Scientific Programme
Applied Sports Sciences
IS-AP03 - Optimising performance in female athletes through improved understanding of natural and synthetic female sex hormone profiles and associated symptomology
Date: 08.07.2026, Time: 11:00 - 12:15, Session Room: Auditorium A (STCC)
Description
Research examining the unique performance considerations for female athletes is (finally) increasing. Much of this work has focused on how fluctuating female sex hormones across the menstrual cycle may influence different aspects of performance and training adaptations. However, many female athletes use hormonal contraceptives (HC), which suppress these natural hormone fluctuations, yet sport science research on the different HC formulations and doses is very limited. Reducing menstrual symptoms like pain, cramps, and heavy bleeding is one of the main reasons female athletes report for using HC. Despite this, research has only recently started exploring how menstrual- and HC-related symptoms may interact with training and performance. This symposium will synthesise all this information to provide an overview of current knowledge on the effect of natural and synthetic female sex hormone profiles on the main components of sports performance combined with the latest research on symptomology. The first presentation will focus on strength and adaptations to resistance training. The second presentation will address endurance performance and training adaptations. The third presentation will focus on symptomology of the menstrual cycle and HC. This symposium will present the latest research, as well as evidence-based practical suggestions, and is therefore relevant for sport scientists, coaches and everyone interested in optimising performance in female athletes.
Chair(s)
Xanne Janse de Jonge
Griffith University, Griffith Sport Science
Australia
Speaker A
Xanne Janse de Jonge
Griffith University, Griffith Sport Science
Australia
Read CVECSS Rimini 2025: IS-AP03
Understanding the Female Sex Hormone Factors in Muscle Strength and Adaptations to Resistance Training
To assist female athletes in optimising performance it is important to consider potential effects of female sex hormones. Due to the proposed strengthening effect of oestrogen much of the early menstrual cycle research in sport science investigated potential changes in muscle strength throughout the cycle (1). Methodological differences in timing of testing and menstrual cycle phase verification, as well as the large inter- and intra-individual variation throughout the menstrual cycle, however, often resulted in conflicting findings. Furthermore, many female athletes use hormonal contraceptives (HC), with oral contraceptives (OC) being most commonly taken. While most OC contain the synthetic ethinyl estradiol (EE), the concentration of EE varies. Importantly, there are many different types of progestin used in OC, which may have different levels of androgenicity. Therefore, the potential effect of the various exogenous hormones on muscle strength also needs to be considered. This presentation will summarise the latest research on the effects on muscle strength of the fluctuations in endogenous female sex hormones throughout the menstrual cycle, as well as the exogenous female sex steroids in OC and other hormonal contraceptives. Besides potential acute effects of female sex hormones on muscle strength, another research area that is starting to receive more attention is how women respond to resistance training. Some studies on acute responses to resistance training suggest that endogenous oestrogen may assist in protection against muscle damage (2). This theory appears to be supported by research on chronic adaptations to resistance training timed to coincide with the higher endogenous oestrogen concentrations during the follicular phase. Menstrual cycle phase-based resistance training with more sessions during the follicular phase and less sessions during the luteal phase has shown greater improvements in strength than traditional training in some studies, while others have shown no difference between training methods (2). The limited research on adaptations to resistance training in women taking oral contraceptives suggests that both the type of exogenous hormones and their concentration could affect responses in both muscle strength and size (3,4). This presentation will provide an overview of the emerging research on chronic adaptations to resistance training in females and more specifically on how synchronising training programs to female hormone fluctuations may support optimal training adaptations. The information presented in this session will be accompanied by practical examples from case studies and recommendations for implementation. 1. Janse de Jonge et al., J Physiol 2001. 2. Thompson et al., Sports Med 2020. 3. Dalgaard et al., Front Physiol 2019. 4. Engstad et al., Scand J Med Sci Sports 2025.
Speaker B
John Osborne
UiT - The Arctic University of Norway, School of Sport Sciences
Norway
Read CVECSS Rimini 2025: IS-AP03
Understanding the Female Sex Hormone Factors in Endurance Training and Performance
Endurance performance depends on fractional utilisation and maximal oxygen uptake, anaerobic capacity, and movement economy, arising from integrated physiological systems. In female athletes, these systems operate across changing hormonal milieus associated with the menstrual cycle (MC) and hormonal contraceptive (HC) use, which have been plausibly linked to endurance performance. For example, higher luteal progesterone can elevate core temperature and increase potential heat strain, while higher oestrogen has been linked to greater lipid oxidation and glycogen sparing (1). Although biologically credible, practical effects on endurance performance appear modest at best, and heterogeneous MC verification, underpowered samples and the exclusion of HC users may also contribute to inconsistent findings (2). This presentation aims to translate the current evidence into applied outcomes for researchers and coaches. Recent reviews usually report trivial to small and inconsistent group-level differences across MC phases for time-trial performance, time to exhaustion and maximal oxygen uptake, with wide inter- and intra-individual variability (3). Well-controlled laboratory-based studies have typically found no practically meaningful effects of the MC phase on objective endurance outcomes. In contrast, athletes frequently report perceived impairments around bleeding days that align with higher symptom incidence, lower sleep quality and reduced perceived readiness to train; this helps explain why many feel affected even when group means show minimal change (4). Exogenous hormones from HC add further complexity in female athlete research, as different dosages, hormones, and delivery, may have an heterogeneous response. This complexity likely contributes to the sparse evidence on HC use and athletic performance, despite widespread use of HCs by athletes. Evidence for a HC-mediated suppression or enhancement of endurance performance is minimal, with minimal effects on endurance outcomes. Side effect burden and bleeding patterns appear more influential for adherence, reinforcing the need to phenotype HC use rather than exclude it (4). Translation of the existing research evidence to practice suggests emphasising individualised, symptom-informed planning rather than rigid phase-based prescriptions. For endurance sport, a key priority is to preserve training quality to achieve beneficial physiological adaptations while accommodating individual symptom patterns. This presentation will also highlight practical considerations and example strategies for coaches and sports scientists on how to integrate and use MC status, HC use, and symptom profiles to inform daily monitoring, training planning and performance preparation to ensure optimal athletic performance. 1. Janse de Jonge Sports Med, 2003. 2. Elliott-Sale, et al. Sports Med, 2021. 3. McNulty, et al. Sports Med, 2020. 4. Engseth, et al. J Sports Sci, 2025.
Speaker C
Ana B. Peinado
Universidad Politécnica de Madrid , Salud y Rendimiento Humano
Spain
Read CVECSS Rimini 2025: IS-AP03
Performance Under Pressure: Are Hormonal Fluctuations or Symptoms the Key?
Female athletes experience fluctuating endogenous hormone levels across the menstrual cycle (MC) or varying exogenous levels due to hormonal contraceptive (HC) use (1). These synthetic hormones suppress endogenous hormone secretion, altering bleeding patterns and potentially influencing associated symptoms. Despite growing research, the impact of female sex hormone fluctuations on performance and recovery remains unclear. Nevertheless, many athletes perceive their menstrual cycle or HC use as interfering with training, recovery, or performance - especially during pre-bleeding and bleeding days, when fatigue, poorer sleep, and elevated resting heart rate are reported (2). Evidence shows that both naturally menstruating and HC-using athletes experience the highest symptom burden during these phases, with greater perceived impairment of performance among those reporting more severe symptoms (3). Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) affect many women, causing mood disturbances and disruptions to daily life (4). These symptoms can lead to physical discomfort and emotional instability, impacting training routines, focus, and overall performance. Dysmenorrhea, or menstrual pain, is also common and may limit physical capacity. Beyond menstruation-related symptoms, intermenstrual pain- often unpredictable and severe - can reduce motivation and energy, impairing both physical and mental performance and contributing to decreased output, slower recovery, and negative effects on mental health, including higher risks of depression (5). The limited understanding of how hormonal fluctuations and related symptoms influence performance means women often lack tailored strategies to assist with training and performance. Hormonal variations and the associated symptoms are not merely health issues; these symptoms directly affect training, recovery, and performance. This presentation will provide an overview of the latest research on symptoms associated with female sex hormone profiles. Further long-term, prospective studies are needed to clarify how symptom type, frequency, and severity across MC and HC phases influence exercise performance, training and recovery outcomes. The CICLOS Project is a multicenter initiative led by a multidisciplinary team from seven Spanish and three international universities. The main goal of this project is to assess the prevalence of menstrual cycle–related symptoms among reproductive-aged women in Spain and examine their relationship with physical and mental performance. Preliminary findings from this project will also be presented in this session. 1. Elliott-Sale et al. Sports Med 2021;51(5):843–861; 2. McNulty et al. Women Sport Phys Act J 2023;32(1):1–13; 3. Bruinvels et al. Sports Med 2022;52(7):1457–1460; 4. Hofmeister & Bodden Am Fam Physician 2016;94(3):236–240; 5. Grandi et al. Gynecol Obstet Invest 2013;75:97–100.