The Menstrual Cycle and Exercise Performance
1: Sports Med. 2003;33(11):833-51.
Effects of the menstrual cycle on exercise performance.
Janse de Jonge XA.
School of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney,
New South Wales, Australia.
[email hidden]
This article reviews the potential effects of the female steroid hormone fluctuations during the
menstrual cycle on exercise performance. The measurement of estrogen and progesterone concentration
to verify menstrual cycle phase is a major consideration in this review. However, even when hormone
concentrations are measured, the combination of differences in timing of testing, the high inter-
and intra-individual variability in estrogen and progesterone concentration, the pulsatile nature of
their secretion and their interaction, may easily obscure possible effects of the menstrual cycle on
exercise performance. When focusing on studies using hormone verification and electrical stimulation
to ensure maximal neural activation, the current literature suggests that fluctuations in female
reproductive hormones throughout the menstrual cycle do not affect muscle contractile
characteristics. Most research also reports no changes over the menstrual cycle for the many
determinants of maximal oxygen consumption (VO2max), such as lactate response to exercise,
bodyweight, plasma volume, haemoglobin concentration, heart rate and ventilation. Therefore, it is
not surprising that the current literature indicates that VO2max is not affected by the menstrual
cycle. These findings suggest that regularly menstruating female athletes, competing in
strength-specific sports and intense anaerobic/aerobic sports, do not need to adjust for menstrual
cycle phase to maximise performance. For prolonged exercise performance, however, the menstrual
cycle may have an effect. Even though most research suggests that oxygen consumption, heart rate and
rating of perceived exertion responses to sub-maximal steady-state exercise are not affected by the
menstrual cycle, several studies report a higher cardiovascular strain during moderate exercise in
the mid-luteal phase. Nevertheless, time to exhaustion at sub-maximal exercise intensities shows no
change over the menstrual cycle. The significance of this finding should be questioned due to the
low reproducibility of the time to exhaustion test. During prolonged exercise in hot conditions, a
decrease in exercise time to exhaustion is shown during the mid-luteal phase, when body temperature
is elevated. Thus, the mid-luteal phase has a potential negative effect on prolonged exercise
performance through elevated body temperature and potentially increased cardiovascular strain.
Practical implications for female endurance athletes may be the adjustment of competition schedules
to their menstrual cycle, especially in hot, humid conditions. The small scope of the current
research and its methodological limitations warrant further investigation of the effect of the
menstrual cycle on prolonged exercise performance.
2: Sports Med. 2002;32(10):601-14.
Physiological responses to the menstrual cycle: implications for the development of heat illness in
female athletes.
Marsh SA, Jenkins DG.
School of Human Movement Studies, University of Queensland, Brisbane, Australia.
[email hidden]
Fluctuations in estrogen and progesterone during the menstrual cycle can cause changes in body
systems other than the reproductive system. For example, progesterone is involved in the regulation
of fluid balance in the renal tubules and innervation of the diaphragm via the phrenic nerve.
However, few significant changes in the responses of the cardiovascular and respiratory systems,
blood lactate, bodyweight, performance and ratings of perceived exertion are evident across the
cycle. Nevertheless, substantial evidence exists to suggest that increased progesterone levels
during the luteal phase cause increases in both core and skin temperatures and alter the temperature
at which sweating begins during exposure to both ambient and hot environments. As heat illness is
characterised by a significant increase in body temperature, it is feasible that an additional
increase in core temperature during the luteal phase could place females at an increased risk of
developing heat illness during this time. In addition, it is often argued that physiological gender
differences such as oxygen consumption, percentage body fat and surface area-to-mass ratio place
females at a higher risk of heat illness than males. This review examines various physiological
responses to heat exposure during the menstrual cycle at rest and during exercise, and considers
whether such changes increase the risk of heat illness in female athletes during a particular phase
of the menstrual cycle.
3: Curr Womens Health Rep. 2001 Dec;1(3):232-40.
Relationship between athletic performance and menstrual cycle.
Lebrun CM, Rumball JS.
Primary Care Sport Medicine and Research, Fowler Kennedy Sport Medicine Clinic, University of
Western Ontario, London, Ontario N6A 3K7, Canada. [email hidden]
actions on body systems other than the reproductive axis. Female athletes, coaches, medical
professionals, and researchers have long been concerned about the potential impact of menstrual
cycle fluctuations in these hormones on components of athletic performance. Estrogen is known to
affect the cardiovascular system, bone, and the brain; progesterone primarily influences
thermoregulation and ventilation. Substrate metabolism is likely altered by both hormones. Net
physiological effects can be either opposing or synergistic and are determined by the relative
proportions of each. Nevertheless, investigations to date have not consistently demonstrated
significant differences in aerobic capacity, anaerobic capacity, aerobic endurance, or muscle
strength in any specific menstrual cycle phase. The course of some chronic diseases may vary
slightly during the menstrual cycle, but the mechanism is currently unknown. Recent research in
underlying hormonal causes for anterior cruciate ligament (ACL) injuries also is not convincing.
4: Int J Sport Nutr Exerc Metab. 2001 Dec;11(4):430-41.
Carbohydrate-loading during the follicular phase of the menstrual cycle: effects on muscle glycogen
and exercise performance.
Paul DR, Mulroy SM, Horner JA, Jacobs KA, Lamb DR.
Diet and Human Performance Laboratory at the Beltsville Human Nutrition Research Center, ARS, USDA,
MD 20705, USA.
The effects of employing a high-carbohydrate diet (carbohydrate-loading) to increase glycogen
storage in skeletal muscle are not well established in female athletes. On 4 occasions--2
familiarization trials and 2 experimental trials--6 well-trained female subjects completed 6 x
15-min continuous intervals of cycling (12 min at 72% VO2max, 1 min at maximal effort, and 2 min at
50% VO2max), followed by a time trial 15 min later. The women consumed their habitual diets (HD; 6-7
g carbohydrate/kg lean body mass) for 3 days after the second familiarization trial and before the
first experimental trial. During the 3 days following the first experimental trial, the subjects
consumed a high-carbohydrate diet (CD; 9-10 g carbohydrate/kg lean body mass) prior to the second
experimental trial. Mean (+/-SEM) pre-exercise muscle glycogen concentrations were greater after CD
versus HD (171.9+/-8.7 vs.
5.4+/-10.3 mmol/kg wet weight, P < 0.003). Although 4 of the 6 subjects improved their time-trial
performance after CD, mean performance for the time trial was not significantly different between
diets (HD: 763.9+/-35.6 s; CD:
6.9+/-30.1 s). Thus, female cyclists can increase their muscle glycogen stores after a
carbohydrate-loading diet during the follicular phase of the menstrual cycle, but we found no
compelling evidence of a dietary effect on performance of a cycling time trial performed after 90
min of moderate-intensity exercise.
7: J Exp Biol. 2002 Jan;205(Pt 2):233-9.
Effect of menstrual cycle phase on exercise performance of high-altitude native women at 3600
m.
Brutsaert TD, Spielvogel H, Caceres E, Araoz M, Chatterton RT, Vitzthum VJ.
Department of Anthropology, The University at Albany, State University of New York, 12222, USA.
[email hidden]
At sea level normally menstruating women show increased ventilation (VE) and hemodynamic changes due
to increased progesterone (P) and estrogen
(E2) levels during the mid-luteal (L) compared to the mid-follicular (F) phase of the ovarian cycle.
Such changes may affect maximal exercise performance. This repeated-measures, randomized study,
conducted at 3600 m, tests the hypothesis that a P-mediated increase in VE increases maximal
oxygen consumption (V(O(2)max)) during the L phase relative to the F phase in Bolivian women,
either born and raised at high altitude (HA), or resident at HA since early childhood. Subjects
(N=30) enrolled in the study were aged 27.7 +/- 0.7 years (mean +/- S.E.M.) and non-pregnant,
non-lactating, relatively sedentary residents of La Paz, Bolivia, who were not using hormonal
contraceptives. Mean salivary P levels at the time of the exercise tests were 63.3 pg ml(-1)
and 22.9 pg ml(-1) for the L and F phases, respectively. Subset analyses of submaximal (N=23)
and maximal (N=13) exercise responses were conducted only with women showing increased P levels
from F to L and, in the latter case, with those also achieving true (V(O(2)max)). Submaximal
exercise VE and ventilatory equivalents were higher in the L phase (P<0.001). P levels were
significantly correlated to the submaximal exercise VE (r=0.487, P=0.006). Maximal work output
(W) was higher (approximately 5 %) during the L phase (P=0.044), but (V(O(2)max)) (l min(-1))
was unchanged (P=0.063). Post-hoc analyses revealed no significant relationship between changes
in P levels and changes in
(V(O(2)max))) from F to L (P=0.072). In sum, the menstrual cycle phase has relatively modest effects
on ventilation, but no effect on
(V(O(3)max)) of HA native women.
6: Am J Physiol Endocrinol Metab. 2001 Oct;281(4):E817-25.
Glucose kinetics and exercise performance during phases of the menstrual cycle: effect of glucose
ingestion.
Campbell SE, Angus DJ, Febbraio MA.
Exercise Physiology and Metabolism Laboratory, Department of Physiology, The University of
Melbourne, Parkville, Victoria 3010, Australia.
To study the effect of menstrual cycle phase and carbohydrate ingestion on glucose kinetics and
exercise performance, eight healthy, moderately trained, eumenorrheic women cycled at 70% of peak
O(2) consumption for 2 h and then performed a 4 kJ/kg body wt time trial. A control (C) and a
glucose ingestion (G) trial were completed during the follicular (F) and luteal (L) phases of
the menstrual cycle. Plasma substrate concentrations were similar before the commencement of
exercise. Glucose rates of appearance and disappearance were higher (P < 0.05) during the 2nd h
of exercise in FC than in LC. The percent contribution of carbohydrate to total energy
expenditure was greater in FC than in LC, and subjects performed better (13%, P < 0.05) in FC.
Performance improved (19% and 26% in FG and LG compared with FC and LC, respectively, P < 0.05)
with the ingestion of glucose throughout exercise. These data demonstrate that substrate
metabolism and exercise performance are influenced by the menstrual cycle phase, but ingestion
of glucose minimizes these effects.
7: Med Sci Sports Exerc. 2000 Feb;32(2):486-92.
Influence of the menstrual cycle phase and menstrual symptoms on maximal anaerobic performance.
Giacomoni M, Bernard T, Gavarry O, Altare S, Falgairette G.
Unite d'Ergonomie Sportive et Performance, U.F.R.
S.T.A.P.S, Universite de Toulon et du Var, France.
PURPOSE: This study was designed to analyze the effect of the menstrual cycle phase on maximal
anaerobic performance during short-term anaerobic tests. METHODS: Seven eumenorrheic women (NOC) and
10 women using monophasic oral contraceptives (OC) performed three anaerobic tests (force-velocity,
multi-jump, and squatting jump tests) during menstruation (M: between days 1 and 4), the
midfollicular phase (F: between days 7 and 9), and the midluteal phase (L: between days 19 and 21)
of the ovarian cycle. Follicular and luteal phases were confirmed by serum progesterone levels. The
order of testing sessions was randomly assigned and a 15-min standardized warm-up preceded each
testing session. Rectal temperatures were taken before (Trec(b)) and after (Trec(a)) warm-up.
RESULTS: No significant differences were observed among M, F, and L in Trec(b), Trec(a) maximal
cycling power (Pmax(c)), maximal jumping power (Pmax(j)), or maximal height of jump (h(j)) in either
NOC or OC. Ten of the women suffered premenstrual or menstrual symptoms (MS); the other seven did
not report any premenstrual or menstrual discomfort (NMS). Presence or absence of symptoms was not
correlated with oral contraceptive use. No significant differences were observed among the three
stages of the menstrual cycle in Pmax(c), Pmax(j), or h(j) in NMS. In MS, only Pmax(j) decreased by
8% in M compared with that in F (P < .05). CONCLUSIONS: Although there were no significant
differences in maximal anaerobic performance during different menstrual cycle phases, results of
this study suggest that the presence or absence of premenstrual or menstrual syndrome symptoms may
have an effect, possibly through an action on the stretch-shortening cycle of tendons and ligaments.
8: Can J Appl Physiol. 2000 Feb;25(1):35-54.
Exercise and training in women, Part II: Influence of menstrual cycle and pregnancy.
Shephard RJ.
Physical Education & Health, Department of Public Health Sciences, University of Toronto, P. O. Box
521 Brackendale, BC V0N 1H0.
This part of the review considers the impact of the menstrual cycle and pregnancy upon exercise
performance, together with the implications of continued, regular exercise for the developing
foetus. Specific issues that are covered include changes in physical performance over the
menstrual cycle; the impact of training on the menstrual cycle; a need for awareness of potential
pregnancy; alterations in fitness, performance, circulatory, respiratory and metabolic function
during pregnancy; potential hazards to the foetus from hyperthermia and hypoxia; a recommended
physical activity programme for the pregnant woman; and the impact of continued exercise upon
pregnancy outcomes.
9: J Appl Physiol. 2000 Feb;88(2):690-7.
Effect of menstrual cycle phase on carbohydrate supplementation during prolonged exercise
to fatigue.
Bailey SP, Zacher CM, Mittleman KD.
Department of Physical Therapy Education, Elon College, Elon College, North Carolina 27244, USA.
[email hidden]
The effects of menstrual cycle phase and carbohydrate (CHO) supplementation were investigated during
prolonged exercise. Nine healthy, moderately trained women cycled at 70% peak O(2) consumption until
exhaustion. Two trials were completed during the follicular (Fol) and luteal (Lut) phases of the
menstrual cycle. Subjects consumed 0.6 g CHO. kg body wt(-1). h(-1) (5 ml/kg of a 6% CHO solution
every 30 min beginning at min 30 of exercise) or a placebo drink (Pl) during exercise. Time to
exhaustion during CHO increased from Pl values (P < 0.05) by
10.4 +/- 8.5 (Fol) and 11.4 +/- 7.1% (Lut); no differences were observed between menstrual cycle
phases. CHO attenuated (P < 0.05) the decrease in plasma glucose and insulin and the increase
in plasma free fatty acids, tryptophan, epinephrine, and cortisol observed during Pl for both
phases. Plasma alanine, glutamine, proline, and isoleucine were lower (P < 0.05) in Lut than
in Fol phase. CHO resulted in lower (P < 0.05) plasma tyrosine, valine, leucine, isoleucine,
and phenylalanine. These results indicate that the menstrual cycle phase does not alter the
effects of CHO supplementation on performance and plasma levels of related substrates during
prolonged exercise.
11: Eur J Appl Physiol Occup Physiol. 1999 Jul;80(2):76-83.
Influence of menstrual cycle and oral contraceptives on tolerance to uncompensable heat stress.
Tenaglia SA, McLellan TM, Klentrou PP.
Defence and Civil Institute of Environmental Medicine, Human Protection and Performance Section,
North York, ON, Canada.
In this study we examined the influence of menstrual cycle phase and oral contraceptive use on
thermoregulation and tolerance during uncompensable heat stress. Eighteen women (18-35 years), who
differed only with respect to oral contraceptive use (n = 9) or non-use (n = 9), performed light
intermittent exercise at 40 degrees C and 30% relative humidity while wearing nuclear, biological
and chemical protective clothing. Their responses were compared during the early follicular (EF,
days 2-5) and mid-luteal (ML, days 19-22) phases of the menstrual cycle. Since oral contraceptives
are presumed to inhibit ovulation, a quasi-early follicular (q-EF) and quasi-mid-luteal (q-ML) phase
was assumed for the users. Estradiol and progesterone measurements verified that all subjects were
tested during the desired phases of the menstrual cycle. Results demonstrated that rectal
temperature (Tre) was elevated in ML compared with EF among the non-users at the beginning and
throughout the heat-stress trial. For the users, Tre was higher in q-ML compared with q-EF at the
beginning, and for 75 min of the heat-stress exposure. Tolerance times were significantly longer
during EF [128.1
(11.1) min, mean (SD)] compared with ML [107.4
(11.2) min] for the nonusers, indicating that these women are at a thermoregulatory advantage during
the EF phase of their menstrual cycle. For the users, tolerance times were similar in both
the q-EF [113.0 (5.8) min] and q-ML [116.8 (11.2) min] phases and did not differ from those
of the non-users. It was concluded that oral contraceptive use had little or no influence on
tolerance to uncompensable heat stress, whereas tolerance was increased during EF for
non-users of oral contraceptives.
12: J Appl Physiol. 1999 May;86(5):1519-26.
Exercise VE and physical performance at altitude are not affected by menstrual cycle phase.
eidleman BA, Rock PB, Muza SR, Fulco CS, Forte VA Jr, Cymerman A. Thermal and Mountain Medicine
Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
01760, USA. [email hidden]
We hypothesized that progesterone-mediated ventilatory stimulation during the midluteal phase of the
menstrual cycle would increase exercise minute ventilation (VE; l/min) at sea level (SL) and with
acute altitude (AA) exposure but would only increase arterial O2 saturation (SaO2, %) with AA
exposure. We further hypothesized that an increased exercise SaO2 with AA exposure would enhance O2
transport and improve both peak O2 uptake (VO2 peak; ml x kg-1 x min-1) and submaximal exercise time
to exhaustion (Exh; min) in the midluteal phase. Eight female lowlanders [33 +/- 3 (mean +/- SD) yr,
58 +/- 6 kg] completed a VO2 peak and Exh test at 70% of their altitude-specific VO2 peak at SL and
with AA exposure to 4,300 m in a hypobaric chamber (446 mmHg) in their early follicular and
midluteal phases. Progesterone levels increased (P < 0.05) approximately 20-fold from the early
follicular to midluteal phase at SL and AA. Peak VE (101 +/- 17) and submaximal VE (55 +/- 9) were
not affected by cycle phase or altitude. Submaximal SaO2 did not differ between cycle phases at SL,
but it was 3% higher during the midluteal phase with AA exposure. Neither VO2 peak nor Exh time was
affected by cycle phase at SL or AA. We conclude that, despite significantly increased progesterone
levels in the midluteal phase, exercise VE is not increased at SL or AA. Moreover, neither maximal
nor submaximal exercise performance is affected by menstrual cycle phase at SL or AA.
13: Eur J Appl Physiol Occup Physiol. 1998 Nov;78(6):565-72.
Effects of menstrual cycle phase and oral contraceptive use on intermittent exercise.
Lynch NJ, Nimmo MA.
Scottish School of Sport Studies, University of Strathclyde, Glasgow, UK.
Five women using low-dose, monophasic oral contraceptive (OC) agents (OC group) and ten normally
menstruating women (Non-OC group) performed a treadmill protocol to determine the effect of OCs and
the menstrual cycle (MC) on intermittent exercise performance and some commonly used metabolic
markers. The Non-OC group were tested once in the mid-follicular phase (MFP) and once in the late
luteal phase (LLP) of the MC, while the OC group performed their first test within 1 week of taking
the OC (T1) and their second test 1 week later (T2). Despite performance time being the same in both
groups [mean (SD), Non-OC group: 77.7 (14.9) s versus OC group: 77.7
(13.1)a], plasma ammonia concentration ([NH3]pl) was higher in the Non-OC group when compared to the
OC group throughout recovery (P < 0.05). No differences were found in blood lactate (BLa),
maximum heart rate or aural temperature (Tau) between groups. Within the Non-OC group Tau
increased with exercise in both phases (P < 0.05), however Tau was higher in the LLP at rest
[36.1 (.3) degrees C) and 1 min post-exercise [37.1 (.6) degrees C), when compared to the
MFP [35.8 (.3) and 36.9 (0.7) degrees C, rest and 1 min post-exercise respectively, P <
0.05]. Within the OC group T1 resulted in a higher peak BLa [11.2 (.4) mmol/l] and [NH3]pl
(143.0 (26.2) Umol/l] when compared to T2 [BLa, 9.6 (0.9); [NH3], 119.4
(13.2), P<0.05]. These results suggest that: (1) exercise performance does not vary between the
MFP and the LLP of the MC, nor does it appear to be affected by the number of days using
the OC, and
(14) an altered metabolism occurs both between groups (Non-OC versus OC) and within the OC group.
15: Am J Sports Med. 1998 Sep-Oct;26(5):614-9.
Erratum in: Am J Sports Med 2000 Sep-Oct;28(5):747.
Comment in: Am J Sports Med. 1999 Mar-Apr;27(2):270-1. Am J Sports Med. 2000 Jan-Feb;28(1):131.
Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes.
Wojtys EM, Huston LJ, Lindenfeld TN, Hewett TE, Greenfield ML.
MedSport, Section of Orthopaedic Surgery, University of Michigan, Ann Arbor, USA.
Anterior cruciate ligament injury rates are four to eight times higher in women than in men. Because
of estrogen's direct effect on collagen metabolism and behavior and because neuromuscular
performance varies during the menstrual cycle, it is logical to question the menstrual cycle's
effect on knee injury rates. Of 40 consecutive female athletes with acute anterior cruciate ligament
injuries (less than 3 months), 28 (average age, 23 +/- 11 years) met the study criteria of regular
menstrual periods and noncontact injury. Details concerning mechanism of injury, menstrual cycle,
contraceptive use, and previous injury history were collected. A chi-square test was used to compute
observed and expected frequencies of anterior cruciate ligament injury based on three different
phases of the menstrual cycle: follicular (days 1 to 9), ovulatory (days 10 to 14), and luteal (day
15 to end of cycle). A significant statistical association was found between the stage of the
menstrual cycle and the likelihood for an anterior cruciate ligament injury (P = 0.03). In
particular, there were more injuries than expected in the ovulatory phase of the cycle. In contrast,
significantly fewer injuries occurred in the follicular phase. These hormones may be a factor in the
knee ligament injury dilemma in women.
16: Med Sci Sports Exerc. 1995 Mar;27(3):437-44.
Effects of menstrual cycle phase on athletic performance.
Lebrun CM, McKenzie DC, Prior JC, Taunton JE.
Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada.
The purpose of this study was to examine the effects of menstrual cycle phase on four selected
indices of athletic performance: aerobic capacity, anaerobic capacity, isokinetic strength, and high
intensity endurance. Sixteen eumenorrheic women (VO2max > or = 50 ml.kg-1.min-1) were tested during
the early follicular (F) and midluteal (L) phases of the menstrual cycle. Cycle phases were
confirmed by serum estradiol and progesterone assays. No significant differences were observed
between F and L tests in weight, percent body fat, sum of skinfolds, hemoglobin concentration,
hematocrit, maximum heart rate, maximum minute ventilation, maximum respiratory exchange ratio,
anaerobic performance, endurance time to fatigue (at 90% of VO2max), or isokinetic strength of knee
flexion and extension. Both absolute and relative VO2max, however, were slightly lower in L than in
F (F= 3.19 +/- 0.09.min-1, L = 3.13 +/- .08.min-1, P = 0.04; and F = 53.7 +/- 0.9
ml.kg-1.min-1, L = 52.8 +/- 0.8 ml.kg-1.min-1, P
= .06). These results suggest that the cyclic
increases in endogenous female steroid hormones of an ovulatory menstrual cycle may have a slight,
deleterious influence on aerobic capacity, with potential implications for individual athletes.
Nevertheless, the cycle phase did not impact significantly on the majority of the other performance
tests and cardiorespiratory variables measured in this study.
15: Clin Sports Med. 1994 Apr;13(2):419-41.
The effect of the phase of the menstrual cycle and the birth control pill on athletic performance.
Lebrun CM.
Department of Family Practice, Faculty of Medicine, University of British Columbia,
Vancouver, Canada.
Investigators are not in agreement on the effects of either the phase of the menstrual cycle, or the
administration of OCAs on athletic performance. It appears, however, that apart from subtle changes
in some variables, for most women there is no significant effect. Medals have been won and world
records set in any phase of the menstrual cycle, and also by women taking OCAs. In terms of
documentation of cycle phase, newer hormonal measurement techniques such as the levels of urinary
luteinizing hormone (LH) to detect ovulation or salivary progesterone, should make it easier in the
future to obviate the methodologic difficulties encountered in earlier studies. Further studies
should also focus on the midcycle estradiol surge as well, in order to determine the relative
contributions of estrogen and progesterone to any observed performance changes. Given the
possibility that some cardiovascular, respiratory, and metabolic variables may change slightly
during the course of a regular ovulatory menstrual cycle, it behooves researchers who are using
women as subjects in other types of studies to standardize the menstrual cycle phase in which they
are tested, in order to eliminate any possible confounding effects due to hormonal variation.
Regarding the effects of oral contraceptives on performance, any conclusions from the studies to
date are complicated by the proliferation of preparations currently on the market. Further studies
are needed on monophasic, biphasic and triphasic formulations, including OCAs with the newer
progestins (desogestrel, gestodene and norgestimate), as well as the progesterone-only agents (both
oral and injectable). Prospective double blind randomized studies must be done, using a proper
control group. The difficulty with this technique, however, is that women in the control group will
inevitably be in various phases of the cycle, so accurate hormonal documentation is also essential
in order to correctly interpret the findings. Just as the past few decades have seen a significant
advancement in the participation of women in sports, future years should bring an enhanced
scientific knowledge base about the interactions of the special hormonal considerations of the
exercising woman throughout her reproductive life cycle.
PIP: Research has not yet conclusively settled the question of potential effects of oral
contraceptives (OCs) or of the phase of the menstrual cycle on athletic performance. The current
evidence suggests that most women's athletic performance is not affected by OCs or the phase of the
menstrual cycle. In fact, female athletes have won competitions and set world records at all phases
of the menstrual cycle. Even though many female athletes use OCs, the sports medicine community
knows little about the possible OC-induced metabolic effects on athletic performance. Sports
medicine researchers can use newer hormonal measurement techniques (e.g., urinary luteinizing
hormone levels) to detect ovulation or salivary progesterone, which avoid the methodological
difficulties in earlier studies. They should also concentrate on the midcycle estradiol surge to
learn the relative contributions of estrogen and progesterone to changes in athletic performance.
Since some cardiovascular, respiratory, and metabolic variables may change during a regular
menstrual cycle, researchers should also standardize the menstrual cycle phase in which female
athletes are tested to control for any possible confounding effects caused by hormonal variation.
The increase in the variety of OC preparations available to women complicate any conclusions about
the effects of OCs.