Menstrual-Cycle-Aware Training: A Synthesis of the Performance, Symptom, and Health Evidence Base (2024–2026)
DOI:
https://doi.org/10.54938/ijemdss.2026.05.4.798Keywords:
Menstrual Cycle, Female Athletes, Athletic Performance, Hormonal Contraceptives, Injury RiskAbstract
There is still a debate surrounding how the menstrual cycle (MC) affects female athletes and a growing number of high-quality studies have been published in the last three years (2024-2026). The purpose of this paper is to review the latest (2024-2026) peer-reviewed literature and summarize the evidence regarding the link between MC phase, hormonal contraceptive use, athletic performance, symptom burden, and injury risk, as well as applied training practice. Methods: A structured narrative and scoping review was performed across PubMed, Scopus, Web of Science, SPORTDiscus and Frontiers, using a framework similar to that used in PRISMA screening and restricting publications to January 2024 to the early part of 2026. The findings: When high methodological standards are applied to systematic reviews, the effect of MC phase on objectively measured strength, power and endurance performance is trivial-to-small and mostly inconsistent. In contrast, symptom prevalence, perceived exertion, and self-reported performance impact are large, consistent, and athlete-relevant and impact a majority of surveyed athletes. The use of hormonal contraceptives is a unique and different physiological profile, making the pooled analyses difficult. Variations in injury-risk surrogates, in particular for anterior cruciate ligament, are phase linked and iron deficiency is under-recognized as a performance limiting factor associated with heavy menses. Conclusion: The evidence base still supports individualized, symptom-driven management of athletes over the use of strict phase-based training protocols, and shows continued methodological weaknesses; notably, the lack of consistent hormonal verification of the primary literature.
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