It is becoming more evident through research that how a woman trains and what types of exercise she does at different stages of her menstrual cycle, affect her body's response to exercise, its' efficacy and may even increase the risks of specific injuries.
So is it time for women to start adapting the types of exercise taken depending on the time of her menstrual cycle?
In this article my aim is to present some of the recent research and give some guidance as to what women need to think about when choosing how and when to train.
Through scientific studies, research on the effects of exercise have largely included men and post-menopausal women, which research now suggests- may have given a wrong indication for women at other stages of their lives, of how and when to exercise to optimise performance and wellbeing.
A recent meta-analysis published in 2017 in the British Journal of Sports showed that women have been largely underrepresented in sports studies (1), meaning that much of the advice given also to women, have been based on the results in men.
Recent studies have started looking into the effects and the efficacy of exercise for women during different times of the menstrual cycle and results are showing that the intensity and the types of training, may have varied effects at different times of a woman's menstrual cycle.
For so long, women were expected to be able to train pretty much the same way throughout the month (except potentially during her period) and it is only lately that the more "traditional" way of exercising and its efficacy for women has started to become questioned.
There are today many female athletes who have begun to sync and adapt their training to follow their menstrual cycle and one example is the Chelsea FC women's football team which has adopted this way of training (2).
So what is the reasoning for adapting how women train, the intensity and duration?
The reasons relate to the hormonal fluctuations which occur for women during the menstrual cycle.
So let's look briefly at the various stages of a woman's cycle and what may be important to think about when it comes to exercise.
First few days of the cycle (often day 1-5)
Menstruation means the start of a new cycle and during the first few days, hormone and iron levels are lower which can affect both mood, energy levels, appetite and cravings (3). How women feel during menstruation varies greatly, and as always, it is very important to focus on how you feel and what you feel is good for your body during this time. Many women experience severe crampings and although gentle exercises such as yoga (certain inverted poses may be advised to avoid), walking, swimming and gentle stretches may be hugely helpful for calming cramps and it is important to not feel pressured to exercise if you are feeling unwell.
The follicular phase (varies greatly but often from the first day of menstruation to day 14-16)
This is the first half of a woman's cycle and throughout this time, oestrogen increases (4) and women tend to generally feel good during this phase.
Recent research suggest that women may benefit more from endurance training during this first half of her cycle and that strength training may have the best results during this time, in terms of increasing muscle mass (5). Testosterone levels are also higher during the follicular phase (yes, women do have testosterone too), which helps build lean muscle mass more easily during this time. It is important however, to note that women are at a significantly increased risk of anterior cruciate ligament injuries compared to men and a recent meta-analysis showed that hormonal changes may increase the risk of tendon injury with the risk highest of injury in the few days leading up to ovulation (6). Oestrogen, which is high at this time, is believed to play an important role in the increase of these risks and it is important to include longer warming-up exercises and to not overstretch to prevent any injury.
Ovulation (this can vary greatly but often around day 12- 16)
During ovulation oestrogen levels are at their highest and energy levels are often high as a result, which means that women may be able to push themselves further in terms of exercise at this time.
This can therefore be a good time for more high-intensity training.
The luteal phase (from ovulation until day 28-35, but may vary)
During this second half of a woman's cycle, leading up to menstruation, progesterone increases (7). During this time it is common with increased water retention and research indicates that women may experience a decrease in energy, performance and endurance during the luteal phase. One study, looking at endurance and performance of female soccer players, found that maximum performance decreased during the luteal phase (8).
Many women also experience PMS, leading up the menstruation, which may further affect mood, energy levels and pain and general wellbeing.
This is a time when women may benefit more from gentle exercises and not focusing on high intensity endurance- and strength training to the same extent as during the follicular phase.
The results from recent research show that more gender-specific research is recommended to further investigate and to understand the effects and efficacy of different types of exercises to female general- and hormonal health and wellbeing.
It is important to note that intense or extreme exercise for prolonged periods of time is not healthy for women at any stage of the hormonal cycle- and may lead to hormonal imbalances affecting health negatively. It is also important to bare in mind that all women are different and that exercise will affect women also on an individual basis.
Disclaimer:
Please note that the information in this article is for educational purposes only and is not intended to diagnose, treat or cure any disease.
The information given is not exhaustive or prescriptive and is not intended to be used as medical advice or as a substitution for medical care. health and wellness is individual and if you have any health concerns make sure to contact a registered and qualified health practitioner, suitable for your specific needs.
References:
1. Bruinvels G, Burden RJ, McGregor AJ, et al Sport, exercise and the menstrual cycle: where is the research? British Journal of Sports Medicine 2017;51:487-488.
2. The Telegraph (2020) Exclusive: Chelsea become first club to tailor training to menstrual cycle available at https://www.telegraph.co.uk/football/2020/02/13/exclusive-chelsea-become-first-club-tailor-training-menstrual/
3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Heavy periods: Overview. [Updated 2017 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279294/
4. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. [Updated 2018 Aug 5]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/
5. Wikström-Frisén L, Boraxbekk CJ, Henriksson-Larsén K. Effects on power, strength and lean body mass of menstrual/oral contraceptive cycle based resistance training. J Sports Med Phys Fitness 2017;57:43-52. DOI: 10.23736/S0022-4707.16.05848-5
6. Belanger, L., Burt, D., Callaghan, J., Clifton, S., & Gleberzon, B. J. (2013). Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review of the literature.The Journal of the Canadian Chiropractic Association,57(1), 76–86.
7. Mesen, T. B., & Young, S. L. (2015). Progesterone and the luteal phase: a requisite to reproduction.Obstetrics and gynecology clinics of North America,42(1), 135–151. https://doi.org/10.1016/j.ogc.2014.10.003
8. Julian, R., Hecksteden, A., Fullagar, H. H., & Meyer, T. (2017). The effects of menstrual cycle phase on physical performance in female soccer players.PloS one,12(3), e0173951. https://doi.org/10.1371/journal.pone.0173951