The menstrual cycle and sport performance

Over the course of an ovulatory menstrual cycle, there are predicable and measurable variations in the female sex steroids (eg, estradiol and progesterone) that have multiple and variable effects on different body systems. Although there are theoretical implications for physical and mental performance in sports, the workplace, and special populations such as the military, there is no conclusive evidence that significant menstrual cycle differences exist. An exception might be a potential adverse luteal-phase effect for endurance events taking place in extremely hot and humid conditions. The ability to generalize current findings is limited by significant methodological problems, and there is substantial interand intraindividual variability. In addition, the full spectrum of menstrual dysfunction that is frequently seen in female athletes further complicates investigation and management. Athletes and coaches should be counseled regarding the menstrual cycle, its relation to performance, the great variability that exists among individuals, and the therapeutic possibilities. OCPs containing synthetic estrogens and progestins are the most commonly used drugs for controlling and manipulating the menstrual cycle, as they have several advantages for the female athlete in addition to being a good contraceptive method. However, although being prescribed for over 40 years, the effect of OCPs on performance and their potential health advantages and disadvantages, especially with the new extended regimens, are not clear. There is a great need for continuing research in this area by studying larger groups of subjects in carefully designed and controlled prospective randomized trials, although individual data collection and tailored therapy should be applied for elite athletes.