Hormonal changes across the menstrual cycle can meaningfully affect how the body performs during exercise — and this systematic review looked at 13 studies involving 152 female athletes to understand exactly how.
The review found that the premenstrual and menstrual phases often brought the most challenges. Athletes in these phases showed reduced sprinting ability, lower muscle power, more exercise-related muscle damage, and decreased subjective well-being including greater fatigue. In contrast, the luteal phase (roughly the second half of the cycle) was linked to better aerobic fitness and higher-intensity performance during matches, while the ovulatory phase showed increased flexibility. Interestingly, measures of maximal strength like jump tests generally did not change significantly across cycle phases.
While this research focused on healthy athletes with regular cycles rather than on PMDD specifically, it provides useful context. Many people with PMDD experience intensified physical and emotional symptoms in the premenstrual phase — and this review confirms that even in athletes without menstrual disorders, that same phase brings measurable drops in physical capacity, increased muscle damage, and lower well-being. This may help validate the experience of feeling physically different at certain times of the cycle.
It is worth noting that the studies reviewed had small sample sizes and used different methods to track cycle phases, so the findings are not yet definitive. The authors emphasize that more standardized research with larger groups is needed to draw firm conclusions about how to best adapt training and activity around the menstrual cycle.
Key findings
- Flexibility was significantly increased during the ovulatory phase compared to the early follicular phase, as measured by the sit and reach test (p < 0.05)
- Aerobic capacity (VO2Max and test duration) was significantly higher during the luteal phase compared to the follicular phase in multiple studies (p < 0.05)
- The premenstrual phase was associated with reduced peak power in repeated sprint efforts, lower neuromuscular efficiency, and increased muscle damage markers (higher creatine kinase levels) compared to follicular and luteal phases (p < 0.05)
- Match performance in soccer showed significantly greater distances covered at high intensity and more sprints during the luteal phase compared to the follicular phase (p < 0.05 and p < 0.001 respectively)
- Subjective well-being decreased significantly during the early follicular (menstrual) and late luteal phases compared to the late follicular phase (p < 0.05)
- No significant differences were found across menstrual cycle phases for maximal and explosive strength measures (CMJ, squat jump, hop test, half-squat 1RM) in most studies
Methods, briefly
Systematic review following PRISMA guidelines, registered on PROSPERO. Comprehensive search conducted in Scopus, Web of Science, and PubMed databases for original studies published between 2013 and 2023. Inclusion criteria required eumenorrheic female athletes without menstrual disorders or oral contraceptive use. N=13 eligible articles reviewed, comprising 152 athletes total. Methodological quality assessed using the McMaster Critical Review Form, with scores ranging from 68.75% to 100% (11 to 16 points). Studies covered team sports (soccer, handball, futsal, basketball) and individual sports (athletics, triathlon, judo).
Limitations to keep in mind
- Small total sample size across all studies (N=152 athletes across 13 studies)
- Significant heterogeneity in athlete characteristics, sports disciplines, and performance tests conducted
- Lack of standardized methodologies across studies for measuring menstrual cycle phases
- Short observation periods in many studies (some only one menstrual cycle)
- Inconsistent definitions and divisions of menstrual cycle phases across studies
- Studies explicitly excluded women using oral contraceptives, limiting generalizability
- Most studies did not control for contextual factors like match outcome and opponent strength that could influence performance metrics
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