For many years, athletic performance has been primarily studied through the lens of male physiology. The knowledge accumulated from these studies has often been generalized to female athletes, but as Dr. Stacy Sims and others have highlighted, “Women are not small men.” Women have unique physiological characteristics, leading to different nutrition requirements, training responses, and recovery needs compared to their male counterparts. One significant factor influencing female physiology and performance is the menstrual cycle. Understanding and leveraging this information can provide a competitive edge for female athletes.


The Phases of Menstrual Cycle

There are 3 basic phases of the menstrual cycle: The follicular phase, ovulation, and the luteal phase.

The follicular phase initiates at the onset of menstrual flow and continues until ovulation around day 12-18 of the cycle. During this phase, estrogen levels start low and gradually rise; this phase provides an environment conducive to muscle growth, increased efficiency in glycogen utilization, and reduced reliance on fatty acids for energy. As a result, high-intensity workouts and heavy lifts may be favored during this time.

Ovulation marks the release of the mature egg and is initiated by a surge in luteinizing hormone and peak estrogen levels. The egg is released from the ovarian follicle which then converts into a structure called the corpus luteum that produces progesterone. Concurrently, estrogen levels fall rapidly from their peak. 

The luteal phase follows ovulation, which continues until the next menstruation. In this phase, progesterone levels increase, preparing the uterine lining for potential implantation. Fatty acid utilization is now favored. Progesterone’s dominance relative to estrogen in the luteal phase can lead to a subjective feeling of increased exertion, impacting muscle repair and recovery. Endurance activities and attention to adequate protein intake become more important during this phase.


Does Training with Your Menstrual Cycle Boost Performance?

The debate over the synchronization of training with the menstrual cycle remains contentious. While existing research lacks definitive conclusions, a majority of athletes subjectively report that their menstrual cycles influence their training and performance. The variability among individual cycles in the same woman and similarly across populations of women,  presents a challenge for population studies. This variation mathematically makes statistical significance difficult to achieve. Despite these study design challenges, the anecdotal evidence from athletes cannot be discounted.


Training with Awareness of Your Menstrual Cycles

Acknowledging the individuality of each woman’s cycle is crucial. Changes to the menstrual pattern can signal underlying physiological issues affecting performance and overall health. Although there is no universal regimen, training synchronized with the menstrual cycle serves as a potentially powerful personalized tool for athletes. Contact us for valuable resources and insights into optimizing training according to different menstrual phases.


Hormonal Contraception

Many female athletes use hormonal contraception for a variety of personal reasons. While it may alleviate menstrual-related challenges, different contraceptive methods may impact athletic performance in disparate ways. Combined estrogen/progestin pills have been associated with decreased performance in some studies. Progestin-only methods, particularly the intrauterine device (IUD), present alternative options with lower systemic hormonal exposure. Understanding the potential positive and negative impacts of hormonal contraception on performance is crucial, especially concerning the possibility of masking indicators of low energy availability.



The case for synchronizing training with the menstrual cycle should be approached with an understanding of its individualized nature. While existing evidence lacks definitive population-based conclusions on its performance benefits, athletes can personalize their training based on their cycle to seek optimal performance and determine for themselves if this is an effective strategy. Hormonal contraceptives introduce novel sets of considerations for female athletes, and a thorough understanding of their potential impact is essential. Ultimately, reproductive choice and the holistic well-being of female athletes should guide decisions regarding contraceptive methods.

The menstrual cycle is a distinct physiological factor to consider in female athletes, and understanding its influence can provide a competitive advantage. Dr. Carla DiGirolamo emphasizes the need for an individualized approach to training and hormonal considerations in promoting optimal athletic performance and overall well-being. Consult with Dr. Carla DiGirolamo to craft a strategy that suits your unique needs and goals.