research will only continue to grow. Wouldn’t it be amazing to be able to harness the power of our unique physiology to further support and benefit our sporting endeavours?
If you are experiencing any unusual symptoms during your menstrual cycle it is important to seek help from a medical practitioner. In this article we refer to the menstrual cycle as a natural cycle without modification by various forms of contraception.