Ever wondered why some days your workout feels effortless, and the others feel impossible? Your menstrual cycle may play a more significant role than you think, with hormonal shifts influencing mood, strength, energy and recovery. Understanding these changes can help you train smarter, feel in control and optimise performance.

What is the menstrual cycle?

The menstrual cycle consists of two phases: phase one, the follicular (proliferative) phase and phase 2, the luteal (secretory) phase, separated by ovulation (Thiyagarajan, Basit and Jeanmonod, 2024). The menstrual cycle typically lasts a median of 28 days, with cycles varying from 25 to 30 days, depending on ethnicity, Body Mass Index (BMI) and age (Schieren et al., 2024).

Follicular phase (Days 1-14)

• Days 1-8 (early follicular) = Oestrogen, progesterone, follicle-stimulating hormone (FSH), and luteinising hormone (LH) are at their lowest concentration
• Days 9-13 (late follicular) = Oestrogen rises sharply, LH elevates minimally, while both progesterone and FSH remain reduced
• Day 14 (ovulation) = Significant spike in LH triggers ovulation, accompanied by elevations in FSH and oestrogen concentrations. Progesterone also begins to rise, signalling the transition into the luteal phase

Luteal phase (Days 15-28)

• Day 15-18 (early luteal) = progesterone is the dominant hormone, while oestrogen, LH and FSH fall from their ovulatory peaks
• Days 19-23 (mid-luteal) = progesterone peaks, oestrogen rises moderately, LH and FSH concentrations remain depleted
• Days 24-28 (late luteal) = progesterone and oestrogen levels fall, while FSH and LH remain low

What are the physical activity patterns across the menstrual cycle?

In healthy women, total activity time and step count are higher during the follicular phase compared to premenstrual phases (Ozdemir et al., 2026). McNulty et al. (2020) reinforce moderately worse athletic performance in the early follicular phase; however, strength and endurance remain similar across phases. Notably, evidence quality appears low, with large between-study variation and small effect size, reducing confidence in the impact of menstrual phases on performance.

Contrastingly, in female athletes, the menstrual cycle did not significantly alter sedentary, light or moderate physical activity. However, high-intensity exercise is lowest during the ovulatory phase (Recacha-Ponce et al., 2026). This suggests intensity, rather than total activity, is more sensitive to hormonal fluctuations. The between-study discrepancies likely reflect that competitive athletes tend to maintain their training regardless of discomfort, symptoms and phase-related fluctuations in fitness.

How does the menstrual cycle impact physical activity?

Mood and motivation

Psychological changes appear to strongly influence physical activity adherence. During the late luteal phase, mood impairment, emotional tension, irritability and somatic complaints reduce motivation and perceived performance. (Ribeiro et al., 2026). Elevated progesterone and cortisol further increase amygdala reactivity and decrease prefrontal cortex regulation, heightening negative psychological responses. Allopregnanolone concentrations elevate during the luteal phase, correspondingly reducing GABA-A receptor sensitivity, heightening anxiety (Prado et al., 2021). Collectively, these neurobiological modifications may reduce tolerance for discomfort, impair decision-making and may diminish athletic performance.

In contrast, elevated feelings of competitiveness and motivation during ovulation in comparison to the luteal and follicular phases, which may be advantageous to maximise performance within this phase (Paludo et al., 2022).

During menstruation, psychological barriers including self-consciousness, fear of visible bleeding, perceived judgement associated with menstruation and hygiene products reduced motivation to engage in physical activity (Srinivasa Gopalan, Mann and Rhodes, 2024; Kolić et al., 2021).

Strength

Bernstein and Behringer (2023) indicate that the spike in oestrogen levels during the late follicular and ovulation phase may enhance strength. Elevated oestrogen receptor activity in muscle allows oestrogen to bind and stimulate protein synthesis. Additionally, oestrogen interacts with growth hormone, insulin-like growth factor-1 and insulin, supporting muscle building, repair and recovery. Oestrogen may reduce inorganic phosphate levels, maintaining actin-myosin cross-bridge function and helping preserve strength.

Progesterone peaks in the early and mid-luteal phase and may counter muscle growth and strength by enhancing amino acid catabolism and supporting muscle protein breakdown within the muscle. In contrast, cell fluid retention associated with the luteal phase may favourably impact protein synthesis and theoretically stimulate muscle growth (Bernstein and Behringer, 2023). Evidence surrounding menstrual cycle impacts on strength is mixed, with most studies relying on animal or in vitro models, limiting direct application to humans.

Energy metabolism

During the late follicular phase, rising oestrogen enriches fatty acid oxidation, lipolysis and intramuscular lipid stores while enhancing insulin sensitivity, glucose uptake and glycogen storage. This suggests a theoretical improvement in endurance performance (Oosthuyse and Bosch, 2010).

Conversely, rises in progesterone during the luteal phase can oppose oestrogen’s effects by reducing GLUT4 expression and insulin sensitivity, which may weaken endurance capacity. Notably, a metabolic response is only apparent at an elevated oestrogen-to-progesterone ratio. However, ratios vary significantly between women, even within the same menstrual phase; therefore, using phase labels alone is a poor indicator of metabolic response (Oosthuyse and Bosch, 2010).

Campbell et al. (2001) revealed that when carbohydrate is available, the body will prioritise carbohydrate use regardless of the menstrual phase. Phase-specific metabolic differences are only apparent in a carbohydrate-depleted state. As most athletes typically consume adequate carbohydrates, real-world differences in endurance performance may be minimal.

Recovery

Bernstein and Behringer (2023) demonstrate that high levels of oestrogen during the late follicular and ovulatory menstrual phases may improve exercise-induced muscle recovery. Oestrogen acts as an antioxidant, stabilising cell membranes by scavenging free radicals, reducing lipid peroxidation and altering reactive oxygen species pathways. Furthermore, oestrogen may prevent neutrophil and macrophage infiltration, reducing the inflammatory response stimulated by exercise-induced muscle damage, suggesting improved muscle recovery.

Symptom severity

Symptom severity during menstruation can significantly reduce physical capacity. Kolić et al. (2021) suggest that women who avoided physical activity during menstruation typically had more severe pain, heavier flow, increased fatigue and a longer period duration in comparison to non-avoiders. Even when exercise was performed, menstrual discomfort reduced both the quality and intensity of exercise, highlighting how strongly symptoms can affect performance and adherence (Srinivasa Gopalan, Mann and Rhodes, 2024). Menstrual conditions, including heavy menstrual bleeding, dysmenorrhea and premenstrual syndrome, further increase menstrual-associated challenges and negatively affect adherence and performance (Srinivasa Gopalan, Mann and Rhodes, 2024). Heavy menstrual losses may increase anaemia risk, reducing oxygen transport and impairing high-intensity exercise (Reilly, 2000).

During the mid-luteal phase, rising progesterone increases body temperature by 0.3-0.5°C, raising ventilation rate and perceived exercise despite aerobic capacity and VO2 max being unchanged (Reilly, 2000).

What do the studies say about adapting physical activity?

Current evidence does not support routinely adapting training to specific menstrual cycle phases. Evidence remains limited due to reliance on animal and in vitro models, intra-individual variability in hormone concentration, and misclassification of menstrual phases. Many female athletes have irregular menstrual cycles or use oral contraceptives, complicating research (D’Souza et al., 2023). Furthermore, symptoms including fatigue, mood changes, bloating, sleep disruption and pain appear more influential than hormone levels alone (Bruinvels, Hackney and Pedlar, 2022). This may explain why female athletes within the same menstrual phase have differing experiences in training and performance.

Given this variability, a holistic approach may be more beneficial than a one-size-fits-all guideline, due to individual fluctuations in psychological and physiological challenges across the menstrual cycle and corresponding alterations in performance (Ryman Augustsson and Findhé-Malenica, 2025). Therefore, current evidence suggests tracking symptoms, recovery and performance across multiple cycles allows for individualised training adjustments (Bangsbo et al., 2025).

Practice guidance for adapting training

Based on current evidence, practical adaptations should focus on adjusting training according to individual symptoms and performance, rather than following fixed menstrual-phase rules. Tracking recovery, performance and symptoms across multiple cycles can help identify whether recurring patterns exist and allow training to be adjusted when a pattern repeats consistently.  The following steps outline how an individualised, symptom-focused approach can be applied in practice:

1. Track cycle + symptoms + performance across multiple months
2. Identify whether a reproducible pattern exists in performance during different menstrual phases
3. Maintain normal training when performance is unaffected
4. Modify volume/intensity when symptoms impact performance
5. Prioritise nutrition, sleep and recovery, particularly when symptoms are elevated
6. Reassess the pattern regularly, over multiple cycles, to identify changes over time

Reference List

Bangsbo, J., Hostrup, M., Hellsten, Y., Hansen, M., Melin, A., Kjær, M., Burr, J.F., Engebretsen, L., Egan, B., Hackney, A.C., Chambers, T.L., Jones, A.M., Pitsiladis, Y., Magnusson, P., Petersen, J., Deshmukh, A.S., Calbet, J.A.L., Elliott‐Sale, K., Joyner, M., Andersen, J.L., Christensen, P.M., Dünweber, M.R., Rømer, T., Wickham, K.A., Jessen, S.K., Kissow, J., Jeppesen, J.S. and Moesgaard, L. 2025. Consensus statements—Optimising performance of the elite athlete. Scandinavian Journal of Medicine & Science in Sports. 35(8).

Bernstein, C. and Behringer, M. 2023. Mechanisms underlying menstrual cycle effects on exercise performance: A scoping review. Women in Sport and Physical Activity Journal. 31(2), pp.1–18.

Bruinvels, G., Hackney, A.C. and Pedlar, C.R. 2022. Menstrual cycle: The importance of both the phases and the transitions between phases on training and performance. Sports Medicine. 52(7).

Campbell, S.E., Angus, D.J. and Febbraio, M.A. 2001. Glucose kinetics and exercise performance during phases of the menstrual cycle: Effect of glucose ingestion. American Journal of Physiology-Endocrinology and Metabolism. 281(4), pp.817–825.

D’Souza, A.C., Wageh, M., Williams, J.S., Colenso-Semple, L.M., McCarthy, D.G., McKay, A.K.A., Elliott-Sale, K.J., Burke, L.M., Parise, G., MacDonald, M.J., Tarnopolsky, M.A. and Phillips, S.M. 2023. Menstrual cycle hormones and oral contraceptives: A multi-method systems physiology-based review of their impact on key aspects of female physiology. Journal of Applied Physiology. 135(6).

Kolić, P.V., Sims, D.T., Hicks, K., Thomas, L. and Morse, C.I. 2021. Physical activity and the menstrual cycle: A mixed-methods study of women’s experiences. Women in Sport and Physical Activity Journal. 29(1), pp.1–12.

McNulty, K.L., Elliott-Sale, K.J., Dolan, E., Swinton, P.A., Ansdell, P., Goodall, S., Thomas, K. and Hicks, K.M. 2020. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: A systematic review and meta-analysis. Sports Medicine. 50(10), pp.1813–1827.

Oosthuyse, T. and Bosch, A.N. 2010. The effect of the menstrual cycle on exercise metabolism. Sports Medicine. 40(3), pp.207–227.

Ozdemir, S., Galbarczyk, A., Wachowicz, A., Słojewska, K., Klimek, M., Jasienska, G. and Marcinkowska, U.M. 2026. Variations in physical activity across the menstrual cycle in healthy women: A focus on step count and activity intensity. American Journal of Human Biology. 38(2).

Paludo, A.C., Paravlic, A., Dvořáková, K. and Gimunová, M. 2022. The effect of menstrual cycle on perceptual responses in athletes: A systematic review with meta-analysis. Frontiers in Psychology. 13(13).

Prado, R.C.R., Silveira, R., Kilpatrick, M.W., Pires, F.O. and Asano, R.Y. 2021. Menstrual cycle, psychological responses, and adherence to physical exercise: Viewpoint of a possible barrier. Frontiers in Psychology. 12.

Recacha-Ponce, P., Collado-Boira, E., Suarez-Alcazar, P., Montesinos-Ruiz, M. and Hernando-Domingo, C. 2023. Is it necessary to adapt training according to the menstrual cycle? Influence of contraception and physical fitness variables. Life. 13(8), p.1764.

Recacha-Ponce, P., Hernando, C., Capdevila-Seder, A., Collado-Boira, E., Suárez-Alcázar, M. and Salas Medina, P. 2026. Daily physical activity patterns across the menstrual cycle in EUMENORRHEIC female athletes: An accelerometry-based study. Frontiers in Sports and Active Living. 8, article no: 1793624.

Reilly, T. 2000. The menstrual cycle and human performance: An overview. Biological Rhythm Research. 31(1), pp.29–40.

Ribeiro, T.D., Peralta, M., Iglésias, B., Filipe Manuel, C., Silva, A.F. and Marques, A. 2026. Psychological outcomes across the natural menstrual cycle in active women and athletes: A systematic review. Performance Enhancement & Health. 14(2), article no: 100423.

Ryman Augustsson, S. and Findhé-Malenica, A. 2025. Power in the flow: How menstrual experiences shape women’s strength training performance. Frontiers in Sports and Active Living. 7.

Schieren, A., Koch, S., Pecht, T. and Simon, M.-C. 2024. Impact of physiological fluctuations of sex hormones during the menstrual cycle on glucose metabolism and the gut microbiota. Experimental and Clinical Endocrinology & Diabetes. 132(5), pp.267–278.

Srinivasa Gopalan, S., Mann, C. and Rhodes, R.E. 2024. Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review. Preventive Medicine. 184(107980), article no: 107980.

Stricker, R., Eberhart, R., Chevailler, M.-C., Quinn, F.A., Bischof, P. and Stricker, R. 2006. Establishment of detailed reference values for luteinizing hormone, follicle stimulating hormone, estradiol, and progesterone during different phases of the menstrual cycle on the abbott ARCHITECT® analyzer. Clinical Chemistry and Laboratory Medicine (CCLM). 44(7).

Thiyagarajan, D.K., Basit, H. and Jeanmonod, R. 2024. Physiology, menstrual cycle. [Online]. Treasure Island (FL): StatPearls Publishing. [Accessed 28 September 2026]. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK500020/

About the author

Anna is a recent Nutrition BSc (Hons) graduate from the University of Leeds who aims to pursue an MSc in Dietetics. Having always been involved in sport, she is particularly interested in how hormonal fluctuations influence training and wellbeing in female athletes. She is committed to translating this evidence into clear, practical guidance that empowers them to understand their bodies, build confidence in their abilities and make informed decisions that enhance performance and long‑term health. She has gained practical, hands-on experience across culturally inclusive public-health projects, paediatric dietetics and mental-health physical activity programmes, and is motivated by making a positive difference to individual health. Anna is keen to pursue a career that provides person-centred, evidence-based and accessible nutritional care that genuinely makes a meaningful difference to people’s