The Menstrual Cycle and Sport Performance

The menstrual cycle

The menstrual cycle is perhaps the second most important biological rhythm, next to the circadian one. It is created by the interplay between hypothalamic, hypophyseal, and ovarian hormones, bringing about various changes not only in the female reproductive tract but also in many other tissues of the body. It is traditionally divided into two phases (follicular and luteal) or three phases (follicular, ovulatory, and luteal), based on ovarian function. The follicular phase begins on the first

Methodological considerations

Proper study design and methodology are necessary for any meaningful research into the relationship between the menstrual cycle and athletic performance. Case reports or clinical series (with or without historical controls) and cross-sectional studies do not offer much helpful information and cannot be generalized for a larger population. Case-control (retrospective) studies are notoriously prone to subjective recall and other types of bias. Prospective and historical cohorts can be followed

Biological effects of the sex steroid hormones

Estrogen in its various forms is responsible for the development of secondary sexual characteristics and the typical female pattern of fat deposition in the breasts, buttocks, and thighs. Progesterone can, in many ways, have antiestrogenic and androgenic actions. Circulating estrogen and progesterone levels cause variation in many cardiovascular, respiratory, and metabolic parameters, with subsequent implications for strength and aerobic and anaerobic performance. Much less is known about the

The menstrual cycle and physical performance

Several factors related to the menstrual cycle, including psychologic and physical, affect athletic performance. Key physical factors are strength, and aerobic and anaerobic capacity.

The menstrual cycle and performance in different sports

Peak athletic performance is composed of anatomic, physiologic, metabolic, biomechanical, and psychologic elements. The relative contribution of each of these elements varies, depending on the type of sport. Therefore, the diverse effects on performance will not necessarily result in any significant changes in actual achievements. The ventilatory effects of hormones may be more relevant to an aerobic sport, as thermoregulation may be more relevant on a hot day; hormone levels on one day may not

Menstrual cycle, injuries, and ligament laxity

Women have a higher injury rate in sports than men, sometimes by a factor of almost ten [78]. These data have been accumulated from activities such as ball games, running, and military training. Suggested mechanisms that may be affected by the female hormones include anatomic and biomechanical factors, neuromuscular control, and ligament laxity. Interestingly, females also have higher injury rates in sport types that do not include the more common running, jumping, and landing activities. In a

Therapeutic considerations

The question of how to alter the menstrual cycle to improve performance must only be asked following the question whether the menstrual cycle should be altered. Most of the literature indicates that regularly menstruating female athletes do not need to adjust their menstrual cycle to maximize performance, unless possibly competing in endurance events under hot and humid conditions. Also, the pattern of the hormonal changes during the menstrual cycle and any physiologic and psychologic effects

Hormonal modification of the menstrual cycle

The menstrual cycle can be easily controlled and manipulated by hormonal therapies. However, therapeutic usage of hormones merely for menstrual manipulation should be saved only for mature, elite athletes whose performance is negatively affected, as the health implications of continuous shifting of the menstrual cycle are not yet known.

Oral contraceptive pills and performance

Some studies have suggested a potential decline in aerobic performance (VO₂max) in response to oral contraceptive administration, ranging from 5% to 11% but reversible on discontinuation of therapy [2], [3]. More recent publications have shown a slight decrease in maximal aerobic capacity [108], [109] or no significant effects [110], despite increases in blood lactate and ammonia responses to high-intensity intermittent exercise [111]. A study of five elite rowers taking a triphasic OCP found a

Prescribing oral contraceptive pills for menstrual cycle manipulation

In the absence of medical contraindications, such as thromboembolic disease, impaired liver function, and estrogen-dependent neoplasia, OCPs can be prescribed to athletes who are at least 2 years postmenarche, as administration at an earlier age might halt growth.

There is an extensive choice of OCPs, many with various types and amounts of estrogen and progesterone. Which OCP to prescribe is an individual decision and depends on what the specific needs of the woman are and what suits her. The

Oral contraceptive pills and drug testing

In 1987, norethindrone (norethisterone), a progesterone found in many OCPs, was placed on the list of banned substances by the International Olympic Committee. Despite the lack of scientific evidence of any performance enhancement, this was done because of difficulties distinguishing between the metabolites of norethindrone and those of nandrolone, a common anabolic-androgenic steroid. This ban was overturned a few months later thanks to the efforts of Dr. Andrew Pipe from Canada and others,

Pregnancy

There have been anecdotal reports about women who conceived to increase performance. The suggested mechanism was through an increase in levels of beta-hCG, a hormone with some anabolic properties. Additional hormonal and biochemical changes occurring in pregnancy may also play a role. Nevertheless, this method seems out of place and extremely unethical, especially if an abortion is originally planned.

Summary

Over the course of an ovulatory menstrual cycle, there are predicable and measurable variations in the female sex steroids (eg, estradiol and progesterone) that have multiple and variable effects on different body systems. Although there are theoretical implications for physical and mental performance in sports, the workplace, and special populations such as the military, there is no conclusive evidence that significant menstrual cycle differences exist. An exception might be a potential