As strength and conditioning coaches, our role is to do no harm: one of the primary values of our role as a coach.
The This girl can campaign has promoted exercise to females, which is a target driven approach by Sport England to increase female participation in recreation sport, health and fitness. This could mean more contact points for us coaches with female athletes from a wide range of ages. These contact points can be as coaches in a team setting or one to one programming. We therefore need to make sure we are able to help them reach their goals and advise them the best we can.
In the past, periodization training was promoted as a way to train athletes, working through particular phases of training at a time during the athletes/team season. And yet periodised training maybe necessary for training the female athlete during their menstrual cycle – targeting specific goals at certain points in their cycle could deliver better improvements in performance. Currently there are not evidence based guidelines for managing exercise performance across the menstrual cycle for exercising women, nor for practitioners working with elite sport people (McNulty, et al 2020).
From the image of the menstrual cycle, which is an ‘average’, some could be less, some could be more. This is why it is important to find out your athlete’s cycle in order to allow you to monitor their performance and training, even if you don’t do anything different to start with. You can get an individualized assessment, same as a movement screening of how your athlete feels and trains over their cycle.
One of the problems I have found reading up on the menstrual cycle in the literature is how there is not a standardized model which researchers refer to when looking at the menstrual cycle, some report the ovulatory, follicular and luteal phase but others, the follicular and luteal phase. The image is a great example of how researchers should look at the menstrual cycle phase, making clearer distinctions where changes may occur – Early Follicular, Late Follicular, Ovulatory, Early Luteal, Mid Luteal and Later Luteal.
Image 1: Taken from Carmichael et al. (2021).
From the menstrual cycle image you can see different hormones are involved with different amounts of hormone present in the body during the menstrual cycle. Each hormone is thought to have different characteristics and effects on the body, which is why during the menstrual cycle it is plausible that different hormone profiles could lead to changes in exercise performance (McNulty et al. 2020)
Estrogen – hormone with anabolic functions (building)
Progesterone – related to catabolic pathways (breaking down)
Due to the different amounts of hormone which fluctuates during the menstrual cycle, and how each one plays a different role in the body and has different characteristics, it is hypothesised that female performance may be impacted at different times during the menstrual cycle. In this review we take a look at:
- Aerobic and Anaerobic Capacity
- Anterior Cruciate Ligament Injuries and Laxity
- Individual and Mood
When prescribing our training plans for females we may wish to think about structuring our training as a periodised plan each month. Looking at particular phases of the cycle to work different training components and manipulate the training load and intensity.
Rodrigues et al. (2019) report that ‘women in different periods of the menstruation cycle produced different levels of muscle strength’ Rodrigues et al. (2019) found participants strength was increased during the mid-follicular phase, which as this ‘mid’ menstrual cycle this would point to the fact that this is not a training adaptation. Rodrigues et al. (2019) considered this and started the research at different stages of participants menstrual cycle. During this part of the menstrual cycle, estrogen levels are raised, but not at their highest.
Rodrigues et al. (2019) subjects produced forces of 237.90 kg in the early follicular phase, 220.97 in the late luteal phase and 248.26 kg in the mid follicular phase.
Anaerobic and Aerobic Capacity
There is currently no real evidence that certain phases of the menstrual improve a females aerobic performance. Menstrual cycle phase would appear to have little affect on continuous aerobic performance, although some studies have shown some outcomes were effected.
Menstrual cycle phase would however appear to effect intermittent aerobic performance, with researchers Julian et al. (2017), reporting female soccer players went further in the early follicular phase.
Carmichael et al. (2021) looked at 16 studies and there effect an anaerobic performance, from these finding only 3 showed any the menstrual cycle to have an effect on anaerobic performance. They report that sprint performance was best in the mid luteal phase, vertical jump height in the early follicular phase and repeated sprint ability in the ovulatory phase.
ACL Injuries and Laxity
It is widely known in the world of sport that females are at a higher risk to injuries, research has looked at female biomechanics (the Q angle) which leads to knee valgus, as well as landing and jumping mechanics. Herzberg et al. (2017) refers to two studies which define the menstrual cycle as pre-ovulatory and post ovulatory., whilst 3/5 studies they refer to use the follicular, ovulatory and luteal phase diagram. Which in itself is confusing as studies are yet to define a model to use, where each is referring to the same cycle! Results from Herzberg et al. (2017) suggest the lowest risk for all injuries is the menstrual cycle is in the luteal phase. The studies go on to report estradiol maybe contributing to this as when estradiol was at its highest, so to was joint laxity.
This does raise the question regarding specific training drills and what kind of drills athletes and clients should be carrying out during specific times of the menstrual cycle – no twisting and turning, no plyometrics.
Hertzberg et al. (2017) feel this strength of evidence and confidence in the findings remain low, though the number of studies researching the menstrual cycle has substantially increased. Interestingly the same year Balachandar et al (2017) felt there systematic review provides strong evidence that females are greatest risk of ACL injuries during the pre-ovulatory phase of the menstrual cycle. Again, different phases of the menstrual cycle have been used!
Lee et al. (2013) report ACL elasticity was significantly grater during the ovulatory phase of the menstrual cycle. The interesting finding in this study was that the elasticity of the ACL when it was heated to 38 degrees. Results showed that even heating the muscles up during the menstrual cycle, the ovulatory phase still had the greatest elasticity.
Individual and Mood
Findlay et al. (2019) research paper looked at the menstrual cycle and performance, they asked 15 female international rugby players their experiences and perceptions of how the menstrual cycle affected their sporting performance. Findlay et al. (2019) research is interesting as it looking at who the athlete, as opposed to measurable figures, such as power etc.
Below is a few quotes form the study:
- 93% of participants reported having negative symptoms (physical or psychological)
- Most prevalent physical symptoms – cramps, abdominal pain, general discomfort and reduced energy levels
- Psychological = subjects where always think about it, hope it does not start today, having tampons and sanitary towels, if on a training camp, fear of flooding and worries about their period showing on their kit (white shorts)
- Motivation – suck it up and get on with it, if on a camp. Reason to miss training
Findlay et al. (2019) report that we need to start the conversation, the menstrual cycle is still a taboo subject/word. As coaches we need to minimize the negative and maximise the positive outcomes. We need to initiate conversations with our athletes, we need to make them feel comfortable but showing them support and empathy.
Sargent (2019) in her talk, shows several studies which I have been unable to get access to or locate, where an athletes mood state, alters over the course of a menstrual cycle. Sargent (2019) goes on to highlight how we as coaches, can use language and the way we speak to and encourage athlete’s will also have to change during the menstrual cycle. There will be times when we can motivate and encourage our athletes and other times when we will need to be a calming figure, keep things simpler. This may mean shortening conversations and not trying to teach lifts due to poor concentration levels.
It is still early days, with sport teams such as Chelsea and the USA team monitoring menstrual cycles of their players, I am sure there are training plans in place which work alongside the menstrual cycle, targeting specific aspect needs for their sport at the right time of the menstrual phase.
Image Two: Summary of training phases during the menstrual cycle using the data reported in this article.
Research is pointing in the direction that as a strength and conditioning coach we need to be mindful of our training plan, we need to consider the menstrual cycle of our athletes. This also raises the question for researchers when using females for studies as McNulty et al. (2020) points out, no current guidelines exist for practitioners in the field, should there also be guidelines for researchers?
The other question, although this is okay for training where we can manipulate the variables in training – intensity, volume etc what happens for females who are about to compete? Players are not in control of their menstrual cycle, what day will it fall on? What happens if they are on the wrong phase of their cycle for the Olympic final? FA Cup Final? Marathon day? If your athlete has not trained ‘power’ during the luteal phase, what are they thinking? How will this effect your athlete psychologically when they come to compete?
The research highlighted in many of the literature, Carmichael et al. (2021) 15 out of 35 studies, reviews and Sargent (2019) talk at the UKSCA conference, highlight just as many research papers, if not more which do not show an effect of the menstrual cycle on performance. What we need to look at further is the fact that many females feel that their menstrual cycle does affect their performance (Carmichael et al 2021). If we are to have a consensus on recommending training sessions at certain times of the menstrual cycle, more research need to be carried out. Strength and conditioning coaches need to consider the predominant performance variables for that athlete and their sessions (Carmichael et al. 2021).
Balachandar, V., Marciniak, J., Wall, O. and Balachandar, C. (2017) Effects of the menstrual cycle on lower limb biomechanics, neuro-muscular control and anterior cruciate ligament injury risk: a systematic review. Muscles, Ligaments and Tendons Journal 7 (1) : 136-146.
Carmichael. A. M., Thomson, R. L., Moran, L. J. and Wycherley, T. P. (2021). The impact of menstrual cycle phase on athletes performance: A narrative review. International Journal of Environmental Research and Public Health. 18 : 1667
Findlay, R. J., Macrae, E. H. R., Whyte, I. Y., Easton, C. and Forrest (nee Whyte) L. J. (2019). How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. British Journal of Sports Medicine. 54 : 1108-1113.
Julian, R., Hecksteden, A., Fullagar, H.H.K. and Myer, T. (2017). The effects of menstrual cycle phase on physical performance in female soccer players. PLoS One (12, e0173951 (CrossRef)
Lee, H., Petrofsky, J. S., Daher, N., Berk, L., Laymon, M. and Khowailed, I. A. (2013). Anterior cruciate ligament elasticity and force for flexion during the menstrual cycle. Medicine and Science Monthly. 19 : 1080-1088.
McNulty, K. L., Elliot-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 : 1813-1827.
Pitchers, G., Elliot-Sale, K. Considerations for coaches Training Female Athletes. (2019). Available online: http//www.UKSCA.org.uk/assets/pdfs/UkscaIqPdfs/considerations-for-coaches-training-female-athletes-637139103922340876.pdf (accessed on 8th March 2021).
Rodrigues, P., de Azevedoo Correia, M. and Wharton, L. (2019). Effect of Menstrual Cycle on Muscle Strength. Journal of Exercise Physioogy online. 22 (5) : 89-97.
UKSCA Travis Triplett (2019) Training female athletes: is it really that different? Available at: https://www.uksca.org.uk/uksca-iq/article/female/1892/training-female-athletes-is-it-really-that-different . Accessed: 11/03/2021.
UKSCA Debbie Sargent (2019) The missing pieces of the female athlete puzzle. Available at: https://www.uksca.org.uk/uksca-iq/article/female/1897/the-missing-pieces-of-the-female-athlete-puzzle. Accessed: 11/03/2021