The Impact of the Menstrual Cycle on Physical Exercise and Performance

August 27, 2025 updated by: Angelica Hirschberg Lindén, Karolinska Institutet

The menstrual cycle implies a basic difference in the biology of women and men but the effect of the hormonal variation on training protocols and physical performance is still not fully understood. Despite no existing evidence, the advice to periodize exercise according to the menstrual cycle has been widely spread among elite athletes, coaches, and sports federations. The advice is based on underpowered studies with considerable methodological weaknesses regarding determination of cycle phase, inclusion of athletes and lack of adequate control groups.

The purpose of this randomized, controlled study is to evaluate the effect of exercise periodization on aerobic fitness during different phases of the menstrual cycle. Further, the effect will be related to premenstrual symptoms, body composition and skeletal muscle morphology, sex hormone receptors, metabolic enzymes, and markers of muscle protein synthesis. This study will be well controlled and follow methodology recommendations for menstrual cycle research in sports and exercise.

Female athletes of fertile age will be randomized to different training regimens during three menstrual cycles (12 weeks):

Group A: Training three times a week throughout the menstrual cycle. Group B: Follicular phase-based training five times a week during the follicular phase and thereafter once a week during the luteal phase.

Group C: Luteal phase-based training five times a week during the luteal phase and once a week in the follicular phase.

The exercise will consist of high intensity intermittent spinning classes. Assessment of aerobic fitness and power will be performed at baseline, and again after three completed menstrual cycles. On the same day, body composition will be examined by DXA and blood samples will be collected for analysis of hormones and binding proteins. To confirm menstrual cycle phase, blood samples will be collected for hormone determination, and urinary stick will be used for detection of ovulation. Subjective ratings of menstrual cycle related symptoms will be performed every day. In a subgroup of women, muscle biopsies will be collected from m vastus lateralis at baseline and at the end of the study. This study will contribute to improved knowledge about exercise periodization in relation to the menstrual cycle. Well-grounded data is crucial to give evidence-based recommendations to female athletes when planning their training protocol to optimize training results and performance.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

111

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 35 years (Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Women exercising at least 3-4 times a week on a high level
  • Regular menstrual cycle with 26-32 cycle days.
  • Fully healthy and be able to follow the training program.

Exclusion Criteria:

  • Hormonal contraceptive users,
  • Users of regular medication
  • Chronic disease
  • Past or present neurological disorder
  • Recent musculoskeletal injury

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Basic Science
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Follicle phase based training
Follicular phase-based training five times a week during the follicular phase (the first two weeks of the menstrual cycle) and thereafter once a week for the rest of the cycle.
Other: Periodization of training
Participants in the three arms will exercise the same dose and number of sessions distributed in three different ways.
Experimental: Luteal phase based training
Luteal phase-based training five times a week during the luteal phase (from ovulation to next menstruation) and once a week in the follicular phase.
Other: Periodization of training
Participants in the three arms will exercise the same dose and number of sessions distributed in three different ways.
Experimental: Regular training
Regular training three times a week throughout the menstrual cycle (control group).
Other: Periodization of training
Participants in the three arms will exercise the same dose and number of sessions distributed in three different ways.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in aerobic performance
Time Frame: Change from baseline aerobic performance at the end of Cycle 4 (each cycle is around 28 days)
Cosmeds K5 Wearable Metabolic System will be used for breath-by-breath gas exchange measurements. Change in VO2peak from baseline to end of study will be evaluated.
Change from baseline aerobic performance at the end of Cycle 4 (each cycle is around 28 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in muscle strength
Time Frame: Change from baseline muscle strength at the end of Cycle 4 (each cycle is around 28 days)
A standardized isokinetic device (Biodex®, Corp, Shirley, NY, USA) will be used for measurements of maximal muscle torque (Nm) in the leg extensor muscles at 90 and 120 gr/sec (11). Change in muscle strength from baseline to end of study will be compared between groups.
Change from baseline muscle strength at the end of Cycle 4 (each cycle is around 28 days)
Change in one-leg sit-to-stand test
Time Frame: Change from baseline test at the end of Cycle 4 (each cycle is around 28 days)
Assessment of functional muscle strength in the lower extremities.
Change from baseline test at the end of Cycle 4 (each cycle is around 28 days)
Change in one-leg hop test for distance
Time Frame: Change from baseline test at the end of Cycle 4 (each cycle is around 28 days)
Assessment of functional muscle strength in the lower extremities.
Change from baseline test at the end of Cycle 4 (each cycle is around 28 days)
Change in body composition
Time Frame: Change from baseline body composition at the end of Cycle 4 (each cycle is around 28 days)
Differences in body fat (%) will be determined by DXA (Lunar equipment).
Change from baseline body composition at the end of Cycle 4 (each cycle is around 28 days)
Change in body composition
Time Frame: Change from baseline body composition at the end of Cycle 4 (each cycle is around 28 days)
Differences in muscle mass (g), will be determined by DXA (Lunar equipment).
Change from baseline body composition at the end of Cycle 4 (each cycle is around 28 days)
Premenstrual symptoms
Time Frame: Every day during the study period
Prospective ratings of premenstrual symptoms will be performed with the Cyclicity Diagnoser
Every day during the study period
Change in metabolic serum markers
Time Frame: Change from baseline metabolic serum markers at the end of Cycle 4 (each cycle is around 28 days)
Blood samples for analysis of IGF-1.
Change from baseline metabolic serum markers at the end of Cycle 4 (each cycle is around 28 days)
Change in mucle morphology
Time Frame: Change from baseline muscle morphology at the end of Cycle 4 (each cycle is around 28 days)
Muscle biopsy in mm vastus lateralis
Change from baseline muscle morphology at the end of Cycle 4 (each cycle is around 28 days)
Change in muscle tissue steroid hormones
Time Frame: Change from baseline muscle tissue steroid hormones at the end of Cycle 4 (each cycle is around 28 days)
Muscle biopsy in mm vastus lateralis
Change from baseline muscle tissue steroid hormones at the end of Cycle 4 (each cycle is around 28 days)
Change in muscle protein synthesis
Time Frame: Change from baseline muscle protein synthesis at the end of Cycle 4 (each cycle is around 28 days)
Muscle biopsy in mm vastus lateralis
Change from baseline muscle protein synthesis at the end of Cycle 4 (each cycle is around 28 days)
Dysmenorrhea
Time Frame: Through study completion, an average of 4 month
Questionnaire
Through study completion, an average of 4 month

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Confirmation of menstrual cycle phase
Time Frame: Through study completion, an average of 4 months
Blood sampels will be collected at early follicular phase, ovulation phase and mid luteal phase for analysis of LH, FSH, estradiol and progesterone.
Through study completion, an average of 4 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Karolinska Institutet

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 1, 2023

Primary Completion (Estimated)

July 1, 2026

Study Completion (Estimated)

July 1, 2026

Study Registration Dates

First Submitted

November 20, 2022

First Submitted That Met QC Criteria

January 16, 2023

First Posted (Actual)

January 25, 2023

Study Record Updates

Last Update Posted (Estimated)

September 4, 2025

Last Update Submitted That Met QC Criteria

August 27, 2025

Last Verified

August 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2021-01650

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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