Faculty Advisor(s)

Heather Biehl, Amy Tremback-Ball

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Abstract

Purpose: The purpose of this study was to understand the physical and perceived effects of the menstrual cycle on female athletes’ performance during training and competition.

Hypothesis: The researchers hypothesized that there would be a significant difference in performance based on the phase of the menstrual cycle.

Methods: This study used EBSCO Academic Search Complete and Science Direct, focusing on peer-reviewed articles from the last 10 years. Search terms included: (exercise or physical fitness or physical activity) AND (menstrual cycle or period or menstruation or menses or follicular phase or luteal phase) AND (female athletes or women athletes or athletic females or sportswomen) AND (competitive or competition). Participants were female athletes experiencing a menstrual cycle, with or without hormonal contraception. Inclusion criteria required studies to assess performance, physical function, and/or mental status across menstrual cycle phases and include competitive athletes, with a potential control group of non-competitive athletes. Exclusion criteria eliminated non-peer-reviewed articles, studies involving male subjects, or those not assessing relevant functions or focusing on menstrual dysfunction. Study quality was assessed using the Hierarchy of Evidence Scale.

Results: In 2024, a comprehensive search using EBSCO and ScienceDirect databases yielded 441 articles, with 9 selected for inclusion and 3 additional articles identified through hand searches. Most studies were classified as level 3 on the hierarchy of evidence, while 2 were deemed not applicable due to qualitative design. In 2025, a similar search produced 83 articles, resulting in 4 included studies and 1 from a hand search. Among these, one was a level 2 experimental study, one was not applicable, and one was a qualitative descriptive study, which was included to provide further insight.

Conclusion: This systematic review highlights the influence of the menstrual cycle on female athletes' performance, with effects varying across different phases. During the follicular phase, women reported lower serenity levels compared to men but exhibited greater motivation during menstruation than their male counterparts. The luteal phase was marked by mood declines in approximately 60% of women, leading to reduced motivation and performance, with these effects often persisting into early menstruation. Additionally, studies found that lactate concentration was higher in the late follicular phase, while endurance capacity declined during the luteal phase. These findings suggest that different menstrual phases influence energy utilization, potentially affecting fatigue levels and recovery rates in female athletes. In conclusion, this review underscores the need for further research to deepen our understanding of menstrual cycle-related performance fluctuations and highlights the importance of integrating these considerations into training and rehabilitation programs.

Clinical Relevance: This study's clinical relevance for physical therapists lies in its potential to guide evidence-based care for female athletes. Understanding how menstrual cycle phases impact performance and physical function can help tailor rehabilitation and training programs. This research can also inform strategies to manage menstrual-related changes, optimizing care, injury prevention, and performance outcomes for female athletes.

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Publication Date

2025

Document Type

Poster

Department

Physical Therapy

Keywords

menstrual cycle, female athletes, competition, sports, female sports, athletics, menstruation, phases, follicular, luteal, ovulation

Disciplines

Medicine and Health Sciences | Physical Therapy | Physiotherapy | Sports Sciences

Physical and Perceived Effects of the Menstrual Cycle on Female Athletes

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