Female lifters and Menstruation


Studies have revealed that there are significant decrements in athletic performance during stages of the menstrual cycle (Davis, Elford & Jamieson, 1991; Wirth & Lohman, 1982; Bale & Nelson, 1985).


Understanding the cycle’s effects on performance could help you and your coach with effective training programme and nutrition plan design, injury prevention and help you develop realistic expectations.


The menstrual cycle has been shown to be associated with fluctuations in:

  • metabolism

  • thermoregulation

  • muscle contractile responses

  • force production

  • endurance

  • risk of in injury

all as a result of the circadian variations in oestrogen and progesterone (Hewett, et al., 2007; Bambaeichi, et al., 2004; Stachenfeld, et al., 2000).


Personally, I have always felt that discussing such matter with my clients and athletes is extremely important. In fact, I include questions about menstruation and toilet habits in my athlete check-in forms. I find that discussing such matters tells me a lot when deciding how to intervene with training and nutrition strategies.


It may not be something you are confident discussing with others, but you should. It's a completely natural process that should not be associated with embarrassment. If you have a coach (you should have!) and they are not willing to discuss such matters, you need to find yourself a new one.


Within this blog post, I aim to help you understand the reasons why discussing such matters with your coach are important, and the effects your cycle will have on your training, dietary habits, mood, sense of well-being and performance.


Understanding the cycle:


A woman's typical cycle lasts approximately 28 days and can be split into two separate phases:


Follicular Phase: Day 0-14

Luteal Phase: Day 15-28



Follicular Phase - Days 0-14:


The follicular phase begins with the hypothalamus in the brain releasing Gonadotropin Releasing Hormone (GnRH). This is transported to the anterior pituitary gland via capillaries and stimulates the release of Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH).


The above process also occurs in males.


In women, FSH and LH travel to the ovaries, again via capillaries, where eggs are produced. FSH stimulates follicles to mature. As these follicles mature they produce the hormone oestrogen. When low in concentration, Oestrogen limits LH production, and as it increases it causes FSH to decrease.


In other words, the more the follicles mature, the more oestrogen they produce and the less FSH is required.


Oestrogen, in women, is essential for:

  • bone density and muscle growth

  • Stimulates Endometrial Growth (layer of uterus)

  • Maintains Secondary Female Characteristics

  • Maintains Glands i.e. breasts

Oestrogen levels continue to rise gradually in the first 10-12 days which eventually causes FSH to drop considerably. LH begins to rise when Oestrogen reaches higher concentrations. The sudden increase in LH stimulates the most mature follicle to ovulate around day 14.



Luteal Phase - Days 15-28:


The follicle which has released the egg turns into corpus leteum (dead follicle). The dead follicle produces both Oestrogen Inhibin and Progesterone that begin to reduce and limit the production of oestrogen.


It also causes Gonadotropin Releasing Hormone, Follicle Stimulating Hormone and Luteinising Hormone to decrease.


The decrease in these hormones means that the maturation of follicles, production of eggs and ovulation is stopped.


Progesterone continues to rise until around day 21.


Progesterone stimulates Endometrial Growth (lining of uterus).


If there is no fertilisation, the egg will not implant into the endometrium. The dead follicle (corpus luteum) will degenerate (corpus albicans) and the secretion of progesterone and oestrogen inhibin decreases.


Remember, both oestrogen and progesterone promote the growth of the endometrium. With both progesterone and oestrogen decreasing at this stage, the endometrium cannot be maintained and it is shed (menstruation).


Gonadotropin Releasing Hormone starts to release from the brain, once again, and as a result a new cycle begins.



Does this process affect performance?


According to recent research by Bruinvels, et al. (2016) approximately 30%–50% of marathon runners have reported that their menstrual cycle seemed to negatively impact both training and performance.


Earlier research by Lebrum, McKenzie and Prior (1995) also suggested the association between reduced performance and the menstrual cycle, reporting that reductions in muscle strength were found.


A very recent study by Isherwood, et al. (2018) found that up to 69.7% of women found a decrement in performance during menstruation.


The most common reason for reduced performance cited in these studies was lethargy, fatigue, disrupted concentration and severely reduced levels of motivation.


As ever, science is never conclusive and as a result we cannot take everything literally.


Annoying, right!?



To make matters confusing, a number of studies have suggested that there is no association between muscle strength and the phases of the menstrual cycle (Jonge, et al., 2001).


62% of athletes from various sports have reported no perceived change in performance during menstruation (Kishali, et al. 2006).


71% of the athletes feel better during the first 14 days (Kishali, et al. 2006).


43% experienced enhanced performance during this time (Isherwood, et al. 2018).


Fortunately, there are two studies in agreement, both suggesting that peak force production occurs during ovulation (Gordona, et al., 2013; Bambaeichi, et al., 2004). Days at or around ovulation (day 14) are generally considered the most accommodating and relaxed of the menstrual cycle for women.


Endurance performance of both trained and untrained women does not seem to be affected negatively during these days (Oosthuyse, Bosch & Jackson 2005).



What affect does oestrogen have on muscle tissue?


Oestrogen appears to have strength enhancing effects. When oestrogen decreases during the luteal phase, performance decreases also (Philips, et al., 1996).


Muscle is an oestrogen responsive tissue. Oestrogen receptors, mRNA and protein levels are sensitive to circulating levels of oestrogens and myosin (contractile protein) is directly affected by oestrogen concentration.


Under conditions of reduced oestrogen levels, as experienced during the luteal phase, there is a reduction in the number of active myosin heads bound to actin, and therefore reduces the force generating capacity of the muscle (Baltgalvis, et al., 2010; Lowe, Baltgalvis and Greising, 2010; Moran, Warren and Lowe, 2006).


Very recently, Otaka, et al. (2018) looked at the serve performance of elite female tennis players during two complete menstrual cycles. The major finding of the study was that tennis serve performance was significantly lower on day 14, near ovulation, which contradicts previous findings. The decreased serve performance was associated with reduced accuracy, but not serve velocity. No significant difference in quadricep muscle strength across the entire menstrual cycle was found.


They researchers did, however, find increased fatigability of hip muscles, decreased stretch reflex response of hip muscles, decreased hip muscle strength and increased postural instability in and around the ovulation period.


All of this may have contributed, in part, to the decreased tennis serve performance around ovulation.


As you can probably tell, there are a tonne of contradictions in the subject.


One thing is certain....


Changes certainly occur as a result of alterations in hormone regulation.


The changes affect women differently very differently, of course.


A particular symptom may exist in one woman, but not the next in another.


As a result, it is important that your coach treats you very differently from someone else. You may be prescribed the same exercise as another female lifter at the club, but the intensity, volume and frequency of such exercise may be very different to accommodate your individual needs throughout your cycle.



What do you need to know?


Please bear in mind that the guidelines below are very general and may not necessarily suit your exact needs. It is your coaches responsibility to amend your training and nutrition plan according to your specific needs.


If I as your coach, let's say, know what to expect from you during various stages of your cycle, we can intervene and adjust your programme to suit your needs exactly when you need it, thus making your programme more suitable and sustainable for you.


If I know what to expect I can identify symptoms and avoid incorrect diagnoses of other potential possibilities (malnutrition, poor admin etc). In other words, If I were to know that you where approaching the mid-luteal phase, I would completely understand if you were craving carbohydrate dense foods and not blame it on your lack of meal prep, for example.


We could certainly maximise the your potential... knowing exactly when to 'push' and when to 'pull'.


We could also significantly reduce your risk of injury.



Follicular phase:


Oestrogen is known to reduce carbohydrate oxidation and increase free fatty acid availability. This means that when oestrogen levels are high, you may tend to conserve glycogen stores and utilise more fat as fuel.


If your primary goal is a physique transformation (perhaps fat loss), it might be wise to adjust nutritional intake in favour of healthy fat intake and reduce carbohydrates. This may also warrant a reduction in conditioning/cardiovascular training intensity. A greater volume at lighter loads (say 50-60% 1RM) may also be justified.


On the other hand...


If you are wanting to increase strength and performance, the general advice I would give would be different.


The follicular phase is when the we should be pushing training as much as possible, as greater levels of force production are likely. Remember, oestrogen has performance enhancing effects.


The issue you may face is working at higher intensities, or within the glycolytic energy system, as during this phase, fat oxidation is preferred and therefore may not provide you with the relevant energy supply required during intense training. Above-normal carbohydrate intake may therefore be necessary. A lot of carbohydrates in fact.


During this phase, a higher-than-normal tolerance for pain is expected, as is a greater force-generation capacity during lifting and training.


You are best served to focus on training progress during this time.


During the early to mid range of the follicular phase, your body trends toward using more carbohydrates as a fuel source and as oestrogen production increases towards ovulation, it will switch to fatty acids.


It is wise to proceed with more intense resistance and power training that will deplete your muscle glycogen stores.


As this phase progresses, more carbohydrates may be required to help fuel performance.


Ovulation:


In and around day 14, your relative strength levels will peak and remain elevated. Your ability to generate force will be sustained and therefore this would be the ideal time for you to attempt personal bests/maximal attempts.


Unfortunately, elevated oestrogen levels directly affects collagen production and as a result you are at a greater risk of injury. In fact, ACL injuries are four to eight times more likely than at other times during the cycle.


So, train very hard but emphasise form - not that you should ignore your 'technical mastery' throughout the rest of your cycle, of course. Just don't do anything stupid (I'm aiming this at you - crossfitters!)

Your insulin sensitivity is slowly declining at this stage and therefore your ability to store and utilise glycogen for fuel is becoming impaired. More carbohydrates may be required, but be careful, particularly if your sport involves weight categories, if you know what I mean?!



Luteal Phase:


During the second phase of your cycle, your body trends toward higher-than-normal temperatures (a few degrees), which can alter cardiovascular output and certainly disrupt sleep.

You'll find yourself ess efficient during exercise and will fatigue sooner than normal.


You may experience excessive water retention.


During this phase, your insulin sensitivity is likely to be low. This means that your instinct will be to eat more carbs, however, your ability to transport these carbohydrates into muscle is going to be very poor.


Decreased insulin sensitivity also means a lack of serotonin production. Serotonin is commonly referred to as the relaxation hormone (it isn't a hormone - it's a neurotransmitter), production of which makes you feel good!


This neurotransmitter is typically triggered by the consumption of carbohydrates as a result of its precursor, tryptophan, being secreted from the digestive system.


This combination of low serotonin and your body's poor ability to deal with carbohydrates will result in mood swings and irritability.


Cravings for carbohydrates will be very high however you need to keep your intake under control or you'll experience fairly significant weight gain.


Your ability to handle pain will be reduced, dehydration is likely as progesterone will alter blood plasma levels and therefore you may experience head aches.


A structured supplementation strategy can certainly help during this time, particularly aiding serotonin production, reduction of pain/Inflammation and the management of cravings. Speak with your coach about this.



Summary:


Ultimately, everybody is different. Monitor your symptoms across a number of different cycles and try to establish trends. Remember, you may experience different symptoms than one of your friends or colleagues.


It is essential to talk with your coach. Be open with them and do not be too embarrassed to explain your symptoms and the problems you face. If your coach doesn't take to well to the conversation, find yourself another one. You may be limiting your progress by not addressing the changes that occur during your cycle.


If you would like help with the matter; perhaps you'd like to discuss your training with us or maybe you have other questions regarding oral contraceptives for example, feel free to get in touch!


We offer both in-house and online coaching with packages and options for every budget. Whether you live near or afar we have options for you. View our services by clicking here




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References:


P. Bale and G. Nelson. The effects of menstruation on per-formance of swimmers. Aust J Sci Med Sport 17(1) (1985)19-22.


J.C. Wirth and T.G. Lohman, The relationship of static musclefunction to use of oral contraceptives. Med Sci Sp Exerc 14(1982) 16-20.


B.N. Davis, J.C. Elford, K.F. Jamieson, Variations in perfor-mance in simple muscle tests at different phases of the men-strual cycle. J Sp Med Phys Fitness 31(40) (1991) 532-537


E. Bambaeichi, T. Reilly, N.T. Cable, M. Giacomoni, The iso-lated and combined effects of menstrual cycle phase and time-of-day on muscle strength of eumenorrheic females. ChronoInt 21 (2004) 645-660.


T.E. Hewett, B.T. Zazulak, G.D. Myer, Effects of the men-strual cycle on anterior cruciate ligament injury: A systematicreview. Am J Sp Med 35 (2007) 659-668.


N.S. Stachenfeld, C. Silva, D.L. Keefe, Estrogen modifies the temperature effects of progesterone. J Appl Physiol 88 (2000)1643-1649.


Bruinvels G, Burden R, Brown N,et al. The prevalence and impact of heavy menstrual bleeding (menorrhagia) in elite and non-elite athletes. PLoS One2016; 11:e0149881


X.A.K.J de Jonge, C.R.L. Boot, J.M. Thom, P.A. Ruell, M.W.Thompson, The influence of menstrual cycle phase on skeletalmuscle contractile characteristics in humans. J Physiol 530(1)(2001) 161-166.


C.M. Lebrum, D.C. McKenzie, J.C. Prior, J.E. Taunton, Ef-fects of menstrual cycle phase on athletic performance. MedSci Sp Exerc 27 (1995) 437-444.

Isherwood, K., Fung, L., Walker, S.and Cotterrell, M., 2018. The effect of menstruation on psychological and physiological correlates of endurance performance.


Kishali NF, Imamoglu O, Katkat D,et al. Effects of menstrual cycle on sports performance. Int J Neurosci2006;116:1549–63


E. Bambaeichi, T. Reilly, N.T. Cable, M. Giacomoni, The iso-lated and combined effects of menstrual cycle phase and time-of-day on muscle strength of eumenorrheic females. ChronoInt 21 (2004) 645-660.


Dan Gordona,∗, Felicity Hughesb, Katherine Youngb, Adrian Scrutona, Don Keillera, Oliver Caddya,James Bakeraand Richard Barnesb. The effects of menstrual cycle phase on the development of peak torque under isokinetic conditions. Isokinetics and Exercise Science 21 (2013) 285–291


Oosthuyse T, Bosch AN, Jackson S. Cycling time trial performance during different phases of the menstrual cycle. Eur J Appl Physiol 2005;94:268–76


S.K. Philips, A.G. Sanderson, K. Birch, S.A. Bruce, R.C.Woledge, Changes in maximal voluntary force of human ad ductor pollicis during the menstrual cycle. J Physiol 496(2), (1996) 551-557.


K.A. Baltgalvis, S.M. Greising, D.A. Lowe, Estrogen regu-lates estrogen receptors and antioxidant gene expression inmouse skeletal muscle. PloS ONE 5 (2010) 1-11.


D.A. Lowe, K.A. Baltgalvis, S.M. Greising, Mechanisms be-hind estrogen’s beneficial effect on muscle strength in fe-males. Exerc Sp Sci Rev 38 (2010) 61-67


A.L. Moran, G.L. Warren, D.A. Lowe, Removal of ovarianhormones from mature mice detrimentally affects muscle con-tractile function and myosin structural distribution. J ApplPhysiol 100 (2006) 548-559.


Otaka M, Chen S-M,Zhu Y,et al. Does ovulation affect performance intennis players? BMJ Open Sport & Exercise Medicine 2018;4

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