ECSS Paris 2023: OP-PN34
INTRODUCTION: Female football players experience cyclical hormonal fluctuations that may influence physiological parameters relevant to performance, including cardiovascular capacity, neuromuscular function, and overall athletic performance. As the professional demands in the women’s game continue to rise, understanding whether menstrual cycle (MC) phases affect football-specific performance is increasingly important for training design and player management. This systematic review examined whether MC phases influence performance-determining parameters in female football players. METHODS: A systematic search of PubMed and SPORTDiscus was following PRISMA guidelines and updated through January 2026. Eligible studies included eumenorrheic football players and reported at least one quantitative performance outcome across two or more defined MC phases. Outcomes were grouped into aerobic performance, sprint and high-intensity running, agility and power. Methodological quality and MC phase verification were assessed using a modified version of an existing quality tool. This study was supported by a Danish Football Union grant. The funder had no role in the study. RESULTS: Fifteen prospective observational studies (n=210) met inclusion criteria. Evidence for MC phase effects on performance was inconsistent. Five out of 15 studies reported reduced aerobic or sprint performance in the early follicular phase compared with the late follicular or mid-luteal phases, whereas ten studies found no differences across phases. No MC phase effects were observed for agility or power outcomes. Methodological limitations were common, including small sample sizes, heterogeneous performance tests, short observation periods, and insufficient MC phase verification. Many studies did not confirm ovulation or hormonal profiles, increasing the risk of misclassification. Most studies were rated low or very low in quality, limiting confidence in the observed effects. CONCLUSION: Current evidence suggests that aerobic and sprint performance may be slightly impaired during the early follicular phase in female football players, potentially reflecting low estrogen and progesterone concentrations or increased symptom burden during bleeding. However, overall findings remain inconclusive. The lack of consistent results likely reflects methodological limitations rather than the absence of physiological effects. Future research should apply standardized performance tests, longer observation periods, and rigorous hormonal verification to clarify whether MC-related hormonal fluctuations meaningfully influence football-specific performance. Individual monitoring of symptoms and performance may be more informative for applied practice than generalized phase-based recommendations.
Read CV Kristine Dahl RasmussenECSS Paris 2023: OP-PN34
INTRODUCTION: Accumulating evidence suggests that the female hormonal profile during the menstrual cycle could be a relevant factor in the regulation of substrate metabolism during endurance exercise. Estrogen has been associated with enhanced lipid oxidation whereas progesterone may attenuate these effects, potentially leading to menstrual cycle phase-dependent differences in fuel utilization[1]. Despite these proposed mechanisms, findings remain inconsistent, especially under steady-state conditions performed at intensities that maximize fat oxidation. Thus, the aim of this study was to investigate fat and carbohydrate oxidation during steady-state running performed at individual Fatmax intensity across three phases of the menstrual cycle. [1]Oosthuyse et al., 2022 METHODS: Fourteen young, physically active (V̇O2max=47.27±4.08 mL/min/kg), naturally menstruating women participated in a randomized crossover study consisting of a 60-min run at Fatmax intensity during three menstrual cycle phases: (a) early follicular, (b) periovulatory, and (c) mid-luteal. These phases were individually determined via mobile app tracking for 5 months, urinary luteinizing hormone tests, and daily tympanic temperature and body mass measurements. During exercise, breath-by-breath ventilatory data were collected with a gas analyzer to calculate fat and carbohydrate oxidation via stoichiometry equations. In addition, muscle oxygen saturation was measured with a Moxy monitor, heart rate was recorded using a chest-strap monitor, and rating of perceived exertion was assessed using the Borg 6–20 scale. Data were analyzed using linear mixed-effects models. RESULTS: No main effect of menstrual cycle phase was found on total fat oxidized (34.5±9.3, 37.0±9.3 and 35.4±9.1 g for early follicular, peri-ovulatory, and mid-luteal, respectively; p=.424), total carbohydrate oxidized (p=.460), or total energy expended (p=.244) during exercise. Additionally, there was no effect of the menstrual cycle phase on mean muscle oxygen saturation (p=.417) or perceived exertion (p=.084). However, a main effect of the menstrual cycle phase was found in mean heart rate, with higher heart rate in the peri-ovulatory compared to the early follicular phase (p=.049). Additionally, there was a main effect of the phase on the mean respiratory frequency with higher values during mid-luteal phase compared to early follicular (p=.035) and peri-ovulatory phases (p=.022). CONCLUSION: In summary, menstrual cycle phase did not influence substrate oxidation, total energy expenditure, muscle oxygen saturation, or perceived exertion during steady-state running at Fatmax intensity. These findings suggest that fluctuations in ovarian hormones do not meaningfully alter fuel utilization under these exercise conditions. However, phase-dependent differences were observed in selected cardiorespiratory variables with a higher heart rate during the periovulatory phase and elevated respiratory frequency during the mid-luteal phase.
Read CV Christel García OrtizECSS Paris 2023: OP-PN34
INTRODUCTION: Oxygen uptake (V̇O2) at a given submaximal running intensity is higher in the high hormone (HH; Days 18-24) phase of the menstrual cycle compared to the low hormone (LH; Days 2-5) phase. Whether this inefficiency also occurs during cycling and how this might impact the cardiovascular system has not been evaluated. This study compared gas exchange and cardiovascular responses to severe-intensity continuous cycling exercise in eumenorrheic females within the LH and HH phases of their menstrual cycle. METHODS: Nine young, healthy females (20 ± 1 years, 164 ± 7 cm, 64.6 ± 14.3 kg) with normal cycle lengths (28 ± 1 days) completed 3 visits: a step-ramp-step cycling test to determine power output at the respiratory compensation point (RCP), and two identical 14 minute and 15 seconds severe-intensity continuous cycling bouts at ~110%RCP performed within their LH and HH menstrual phases. For each severe-intensity bout, participants cycled on an electromagnetically braked ergometer during which breath-by-breath gas exchange was continuously monitored by mass spectrometer and pneumotach. Cardiac output (Q̇) was measured every 3 minutes using open-circuit acetylene breathing. Blood samples were drawn before and after exercise to measure intravascular volumes and hemoglobin (Hb) mass in conjunction with a post-exercise carbon monoxide rebreathing test. RESULTS: Paired t-test revealed that natural (LH: 103 ± 44 pmol/L vs. HH: 326 ± 200 pmol/L; p<0.05) or synthetic estrogen (LH: 0.0 ± 0.0 mg vs. HH: 0.2 ± 0.0 mg; p<0.001) and natural progesterone (LH: 1.3 ± 0.6 nmol/L vs. HH: 24.7 ± 15.9 nmol/L; p<0.05) were higher in the HH phase compared to the LH phase, whereas testosterone (LH: 1.4 ± 0.6 nmol/L vs. HH: 1.2 ± 0.4 nmol/L; p=0.2) and synthetic progestin (LH: 0.0 ± 0.0 mg vs. HH: 1.3 ± 1.6 mg; p>0.05) did not differ across menstrual phases. Neither Hb mass (LH: 585 ± 73 g vs. HH: 582 ± 76 g; p=0.9) nor blood volume (LH: 4225 ± 654 mL vs. HH: 4194 ± 665 mL; p=0.8) were different between phases. Cycling power output was 123±28 W. At the end of the cycling bouts, neither V̇O2 (LH: 2.0 ± 0.5 L/min vs. HH: 1.9 ± 0.5 L/min; p=0.3) nor Q̇ (LH: 15.7 ± 4.6 L/min vs. HH: 15.7 ± 3.3 L/min; p=0.9) differed between menstrual phases. Additionally, there were no between-phase differences in ratings of perceived exertion, cycling cadence, arteriovenous oxygen difference, heart rate, stroke volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, total peripheral resistance, nor rate-pressure product (all p>0.2). The ΔQ̇ (HH-LH; 0.05 ± 2.0 L/min) was not correlated with ΔHb mass (-3 ± 49 g; r=-0.028, p=0.9) nor Δblood volume (-31 ± 433 mL; r=-0.099, p=0.8). CONCLUSION: Neither gas exchange nor cardiovascular responses to severe-intensity exercise differed between the LH and HH phases, suggesting that the cardiovascular stress in response to higher intensity exercise is consistent over the menstrual cycle in young, healthy females.
Read CV Tania PereiraECSS Paris 2023: OP-PN34