Female Athletes, Running, and the Menstrual Cycle: What We Actually Know

In 2023 I wrote an article about how female athletes should synch their training with their cycle, at the time it was based on the current research and assumptions being make in the world of female athlete care. We were are all so excited that science was finally talking about the menstrual cycle and its impact on female athletes. However, what we knew then and what we know has quickly evolved and changed due to the significant increase in research around female athletes. This is an exciting time and next year this article may even be outdated.

2002, Paula Radcliffe won the Chicago Marathon while on her period. When she was interviewed later she discussed how little understanding existed in sports around menstrual cycles and athletic performance. Nearly twenty five years later, we've made progress—but we still have a long, long way to go. When the U.S. Women's National Soccer Team won the 2019 World Cup, their use of menstrual cycle tracking made headlines. For the first time, female athletes and coaches openly discussed using cycle data as part of performance planning. What had long been viewed as a disadvantage was reframed as useful information. Today the US Women's Soccer League continue to be on the cutting edge of female athlete care.

Since 2019, the conversation has continued among those of us who treat female athletes and the science has also continued to evolve. The good news is that researchers are finally paying more attention to female athletes. The challenge is that the answers are not always as simple or as clear as we hoped.

I work with female runners every day from middle school athletes, high school runners, collegiate athletes, recreational runners, and professionals. Despite the years of research done on men and extrapolated to women, we now have enough data to prove that female athletes have different hormonal environments, different physiology, and different recovery needs.

The Menstrual Cycle Isn't The Same For Everyone

What researchers have learned over the last several years is that while these physiological changes are real, the performance impact varies tremendously between athletes. Care and performance metrics must be individualized. 

How athletes feel and what the research says can be different and that is okay.

In 2024 one research paper on British track and field athletes 78.8% of the female athletes stated their menstrual cycle impacted their performance.  In a different 2024 paper, 73.9% of women have symptoms during their cycle that they feel impact their performance - this is despite some research states that performance metrics don't change during the different phases of your cycle even though perception does..

So while cycle based training can be helpful for some women, it may not be helpful for other. Tracking what you feel, when you feel it and how it impacts you will help YOU train best within your own body.

A typical adult menstrual cycle is 28-35 days and a typical adolescent cycle is anywhere from 21-45 days. There are four phases to the menstrual cycle - menustration, follicular, ovulation and luteal. That is where the similarities might stop. Everyone feels and moves differently.

Day one begins on the first day of menstrual bleeding. Throughout the cycle, estrogen, progesterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) fluctuate, influencing many systems in the body, not just the reproductive system..Estrogen and progesterone are the two most commonly talked about hormones.

Estrogen appears to support protein synthesis, cardiovascular health, and recovery. It may also help protect muscle tissue from damage.

Progesterone tends to increase resting heart rate, body temperature, and ventilation. It may also contribute to feelings of fatigue and make heat tolerance more challenging.

These hormones can affect nearly everything important to training:

• Body temperature

• Fluid balance

• Fuel utilization

• Recovery

• Sleep

• Perceived effort

• Mood and motivation

• Muscle breakdown

• Blood Sugar

• Pain threshold

  
  

That means the goal is not to force your training to match a textbook cycle. The goal is to understand your own patterns. This means you have to first know what your typical pattern

looks like.

Menstrual Phase

During menstruation, estrogen and progesterone are at their lowest levels.

Some women feel sluggish and uncomfortable during this time. Others feel surprisingly strong and perform at their peak. Paula Radcliffe's Chicago Marathon is a perfect example.

If you experience heavy bleeding, pay attention to iron status, fatigue, and recovery. Female endurance athletes are already at higher risk for iron deficiency and menstrual blood loss can contribute to that risk. Symptoms of heavy bleeding may include fatigue, weakness, dizziness, and shortness of breath.

If you are feeling good, don't be afraid to train hard. If symptoms are significant, adjust accordingly. Make sure to talk to your coach about how your body is feeling or if you don't have a coach give yourself permission to be flexible.

The most important thing is listening to your body rather than assuming your period automatically means poor performance.

• Iron-rich foods if you experience heavy bleeding

• Prioritizing sleep and recovery

• Continuing strength training and movement quality work

• Being flexible with workout intensity if symptoms are significant

Follicular Phase

As estrogen begins to rise following menstruation, many athletes report feeling energetic, motivated, and capable of handling higher training loads.

Research suggests estrogen may support recovery and muscle protein synthesis, making this a favorable time for many athletes to perform demanding workouts.

This can be a great time to focus on:

• Strength training

• Higher-intensity workouts

• Building volume

• Learning new movement skills

  
  

That does not mean every hard workout must occur during this phase. It simply means many athletes report feeling their best here.

Things that Might Help:

• Challenging workouts

• Progressing strength training

• Quality speed sessions

• Adequate carbohydrate intake to support training demands

  
  

Ovulation

Ovulation is associated with peak estrogen levels and a brief rise in testosterone.

Some athletes feel powerful, confident, and energetic during this time. Others notice little change.

Researchers have proposed several mechanisms that may support performance during ovulation, but the evidence remains mixed. While some studies show improvements in strength or power measures, others show no meaningful difference.

What matters most is understanding how you feel and respond.

If you consistently feel strong during this phase, it may be an excellent time to schedule challenging workouts or key training sessions.

Things that Might Help:

• High-quality training sessions

• Race-specific workouts

• Prioritizing hydration

• Maintaining adequate protein intake to support recovery

  
  

Luteal Phase

The luteal phase is where many female runners notice the biggest changes. This is what some of my athletes and I call the "crying and eating chocolate phase."

Progesterone rises, core body temperature increases, and some athletes experience:

• Increased fatigue

• Poorer sleep

• Higher perceived effort

• Increased cravings

• Mood changes

• Reduced heat tolerance

  
  

This does not mean you should stop training.

Instead, this may be a phase where recovery becomes even more important. Paying attention to hydration, fueling, sleep, and stress management can make a substantial difference.

For runners training in hot environments, the increase in body temperature during the luteal phase can make heat feel more challenging and may require additional hydration and cooling strategies.

Things that Might Help:

• Extra attention to hydration and electrolytes

• More recovery between hard efforts if needed

• Consistent fueling throughout the day

• Prioritizing sleep and stress management

• Being flexible if fatigue levels are elevated

  
  

What About Hormonal Birth Control?

This is another area where the science has expanded a lot. Did you know there are over 59+ types of birth control and none of them are the same? Some are combined (estrogen and progestin), progestin only, oral, patch, injectables, implants, ring, IUD- the list goes on.

Hormonal contraceptives alter normal hormonal fluctuations, but current research suggests oral contraceptive use may or may not impair bone, strength, power, or muscle-building adaptations from training. So what does that mean? We don't really know and it depends on what type of contraceptive you are on. It is also note worthy that 40% of women and girls report side effects from birth control.

That said, some athletes feel better on hormonal contraception, while others experience side effects that influence training and performance.

Again, patterns matter more than assumptions.

Female Athlete Health Is Bigger Than the Menstrual Cycle

One of the most important developments in female athlete research over the last several years is the recognition that female athlete health extends far beyond the menstrual cycle.

The International Olympic Committee now recommends considering multiple domains of female health including menstrual health, pelvic floor function, mental health, pregnancy, postpartum recovery, menopause, and breast health because each can influence training, recovery, injury risk, and performance.

The Real Superpower: Awareness

The biggest takeaway from current research is that female athletes deserve to understand their physiology because we are all different.

Track your cycle.

Track your sleep.

Track your energy.

Track your workouts.

Look for patterns.

Over time, you may notice that certain workouts feel easier during specific phases, or that recovery requires more attention during others.

The menstrual cycle should not be viewed as a limitation. It is simply another piece of information that can help you understand your body and train more effectively. Your cycle should be considered your fifth vital sign because it can tell us so much - more on that another day.

Bernstein, C., & Behringer, M. (2023). Mechanisms underlying menstrual cycle effects on exercise performance: A scoping review. Women in Sport and Physical Activity Journal. https://doi.org/10.1123/wspaj.2022-0026 

Bruinvels G, Burden R, Brown N, Richards T, Pedlar C (2016) The Prevalence and Impact of Heavy Menstrual Bleeding (Menorrhagia) in Elite and Non-Elite Athletes. PLoS ONE 11(2): e0149881. doi:10.1371/journal.pone.0149881

Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review. Int J Environ Res Public Health. 2021 Feb 9;18(4):1667. doi: 10.3390/ijerph18041667. PMID: 33572406; PMCID: PMC7916245.

Hayward E, Akam L, Hunter D, Mastana S. Role of the menstrual cycle on performance and injury risk: a survey of female professional rugby players in the United Kingdom. Int J Environ Res Public Health. 2024;21(2):150. doi:10.3390/ijerph21020150

Jones BP, L’Heveder A, Bishop C, et al. Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study. Front Sports Act Living. 2024;6:1296189. doi:10.3389/fspor.2024.1296189.

McNulty KL, Elliott-Sale KJ, Dolan E, Swinton PA, Ansdell P, Goodall S, Thomas K, Hicks KM. The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis. Sports Med. 2020 Oct;50(10):1813-1827. doi: 10.1007/s40279-020-01319-3. PMID: 32661839; PMCID: PMC7497427.

Nolan D, McNulty KL, Manninen M, Egan B. The Effect of Hormonal Contraceptive Use on Skeletal Muscle Hypertrophy, Power and Strength Adaptations to Resistance Exercise Training: A Systematic Review and Multilevel Meta-analysis. Sports Med. 2024 Jan;54(1):105-125. doi: 10.1007/s40279-023-01911-3. Epub 2023 Sep 27.

Smith ES, McCormick R, McKay AKA, Ackerman KE, Elliott-Sale KJ, Stellingwerff T, Harris R, Burke LM. Perceived Negative Menstrual Cycle Symptoms, But Not Changes in Estrogen or Progesterone, Are Associated with Impaired Cycling Race Performance. Med Sci Sports Exerc. 2025 Mar 1;57(3):590-599. doi: 10.1249/MSS.0000000000003587. Epub 2024 Nov 6. PMID: 39501484.