Menstrual Cycle and Athletic Performance

Menstrual Cycle impact on Performance

Imagine this athlete scenario: You are a competitive athlete who works hard daily with the support from your family, coach and teammates. You have been working extra hard for the past three months preparing for a conference coming up next week. You have followed adequate recovery time, been getting good nutrition and rest and you feel great and then you start to feel depressed, bloated and you lose motivation to work and then the cramps in your pelvic area tell you that you're about to start your period. This is terrible timing and it concerns you that this will affect your performance and you would like to know if there are certain hormonal factors that affect recovery or injury risk.

Basic Review of the menstrual cycle

• The menstrual cycle is a natural body process that women experience in preparation for pregnancy.

• Often referred to as period, cycle, menstruation that is measured from day one of one cycle to the first day of the next cycle that is repeated on average every 28 days. The average cycle is anywhere between 25-35 days.

• Ovulation occurs mid-cycle when an egg is released from an ovary and if fertilized by sperm, will result in a pregnancy. If not fertilized, it will result in shedding of the lining of the uterus.

• The lining of the uterus is built up prior to ovulation to support a fertilized egg but if the egg is not fertilized then hormonal shifts occur that will allow the lining to shed during the first week of the next cycle.

• Women experience their first cycle on average between 12 - 15 years of age.

• Cycle length varies based on many things including age, ethnicity, body composition and BMI.

For the purpose of this article, I will not be including the many other factors that affect menstruation including use of oral contraceptives, endometriosis, polyendocrine metabolic ovarian syndrome (PMOS) peri-menopausal changes and is more focused on the general healthy female athlete.

Hormone shifts throughout the menstrual cycle

Much of the literature on the impact of menstruation is focused on two hormones: Estradiol and Progesterone. To simplify the science, we will skip the review of the scientific phase names and focus on what is happening each week of the cycle in regard to estradiol and progesterone levels and how they may impact fitness and recovery.

Cycle Days

Days 1-7: Estradiol: Stable low levels

Progesterone: Stable low levels

During this time women may experience increased hunger, increased GI symptoms such as diarrhea, pelvic cramping, cravings and increased appetite.

Days 8-13: Estradiol: Increasing to peak 2

days before ovulation

Progesterone: Stable low levels

This is an estradiol dominant period which has positive effects on muscle blood flow, lipid oxidation, cardiovascular function and neuromuscular performance. Ligaments and soft tissue are vulnerable. This is an ideal time for increased recovery and optimal muscle gains. Carbohydrate deficient diets in intense exercise may compromise performance.

Days 14-22: Estradiol: Rapid decline and

then gradual increase

Progesterone: Rapid increase

This is a progesterone dominant period where there is a glycogen dominant dependence, increased core body temperature, decreased insulin sensitivity, reduced endurance, increased fatigue, increased brain fog and coordination. Carbohydrate deficient diets in intense exercise may compromise performance. Protein/peptide intake should be elevated to prevent muscle loss. As body temperature increases, so do energy demands (100-300 calories per day).

Days 23-28: Estradiol: Gradual decrease

Progesterone: Gradual decrease

While both estradiol and progesterone decline, pre-menstrual syndrome symptoms are pronounced: sleep disturbances, mood changes, less motivation to exercise. Increase in injuries and increased protein breakdown and protein intake may be higher.

Nutrition Considerations

# 1: Energy intake must meet demands

Athletes generally have high energy demands and when those energy demands are not met chronically it can lead to a serious condition called Relative Energy Deficiency in Sport (RED-S) that can lead to heart and bone conditions as well as increased illness and injuries. Energy intake of 45 calories or more per kg of fat free mass is recommended for athletes to prevent this serious problem. Pay special attention to energy intake just after ovulation while body temp is elevated. Body wearables that track body temperature may be helpful for monitoring here.

# 2: Low Glycemic Index Carbohydrates

To maintain steady glucose levels that help keep insulin levels consistent and provide energy slowly are best for physical performance. Additionally these carbohydrate sources are part of an anti-inflammatory diet necessary to fight inflammation from illness or physical stress.

# 3: Maintain healthy Vitamin D levels

Vitamin D is important for healthy ovulation, helping to maintain balanced hormones.

Adequate Vitamin D has also been found to help with reduced pain with menstrual

cramping. Studies have utilized 500-1000 mg Calcium and 2000 IU of Vitamin D starting on day 15 of the menstrual cycle until cramps and pain have improved.

# 4: Adequate Calcium and Magnesium Daily

These two minerals work nicely together to minimize painful cramps. Calcium can cause

the uterus to tighten but Magnesium helps block too much Calcium. Stable Calcium can

help with reduced food cravings. Lastly, moods can be balanced with these important minerals in adequate amounts.

# 5: Maintain healthy Zinc levels

Zinc has so many benefits for healthy menstruation. It is anti-inflammatory, it improves

blood flow to the pelvic floor helping with less pain, it helps with mood stabilization and

overall well-being. Supplements are only needed if the diet is poor and in deficient states. Studies have used 50-220 mg of Zinc Sulphate started 1-2 days before period and for 3-4 days. Excessive zinc beyond this is not recommended without a lab test.

#6: Anti-inflammatory diets that help reduce inflammation are encouraged. For more information see the previous post here: Anti-Inflammatory Diets | Performance Nutrition

#7: Consider Curcumin supplements (an extract from the Turmeric plant) for their anti-inflammatory properties and studies have shown to reduce premenstrual symptoms. Studies used 250-500 mg of powdered turmeric or curcumin for five days (2 days prior to period and 3 days into period).

Summary Key Points

The literature on how the menstrual cycle impacts performance is a very young area of research and most studies are small with some inconsistencies. The information listed above is a general guideline to inform you that there ARE hormonal shifts throughout a woman's cycle that WILL influence symptoms, exercise capability, motivation and nutritional needs. Every woman is unique and does not follow the perfect 28 day cycle naturally every month so the goal of today’s post is only to inform you and provide more information to assist you with monitoring your performance.

References:

Natalucci V, Spinello G, Moro T, Pavei G, Boccia G, La Torre A, Bonato M. Menstrual Cycle and Hormonal Contraceptives in Female Athletes: Should Symptoms and Nutrition Matter More than Cycle Phase? A Narrative Review. Nutrients. 2026 Apr 2;18(7):1144. doi: https://doi.org/10.3390/nu18071144

Brown N, Martin D, Waldron M, Bruinvels G, Farrant L, Fairchild R. Nutritional practices to manage menstrual cycle related symptoms: a systematic review. Nutrition Research Reviews. 2024;37(2):352-375. doi:https://doi.org/10.1017/s0954422423000227

Cabre HE, Moore SR, Smith-Ryan AE, Hackney AC. Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete. Dtsch Z Sportmed. 2022;73(7):225-234. https://doi.org/10.5960/dzsm.2022.546

Oosthuyse, T., Strauss, J.A. & Hackney, A.C. Understanding the female athlete: molecular mechanisms underpinning menstrual phase differences in exercise metabolism. Eur J Appl Physiol 123, 423–450 (2023). Doi: https://doi.org/10.1007/s00421-022-05090-3

Shrateh ON, Jawed A, Shuja MH, Kumar KA, Rehan ST, Abdelrhman S, Naasan M, Wahab NAA. Curcumin, a bioactive supplement for premenstrual syndrome and dysmenorrhea: A systematic review of randomised clinical trials. Eur J Obstet Gynecol Reprod Biol X. 2025 Oct 29;28:100432. doi:https://doi.org/10.1016/j.eurox.2025.100432