Exercise, Estrogen, and the Female Cycle: What does research suggest?

More discussion as grown in the past few years about the special considerations and ways to take advantage of the female cycle in exercise in sport. For sake of discussion, a young adult (premenopausal) moderately active female field sport athlete will be considered as an example for this article.

A recent study surveyed elite female athletes and found that 86% were unwilling or uncomfortable to take time off from the psychological and physical effects of the menstrual cycle. This fact highlights a need for educating athletes on modulating training according to their cycle (Hayward et al., 2024). Let them know it is fine to not push training hard when felling less athletic and concentration and decision making are not optimal. Also, Relative energy deficiency in sport, disordered eating and body dysmorphia statistically are more prevalent in females. Appropriate referral to a nutritionist, registered sport dietician, and counselor could all be warranted in these circumstances.

Hormonal response to resistance training is different versus males suggesting that estrogen plays a protective role in muscle damage (females can recover faster vs males from the same intensity of training) and may can tolerate higher volumes of training men (Torres & Fernandez-Elias, 2024). Secondly, research was done by Aragón-Vela et al. (2021) after a group of men and women performed 5 sets of squats. Blood markers were done to evaluate muscle/ tissue damage and inflammatory cytokines. The main sex difference was that females had lower serum levels of inflammatory cytokines 24 hours after acute resistance training. Findings from this study explain that maybe females should be programmed for more volume or higher intensity of 1RM compared to males. On the contrary, estrogen might mitigate (i.e. reduce some hypertrophic responses in females compared to males (Torres & Fernandez-Elias, 2024). Females appear to be more resilient to oxidative and mechanical stress and therefore programming and periodization would look different from males in the same sport.

Injury risks in sporting activities with females is a major concern and should be high priority for training to prepare them for the needs of their sport.  Statistics say that during any given season, upwards of 50% of female athletes will experience a lower extremity injury; lower extremity accounts for about 60% of any injury (Bullock et al., 2025). Common injuries are of ankle sprains and knee sprains like the ACL. Therefore, building sufficient strength, coordination, agility, and tissue capacity for ballistic loading would be crucial to help build resiliency and decrease lower quarter injury prevalence. The systemic review by Bullock et al. (2025) suggests than all knee injury prevalence could be reduced 24% and ankle sprains reduced by 39% after partaking in neuromuscular training programs. Recommendations specifically for female lower body injury risk prevention would be performing neuromuscular training for minimum of 10min work/ 2x week which is progressed from bilateral to unilateral training (Bullock et al., 2025). Thus, using a variety of modes of training to accomplish this could include general weight training, agility, declaration, plyometrics, and balance work.

A systematic review by Berger et al. (2023) suggests a probable link between the menstrual cycle, relaxin hormone concentration, and incidence of ACL injuries, shoulder injuries, and impaired tendon remodeling. Such findings suggest reducing volume, intensity, and mode of training during this window. If we use a 28 cycle as an example, usually the relaxin peaks in the late luteal phase around day 23-24 which is usually about 3 days after progesterone peaks. Practical application would be to modulate fatigue and high ballistic loads a few days around days 23-24 reducing potential excess strain to these tissues.

Much research has been published recently on how the menstrual cycle affects physical performance and recovery from sport. Subjective feedback from how one feels and objective measurement both seem to agree the cycle affects the athlete. The cool part of understanding how the female physiology changes allows for one to take advance of certain training stimulus during certain parts of the cycle. Education on this phenomenon to the athletes would also allow them to hopefully become more cognizant of their body and learn when to push training hard and when to back off over their cycle. Estrogen may enhance glycogen stores plus fat oxidation pathways which could explain why greater increases in muscle strength have been observed to be greater in the late follicular phase compared to the other parts of the cycle (Augustsson & Finde-Malenica, 2025). Hence, now would be the time to push training the hardest.

Estrogen appears to have an anabolic affect accounting for this enhanced adaptation by activating muscle satellite cells and inhibiting protein catabolism (Mikkonen & Hakkinen, 2025). We could therefore use the following example to periodize training over the course of a 28 day cycle (onset of menses being day 1). Day 1-5, easy training volume & intensity; Day 6-14 uses the most intense or highest volumes; Day 15-23 includes moderate volume or intensity; day 24-28 relaxin is peaked and use caution in ballistic activities while under fatigue.  The reason why training load should be the lowest during the early follicular phase is because a systematic review determined this period is when the physical performance is the worst, so this is not the time to push training (Augustsson & Finde-Malenica, 2025). However, high individual difference was reported and thus subjective and objective measurements of the athlete’s readiness is recommended for optimum programming.

References:

Aragón-Vela, J., Fontana, L., Casuso, R. A., Plaza-Díaz, J., & Huertas, J. R. (2021). Differential inflammatory response of men and women subjected to an acute resistance exercise. Biomedical Journal, 44(3), 338–345. https://doi.org/10.1016/j.bj.2020.02.005

Berger, G. K., Rockov, Z. A., Byrne, C., Trentacosta, N. E., & Stone, M. A. (2023). The role of relaxin in anterior cruciate ligament injuries: a systematic review. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 33(8), 3319–3326. https://doi.org/10.1007/s00590-023-03618-7

Bullock, G. S., Räisänen, A.,M., Martin, C., Maitland, M., Galarneau, J., Whittaker, J. L., Losciale, J. M., Bizzini, M., Bourne, M. N., Dijkstra, H. P., Dubé, M., Hayden, A., Girdwood, M., Hägglund, M., McLeod, S., Nonhlanhla, S. M., Andrea, B. M., Myles, C. M., Myklebust, G., . . . Emery, C. (2025). Prevention strategies for lower extremity injury: a systematic review and meta-analyses for the Female, Woman and Girl Athlete Injury Prevention (FAIR) Consensus. British Journal of Sports Medicine, https://doi.org/10.1136/bjsports-2025-109910

Hayward, E., Akam, L., Hunter, D., & Mastana, S. (2024). Role of the Menstrual Cycle on Performance and Injury Risk: A Survey of Female Professional Rugby Players in the United Kingdom. International journal of environmental research and public health, 21(2), 150. https://doi.org/10.3390/ijerph21020150

López Torres, O., & Fernández-Elías, V. E. (2024). Training and Nutrition for Performance: Males, Females, and Gender Differences. Nutrients, 16(23), 3979. https://doi.org/10.3390/nu16233979

Mikkonen, Ritva S.1; Häkkinen, Keijo2. Evidence for Periodizing Strength and/or Endurance Training According to Menstrual Cycle Phases to Optimize Female Athlete Performance Is Lacking. Strength and Conditioning Journal ():10.1519/SSC.0000000000000917, May 29, 2025. | DOI: 10.1519/SSC.0000000000000917

Augustsson, S., & Findhé-Malenica, A. (2025). Power in the flow: how menstrual experiences shape women's strength training performance. Frontiers in sports and active living, 7, 1519825. https://doi.org/10.3389/fspor.2025.1519825