The Effects of Menstrual Cycle Phase on Elite Athlete Performance: A Critical and Systematic Review.

Frontiers in physiology. 2021;12:654585
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A one size fits all approach is impossible as athletes often respond differently to a given training stimulus, and the training load required for adaptation may differ significantly between sexes. Ideally, any individualized approach to preparation necessitates methods suited to each athlete’s needs in addition to technical and scientific expertise and resources. In fact, there is substantial interindividual variability leading to menstrual disturbance and it seems to be more frequent among elite athletes. This study is a review which focuses on research studies in elite athletes directly investigating the effects of menstrual cycle (MC) phases on performance parameters such as endurance or power resistance, symptoms linked to MC, ligament stiffness, decision making skills, and/or competitiveness (desire to compete and training motivation). Seven studies were included in the review with a total of 314 females. Results show that links between exercise performance and MC cannot be consistently identified from the present findings. The limited number of studies (including their study design) make these available studies challenging to transpose to the elite field. Authors conclude that there is a clear lack of evidence-based recommendations on training individualisation according to the menstrual cycle. Thus, solid conclusions regarding the impact of the MC for elite athletes cannot be formulated.

Abstract

Background: In elite athletes, training individualization is widely recommended to optimize competitive performance. Previous studies have evidenced the impact of hormonal fluctuations on different performance parameters among female athletes. While consideration of menstrual cycle (MC) phases as a parameter in training individualization strategies is necessary, systematic evidence identifying such impacts in elite athletes should be evaluated. Objective: Systematically review publications that have investigated the link between MC phases and performance in elite female athletes. The overarching aim is to identify whether a consensus across studies exists enabling evidence-based recommendations for training individualization depending on menstrual cycle phases. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three major scientific publication databases were searched from inception until November 3, 2020. Studies included focused on the influence of physiological or psychological parameters throughout at least one phase of the menstrual cycle of elite athletes. Results: A total of 780 search results were yielded and 26 references from a past bibliography were added manually. About 662 papers were reviewed of which 218 studies were assessed for eligibility. Of these, only seven (1%) precisely investigated the influence of a performance or physical parameter during at least one menstrual cycle phase. These seven studies included a total of 314 elite female participants (20.58 ± 1.91 years). Three used interviews, questionnaires or prospective analyses of reports. Four conducted several performance tests or included physical measures although only two performed tests during training or before/during competition. Among the seven studies, five performed hormonal testing through sampling of blood, saliva, or urine. The remaining relied on athletes' menstruation diaries. The current evidence suggests a variable association between menstrual cycle and a few performance-related outcomes, such as endurance or power resistance, ligament stiffness, decision making skills, psychology, or competitiveness. Conclusion: Different sports performance-related parameters are affected during the menstrual cycle among elite athletes, but the parameters themselves and the magnitude and the direction of the effects are inconclusive. Additional longitudinal and prospective studies to systematically monitor on-field performance parameters are urgently required in order to enable recommendations and training individualization in female elite athletes.

Lifestyle medicine

Fundamental Clinical Imbalances : Hormonal
Patient Centred Factors : Mediators/Elite athlete
Environmental Inputs : Physical exercise
Personal Lifestyle Factors : Exercise and movement
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable
Publication Type : Journal Article ; Review

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