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Sport Medicine

Cite as: Archiv EuroMedica. 2026. 16; 3. DOI 10.35630/2026/16/Iss.3.22

Received 20 May 2026;
Accepted 21 June 2026;
Published 25 June 2026

MENSTRUAL CYCLE EFFECTS ON EXERCISE CAPACITY AND TRAINING ADAPTATIONS

Julita Papińska¹ , Jakub Buziak² ,
Magdalena Lengier¹ , Małgorzata Świderska¹ ,
Patrycja Małyszek¹ , Franciszek Cezary Pastuszak¹ ,
Szymon Świstak¹ , Natalia Powęska³ ,
Szymon Zych¹ , Julia Pielacha¹

¹ Cardinal Stefan Wyszynski University in Warsaw, Poland
² Franciszek Raszeja Municipal Hospital in Poznań, Poland
³ Medical University of Łódź, Poland

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  papinskaj@gmail.com

ABSTRACT

Background

Sports science research has historically included fewer female participants than male participants, which has limited the understanding of physiological factors that may influence performance and training responses in physically active women. The menstrual cycle is associated with cyclic changes in estradiol and progesterone, which may affect metabolism, thermoregulation, neuromuscular function, fatigue perception, sleep, recovery, and psychological well-being.

Aim

The aim of this narrative review was to synthesize current evidence on the effects of menstrual cycle phases on exercise capacity and training adaptations in physically active women, with particular attention to individual variability, menstrual cycle-related symptoms, methodological limitations, and practical implications for training management.

Methods

A targeted literature search was conducted in PubMed, Scopus, Google Scholar, ScienceDirect, and Wiley Online Library. The review included clinical studies, experimental studies, systematic reviews, meta-analyses, and relevant narrative reviews addressing menstrual cycle phases, aerobic capacity, strength, power, recovery, symptoms, hormonal contraception, and training adaptations in physically active women and athletes. Evidence was synthesized qualitatively.

Results

Current evidence does not show stable and reproducible changes in aerobic capacity, maximal strength, explosive power, or long-term training adaptations across menstrual cycle phases at the group level. However, individual responses vary. Menstrual symptoms, pain, fatigue, impaired sleep, reduced recovery, mood changes, and hormonal contraceptive use may modify perceived exertion, training tolerance, training quality, or competition readiness in some athletes. Interpretation of the evidence is limited by heterogeneous study populations, inconsistent menstrual cycle phase verification, limited biochemical confirmation of hormonal status, and insufficient data on elite female athletes.

Conclusions

Menstrual cycle phases should not be considered a universal determinant of exercise performance or training adaptation. Current evidence does not support rigid phase-based training prescriptions for all physically active women. Training management should instead be guided by individual monitoring of symptoms, recovery, sleep, psychological status, hormonal context, and total training load. Menstrual cycle monitoring may also provide clinically relevant information for female athlete health surveillance.

Keywords: menstrual cycle, exercise capacity, training adaptations, female athletes, hormonal fluctuations, athletic performance.

1. INTRODUCTION

For many years, research in sports science has been predominantly based on male populations, leading to significant gaps in knowledge regarding the physiology of physically active women [1,16]. One of the most frequently overlooked yet potentially crucial biological factors is the menstrual cycle, the influence of which on exercise capacity and training adaptations remains a subject of ongoing scientific debate [2].

The menstrual cycle is characterized by dynamic hormonal fluctuations — primarily in estradiol and progesterone levels — which affect not only reproductive function but also the musculoskeletal system, metabolism, thermoregulation, and nervous system function [9,17]. Consequently, increasing attention has been directed toward whether these hormonal changes may influence exercise-related capacities, such as strength, endurance, and motor performance, as well as training adaptations in response to physical load.

However, current findings in this area remain inconclusive. While some studies suggest small phase-related variations in performance, systematic reviews and meta-analyses indicate that these effects are likely negligible or lack significance at the group level [8,11]. Interpretation of the available evidence is further complicated by substantial inter-individual variability and methodological inconsistencies across studies, particularly the lack of accurate biochemical verification of menstrual cycle phases [4,6].

In recent years, there has been a growing emphasis on practical, athlete-centered approaches focusing on individualized training and the monitoring of menstrual cycle-related symptoms, which may significantly influence exercise tolerance, recovery, and training quality [5,31,38]. The aim of this narrative review is to synthesize the current state of knowledge regarding the effects of the menstrual cycle on exercise capacity and training adaptations in physically active women, with a particular emphasis on recent evidence and existing methodological limitations.

AIM

The aim of this narrative review is to synthesize current evidence on the effects of menstrual cycle phases on exercise capacity and training adaptations in physically active women. The research objectives were: (1) to evaluate the effects of menstrual cycle phases on aerobic capacity, strength, power, and long-term training adaptations; (2) to assess how menstrual cycle-related symptoms, fatigue, recovery, sleep, and psychological factors may influence exercise tolerance and training quality; (3) to identify key methodological limitations in current research and formulate practical implications for individualized training management.

2. RESEARCH MATERIALS AND METHODS

A narrative review design was applied to synthesize evidence regarding the effects of the menstrual cycle on exercise capacity, training adaptations, and performance-related outcomes in physically active women and female athletes. Literature searches were conducted across PubMed, Scopus, Google Scholar, ScienceDirect, and Wiley Online Library, covering publications from January 2001 to May 2026.

The standardized search strategy utilized the following query: ("menstrual cycle" OR "hormonal fluctuations" OR "follicular phase" OR "luteal phase") AND ("exercise capacity" OR "training adaptations" OR "athletic performance" OR "strength" OR "endurance") AND ("female athletes" OR "physically active women").

The initial search identified 115 records. After removal of 32 duplicate entries, 83 unique records remained for title and abstract screening. Thirty-nine publications were excluded because they represented preprints without peer review, focused strictly on clinical reproductive pathologies rather than exercise physiology, or did not meet basic eligibility criteria. Consequently, 44 peer-reviewed publications fully met the inclusion criteria and were included in the final review. The inclusion criteria required: (1) full-text articles published in English, (2) studies involving eumenorrheic women or users of hormonal contraception, and (3) direct relevance to exercise physiology, physical performance, or training adaptations.

All 44 included studies were synthesized qualitatively, with findings organized thematically into aerobic capacity, strength and power, and training adaptations. Due to the narrative and mechanistic scope of this review, no formal risk-of-bias assessment or quantitative meta-analysis was performed.

3. RESULTS

3.1. Hormonal Fluctuations Across the Menstrual Cycle

The menstrual cycle is defined by cyclical shifts in ovarian hormones, primarily estradiol and progesterone, which may influence multiple physiological systems relevant to athletic performance [9]. The early follicular phase is associated with low concentrations of both hormones, followed by a progressive rise in estradiol during the late follicular phase. Conversely, the luteal phase is characterized by elevated levels of both estradiol and progesterone. These endocrine variations have been proposed to alter substrate metabolism; specifically, higher estradiol levels potentially promote lipid oxidation and glycogen sparing, whereas progesterone may counteract these effects [12].

Estradiol interacts with specific estrogen receptors (α and β) located within skeletal muscle and connective tissues, modulating collagen synthesis and muscle satellite cell activity, providing a theoretical basis for phase-related changes in tissue repair and force transmission [3,18]. Furthermore, progesterone's influence on the central nervous system, particularly through its metabolite allopregnanolone, suggests a potential impact on central fatigue and perceived exertion [10]. Beyond metabolism, progesterone is linked to an increase in basal body temperature (≈0.3–0.5°C) and altered heat dissipation during the luteal phase [9], with potential implications for endurance in thermally challenging environments.

3.2. Aerobic Capacity and Endurance Performance

Aerobic capacity and endurance are among the most frequently investigated domains regarding menstrual cycle-related variability. Most available data indicate that maximal oxygen uptake (VO₂max), a key determinant of aerobic fitness, remains relatively stable across different phases [8]. Similarly, findings regarding submaximal measures — such as time-to-exhaustion, lactate threshold, and exercise economy — suggest that any phase-related differences are generally minor and unlikely to be significant at the group level [2].

Some studies have reported subtle variations in endurance performance, particularly during the luteal phase. These may be associated with elevated progesterone and the corresponding rise in basal body temperature, which could potentially impair performance during prolonged exercise in hot or humid conditions [9]. From a metabolic perspective, elevated estradiol during the late follicular phase is associated with increased lipid oxidation and reduced reliance on glycogen [12]. While these effects might theoretically support endurance, the extent to which they translate into measurable improvements remains uncertain. Furthermore, inter-individual heterogeneity plays a substantial role, as some athletes demonstrate phase-related differences while others show no observable changes [8,30].

3.3. Strength, Power, and Neuromuscular Performance

The majority of studies examining maximal strength (e.g., 1RM tests) report minimal or no consistent differences across phases [3,11]. Similarly, measures of explosive performance, such as vertical jump height and sprint speed, generally show small and inconsistent variations [7,15]. Where differences are observed, they are typically of low magnitude and often fall within the range of normal day-to-day fluctuations.

Methodological limitations — including inconsistent phase verification and small sample sizes — further complicate the interpretation of data. Current literature has not demonstrated stable and reproducible changes in maximal strength or explosive power outcomes at the group level across different phases of the menstrual cycle, with responses being highly individualized. The main performance outcomes are summarized in Table 1.

3.4. Training Adaptations Across the Menstrual Cycle

Training adaptations reflect chronic physiological changes rather than acute responses. Most research indicates that gains in strength, hypertrophy, and aerobic fitness occur similarly regardless of the phase in which training is concentrated [3,11]. Studies comparing follicular-phase-based training to luteal-phase or non-phased approaches generally report comparable improvements over time [1,20]. These findings suggest that stable and reproducible changes in long-term outcomes driven by the acute hormonal environment during individual sessions have not been demonstrated when overall volume and intensity are equated.

Some hypotheses propose that elevated estradiol during the follicular phase may enhance anabolic signaling and muscle repair, while progesterone dominance has been suggested to attenuate these effects. Nevertheless, human training studies have not consistently demonstrated superior adaptations when training is aligned with specific phases. Total training load and individual variability appear to play a substantially greater role in driving long-term performance improvements.

3.5. Menstrual Cycle-Related Symptoms and Subjective Responses

Beyond hormonal levels, cycle-related symptoms represent a vital applied dimension. Common issues include dysmenorrhea, fatigue, mood disturbances, and bloating, typically reported with greater frequency during the luteal and early menstrual phases [5,35,39]. These symptoms may influence exercise tolerance and training quality, although their expression varies markedly between individuals.

Pain associated with primary dysmenorrhea is a frequently reported factor that may lead to reduced training intensity or temporary exercise avoidance [5,29]. Regular physical activity has been suggested to reduce symptom severity in some cases, indicating a bidirectional relationship [13,14]. Evidence indicates that subjective responses such as rating of perceived exertion (RPE) and "readiness to train" may fluctuate, but patterns are often more closely related to symptom severity than to the hormonal phase itself [5,34].

3.6. Inter-individual Variability and Methodological Limitations

A primary factor contributing to inconsistent findings is substantial inter-individual variability. Responses to hormonal fluctuations differ markedly; some women exhibit measurable changes in performance, while others show no detectable variation [2,8]. One critical issue is the inaccurate determination of cycle phases, as many studies rely on calendar-based counting which does not account for variations in cycle length or ovulation. To achieve high methodological rigor, contemporary researchers advocate for a "three-pillar" approach: calendar tracking, urinary ovulation prediction kits, and the gold-standard biochemical verification via serum hormone analysis [4,6].

Heterogeneity in participant characteristics — including training status, age, and contraceptive use — further complicates comparisons. Elite athletes may possess different hormonal sensitivities or compensatory mechanisms compared to sedentary populations, yet they are often grouped together in systematic reviews. Small sample sizes also reduce statistical power and increase the risk of type II errors.

3.7. Practical Applications for Athletes and Coaches

Because stable and reproducible changes in performance at the group level have not been shown across the menstrual cycle phases, the body of evidence currently suggests a cautious approach toward the implementation of rigid, phase-based training prescriptions [3,8]. Instead, published frameworks frequently emphasize a more nuanced and individualized tracking model, focusing on comprehensive baseline monitoring and athlete education to map unique physiological patterns.

The literature indicates that relying on daily wellness tracking and subjective feedback provides a more sensitive marker for training readiness than pre-emptively adjusting loads based solely on calendar-driven estimates. This supports the concept of "reactive periodization," where training modifications are indicated only when an athlete experiences acute symptoms that demonstrably impair recovery metrics [5,26,31]. Furthermore, current research highlights that increasing "menstrual literacy" among coaching staff correlates with improved transparency and psychological safety within the training environment [39]. Systematic monitoring may also help identify individual "responders" who experience reproducible performance fluctuations across cycles [9,12].

3.8. Hormonal Contraception and Exercise Performance

The use of hormonal contraception (HC) is highly prevalent among physically active women and athletes [22,25]. Combined oral contraceptives (COCs) function primarily by suppressing endogenous ovarian hormone production and stabilizing hormonal concentrations across the cycle [11]. Current evidence demonstrates that hormonal contraception has either trivial or only small effects on exercise performance at the group level [11,21]. The majority of reviewed studies indicate no consistent differences in aerobic capacity, maximal strength, or power output between HC users and non-users [23,27].

Thermoregulatory responses also differ in HC users: combined oral contraceptives have been shown to elevate resting body temperature and modify sweating thresholds, potentially altering endurance performance parameters specifically in hot or humid environments [9,24]. A significant challenge in synthesizing these findings is the substantial heterogeneity between contraceptive formulations, with variations in estrogen dose, progestin type, administration schedule, and duration of use complicating direct comparisons [4,6].

3.9. Sleep, Recovery, and Fatigue Perception Across the Menstrual Cycle

Menstrual cycle-related hormonal fluctuations have been shown to influence subjective fatigue, sleep patterns, and perceived recovery status, even when objective performance outcomes remain unchanged [30,31]. Several investigations indicate that subjective sleep disturbances occur more frequently during the late luteal and early menstrual phases [33,35]. Elevated progesterone concentrations, changes in thermoregulation, and premenstrual symptoms are identified as primary contributing factors [26,35].

Athletes frequently report greater perceived exertion, lower motivation, and reduced recovery during phases associated with pronounced menstrual symptoms [5,38]. These subjective responses do not consistently correspond with measurable impairments in objective strength or endurance performance [34,43]. Some evidence suggests phase-related fluctuations in parasympathetic activity, particularly during the luteal phase, although group-level findings remain statistically inconsistent [26].

3.10. Psychological Well-Being, Mood, and Mental Health Across the Menstrual Cycle

While objective physiological changes across the menstrual cycle appear relatively small at the group level [8], subjective psychological responses demonstrate a measurable influence on motivation, recovery perception, and overall athlete experience [34,38]. Fluctuations in estradiol and progesterone are linked to changes in mood regulation, emotional processing, stress sensitivity, and cognitive function [17,37]. Athletes frequently report increased irritability, anxiety, mood instability, and reduced motivation during the late luteal phase, particularly in the presence of premenstrual syndrome (PMS) symptoms [13,36].

Data also highlight that persistent stigma and limited communication surrounding menstruation in sport contribute to the underreporting of symptoms and increased psychological distress [5,38]. Conversely, documented open communication between athletes, coaches, and medical staff correlates with improved symptom management and reduced psychological stress [38,39]. The key domains relevant to individualized monitoring and their practical implications are summarized in Table 2.

4. DISCUSSION

The present narrative review synthesized existing literature regarding hormonal fluctuations and their physiological footprint on performance. A key theme emerging from this analysis is the body's remarkable ability to maintain physiological homeostasis despite cyclical endocrine shifts. While changes in estradiol and progesterone undeniably influence metabolic, thermoregulatory, and neuromuscular systems at a cellular level [9,10], these acute responses appear to be largely buffered by robust compensatory mechanisms. For instance, although elevated progesterone in the luteal phase increases basal body temperature and potentially elevates cardiovascular strain [9], the female organism effectively compensates through altered sweating thresholds and hemodynamic adjustments, thereby preserving objective, functional performance outcomes [8,15].

Another critical nuance is the distinction between statistical significance in laboratory settings and practical, "real-world" relevance. In many of the analyzed cohorts, even when phase-related statistical differences were detected, the absolute magnitude of change typically fell within the range of normal day-to-day performance variation (often less than 1–2%) [8,11]. While acute research often flags the late follicular phase as a potential "anabolic window" due to peak estradiol levels [20], tracking long-term adaptations shows that fundamental training principles — total training volume and progressive overload — remain the definitive drivers of hypertrophy and strength gains [3,7].

Furthermore, the psychological dimension and subjective symptomology (e.g., dysmenorrhea, bloating, and premenstrual fatigue) often present a more reliable baseline for training quality than the tracking of hormonal phases themselves [5,43]. The cognitive perception of being in a specific phase of the cycle can heavily modulate self-efficacy and the RPE, introducing a biopsychosocial confounding effect [34,38].

Limitations of the review

This narrative review has several limitations. First, the available evidence does not allow firm conclusions for all groups of physically active women, as the influence of menstrual cycle phases may differ depending on training status, symptom burden, hormonal profile, use of hormonal contraception, and the type of exercise performed. Second, most conclusions are based on group-level findings that may not reflect individual responses. Third, the applicability of the available evidence to elite female athletes remains limited. Fourth, there remains a gap between plausible physiological mechanisms and demonstrated long-term training outcomes. Finally, further longitudinal studies are needed to determine which athletes may be individual responders.

5. CONCLUSIONS

The findings of this narrative review suggest that menstrual cycle phases do not consistently determine exercise capacity or training adaptations in physically active women at the group level. Although fluctuations in estradiol and progesterone may influence metabolism, thermoregulation, neuromuscular function, fatigue perception, sleep, and recovery, current evidence does not show stable and reproducible changes in aerobic capacity, maximal strength, explosive power, or long-term training adaptations in most women.

However, the absence of a consistent group-level effect does not mean that the menstrual cycle is irrelevant in sports medicine. In some athletes, menstrual symptoms, pain, fatigue, impaired sleep, reduced recovery, mood changes, or hormonal contraceptive use may affect training tolerance, training quality, and competition readiness. Therefore, training decisions should not be based only on the calendar phase of the cycle, but also on individual symptoms, recovery status, psychological well-being, and total training load.

Current evidence does not support universal phase-based training prescriptions for all physically active women. A more appropriate approach is individualized monitoring, with adjustment of training only when symptoms or recovery markers indicate reduced tolerance to load. Menstrual cycle monitoring should also be considered part of female athlete health surveillance, because cycle regularity and symptom patterns may provide clinically relevant information about energy availability, recovery, endocrine function, and bone health. Overall, the menstrual cycle should be regarded as an important physiological and clinical context in sports medicine, but not as a universal determinant of athletic performance or training adaptation.

DISCLOSURE

Author Contributions

Conceptualisation: Julita Papińska.

Methodology: Julita Papińska, Jakub Buziak, Patrycja Małyszek, Natalia Powęska.

Software: Magdalena Lengier, Szymon Zych, Szymon Świstak.

Formal analysis: Natalia Powęska, Magdalena Lengier, Szymon Świstak, Małgorzata Świderska, Franciszek Cezary Pastuszak.

Investigation: Julita Papińska, Jakub Buziak, Patrycja Małyszek.

Resources: Julia Pielacha, Szymon Zych, Franciszek Cezary Pastuszak.

Data curation: Julia Pielacha, Małgorzata Świderska.

All authors have read and agreed with the final, published version of the manuscript.

Funding

The study did not receive special funding.

Conflicts of Interest

The authors declare no conflict of interest.

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