Menstruation and Training - How Do Phases of the Menstrual Cycle Affect Performance?

Athletes who menstruate can experience a huge variation within their training abilities throughout their cycle. Some days they are able to hit personal bests and other days can be struggling to complete their reps or maintain intensity throughout training sessions. These changes can be attributable to fluctuations in hormones, such as oestrogen and progesterone, throughout an athlete's cycle. These fluctuations can cause disruptions to an athlete's lifestyle, with the most commonly reported symptoms being fatigue and low moods, with many athletes struggling to combat these symptoms without compromising their performance.

Fortunately there has recently been an influx of information surrounding women’s health in sport with input from dieticians and sports scientists, largely focussing on how the menstrual cycle affects training and how it can be used as a tool rather than a hindrance.

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The Menstrual Cycle 

The menstrual cycle consists of two main phases, the follicular phase and the luteal phase. These phases are distinct and each has fluctuating levels of menstrual hormones. The follicular phase lasts from bleeding stopping until ovulation occurs. In this time oestrogen increases to thicken uterus lining, follicle-stimulating hormone (FSH) levels also rise to stimulate an egg to mature in the ovaries. At the end of the phase luteinising hormone (LH) will increase to trigger ovulation. The luteal phase lasts from ovulation until the day before bleeding begins again. In this phase oestrogen initially declines to allow for ovulation to occur. Once ovulation has occurred both oestrogen and progesterone rise, progesterone remains high to maintain and thicken the uterus lining to prepare for potential pregnancy. These hormones will decline again at the end of this phase to prepare for bleeding.

Research has highlighted that the menstruation cycle has an effect on temperature control (thermoregulation), breathlessness and general functions of the body. Understanding when changes occur throughout the cycle will allow for better training sessions to be created and allow athletes to better understand and monitor their training levels. Coordination, concentration and tiredness can be influenced by oestrogen. Progesterone can influence the choice of food by athletes, as the increase in progesterone can influence greater muscle breakdown.

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"Menstruation symptoms can increase the likelihood of negative outcomes to training such as missing training/competition"

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Throughout the early follicular phase when menstruation is occurring, oestrogen and progesterone levels are at their lowest. This decline in hormones triggers inflammation due to the shedding of the uterine lining, which can cause some menstrual cycle symptoms with the most commonly reported being fatigue/lethargy and increased mood changes¹. Menstruation symptoms can increase the likelihood of negative outcomes to training such as missing training/competition, missing work/lectures, and also needing to use pain medication as a treatment.

There are both nutritional and recovery strategies to try and minimise these symptoms and allow players to continue training and competing to the best of their abilities. Literature has suggested that during this part of the follicular phase anti-inflammatory and antioxidant rich foods, such as berries, leafy green vegetables and oily fish, should be consumed as they have been shown to assist in managing and alleviating menstrual symptoms by increasing blood flow to relax the uterus and reduce the severity of menstrual cramps.

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Furthermore, an athlete menstruating can also reduce their feelings of fatigue and lethargy by increasing iron intake. Increasing iron intake can elevate energy levels as dietary iron will replace the iron lost through menstrual bleeding, allowing athletes to sustain performance. Alongside iron, carbohydrate intake should also be increased. This is to exacerbate the body’s stores and make it more readily available to the athlete when training. When recovering in this phase it is important to continue with normal recovery strategies such as stretching, cooling down and foam rolling, however it is also important to prioritise sleep and protein intake. During this phase of the cycle, an athlete's body is actively shedding the uterine wall.

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"Even just 30 minutes of sleep can significantly aid in the recovery process."

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Therefore, it is crucial to prioritise sleep to support the recovery process. Even just 30 minutes of sleep can significantly aid in the recovery process. It is also recommended that athletes intake protein within 30 minutes of completing exercise, this allows athletes to be within the “golden window” for protein intake to aid in muscle repair and recovery.

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In the late follicular phase oestrogen levels are rising and peak, however, progesterone levels remain low. The rise in oestrogen can trigger increased serotonin and dopamine levels. This allows for athletes to feel more energised and may be able to increase the intensity and their maximal efforts of their training. It has been shown that training in the follicular phase may be superior to training during the luteal phase². This is due to the physiological adaptation of skeletal muscle during this phase. Although the direct effect of oestrogen on muscle is still elusive, there seems to be a correlation between increased muscle strength and increased oestrogen in circulation³. 

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"it is still important to fuel regularly (every 2-4 hours)"

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Additionally, during this phase, blood sugar tends to be more stable due to the rise in oestrogen, this can often lead to a decrease in appetite. Despite this, it is still important to fuel regularly (every 2-4 hours) . For individuals engaging in general fitness routines daily, macronutrient consumption is recommended to be 3-5g/kg/day of carbohydrate, 0.81g/kg/day of protein and 0.5-1.5g/kg/day of fats. However if athletes are engaging in high volumes of intense training, typically 2-3 hours a day, their macronutrient consumption is recommended to be 5-10g/kg/day of carbohydrates, 1.5-2g/kg/day of protein and 20-35% of total daily calories for fats⁴. Recovery in this phase can also be aided by completing a routine after training/competing, this routine should incorporate cooling down to lower heart rate, stretching and foam rolling.

Throughout the early luteal phase oestrogen levels drop as ovulation occurs. Once ovulation is complete oestrogen and progesterone start to rise and remain high. The rise in progesterone can cause increased heart rate, breathing rate and body temperature, however these are all normal processes. The basal metabolic rate of athletes also tends to increase, leading to an increase in appetite and may lead to cravings occurring. Nutrition in this phase is vital as the increase in progesterone can affect muscle breakdown, therefore it is recommended to intake a source of protein before and after training to maintain muscle mass.

Fuelling regularly with carbohydrates and protein can also help to combat cravings as both macronutrients have a higher satiety index, their intake can also help in the prevention of an energy deficit when training allowing for athletes to train better. Furthermore with body temperature rising in this phase it is also vital to ensure athletes are hydrating with water and electrolyte in sessions as their sweating rates may be altered.  Recovery in this phase should focus on intaking protein 30 minutes within completing exercise to aid muscle recovery, and making sleep a priority by having a consistent bed routine to improve sleep quantity and quality.

Throughout the late luteal phase hormones drop to their lowest point, this being when athletes typically experience premenstrual symptoms (PMS), such as mood swings, increase anxiety and irritability which can all impact motivation levels towards exercise. During this phase antioxidant and anti-inflammatory foods have been found to help reduce PMS severity, whereas heavily processed food should be avoided as they have been found to exacerbate symptoms⁵. Regular fuelling should also be continued throughout this period to help athletes maintain energy levels around training. During this phase stress may be experienced which can cause amplified symptoms, therefore it may be useful to incorporate relaxation techniques, such as meditation, yoga or pilates to help calm the nervous system and decrease stress. Athletes may also experience increased inflammation in this phase therefore to aid their recovery it is important to use nutrition, hydration and a recovery routine after training a priority.

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Utilisation of the PlayerData App

One of the key features of the PlayerData app is the ability to conduct surveys with your athletes. This feature allows coaches and athletes to communicate about their motivation levels, fatigue, and overall well-being. By understanding how an athlete is feeling mentally, coaches can make informed decisions about their training and performance. For example, if an athlete is feeling slightly groggy, the coach and athlete can agree to a lighter training session to promote better recovery and ensure they are fully rested for their next session or upcoming match. Feeling tired and run down may coincide with the luteal phase of the menstrual cycle, when oestrogen is declining and progesterone is on the rise. Create a Survey in the PlayerData App‍

Monitoring the player load by reviewing their past data recordings, will allow for better judgement on training load to work with their cycle. Monitoring the athletes normal training load for when they start to feel tired and unmotivated will be beneficial as it will highlight to the coach and athlete that they will need to have a lighter session to allow for efficient recovery while still benefiting from training.

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Conclusion

It is evident that the menstrual cycle can have a detrimental effect on an athlete's performance. However, by actively understanding the cycle and its impact on both the body and performance, athletes and coaches can turn it into an advantage rather than a hindrance. Through careful consideration of training loads, nutrition, and recovery strategies, athletes can maintain their skill level and performance while being mindful of their health and physical abilities during the menstrual cycle.

As discussed earlier, the menstrual cycle can indeed affect athletic performance. Nonetheless, with a conscious effort from coaches and athletes to comprehend and incorporate improved training sessions and check-ins, they can effectively work with the menstrual cycle and prevent it from impeding the athlete's progress, considering it is beyond their control. Ultimately, the menstrual cycle can become a positive factor in an athlete's training programme.

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References

1. Bruinvels, G., Goldsmith, E., Blagrove, R., Simpkin, A., Lewis, N., Morton, K., . . . Pedlar, C. (2021). Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: A study of 6812 exercising women recruited using the strava exercise app. British Journal of Sports Medicine, 55(8), 438-443. doi: https://doi.org/10.1136/bjsports-2020-102792)
2. Kissow, J., Jacobsen, K.J., Gunnarsson, T.P., Jessen, S. and Hostrup, M., 2022. Effects of follicular and luteal phase-based menstrual cycle resistance training on muscle strength and mass. Sports Medicine, 52(12), pp.2813-2819.
3. Ikeda, K., Horie-Inoue, K. and Inoue, S., 2019. Functions of estrogen and estrogen receptor signaling on skeletal muscle. The Journal of steroid biochemistry and molecular biology, 191, p.105375.
4. Kreider RB, Wilborn CD, Taylor L, Campbell B, Almanda AL, Collins R. et al. ISSN exercise & sport nutrition review: research & recommendations. J Internat Soc Sports Nutr. 2010;7:7–49.
5.  Armour M., A Parry K., Steel K., A Smith C. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int. J. Sports Sci. Coach. 2020;15:316–323. doi: 10.1177/1747954120916073. 
6. Mora, Sebastian. (2020). THE MENSTRUAL CYCLE AND ORAL CONTRACEPTIVES DO NOT AFFECT MUSCLE RECOVERY OR EXERCISE PERFORMANCE IN YOUNG FEMALES. 10.13140/RG.2.2.19101.23522.