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The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis.

McNulty, Kelly Lee; Elliott-Sale, Kirsty Jayne; Dolan, Eimear; Swinton, Paul Alan; Ansdell, Paul; Goodall, Stuart; Thomas, Kevin; Hicks, Kirsty Marie


Kelly Lee McNulty

Kirsty Jayne Elliott-Sale

Eimear Dolan

Paul Alan Swinton

Paul Ansdell

Stuart Goodall

Kevin Thomas

Kirsty Marie Hicks


Background: Concentrations of endogenous sex hormones fluctuate across the menstrual cycle (MC), which could have implications for exercise performance in women. At present, data are conflicting, with no consensus on whether exercise performance is affected by MC phase. Objective: To determine the effects of the MC on exercise performance and provide evidence-based, practical, performance recommendations to eumenorrheic women. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for published experimental studies that investigated the effects of the MC on exercise performance, which included at least one outcome measure taken in two or more defined MC phases. All data were meta-analysed using multi-level models grounded in Bayesian principles. The initial meta-analysis pooled pairwise effect sizes comparing exercise performance during the early follicular phase with all other phases (late follicular, ovulation, early luteal, mid-luteal and late luteal) amalgamated. A more comprehensive analysis was then conducted, comparing exercise performance between all phases with direct and indirect pairwise effect sizes through a network meta-analysis. Results from the network meta-analysis were summarised by calculating the Surface Under the Cumulative Ranking curve (SUCRA). Study quality was assessed using a modified Downs and Black checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group. Results: Of the 78 included studies, data from 51 studies were eligible for inclusion in the initial pairwise meta-analysis. The three-level hierarchical model indicated a trivial effect for both endurance- and strength-based outcomes, with reduced exercise performance observed in the early follicular phase of the MC, based on the median pooled effect size (ES0.5 = −0.06 [95%CrI: −0.16 to 0.04]). Seventy-three studies had enough data to be included in the network-meta-analysis. The largest effect was identified between the early follicular and the late follicular phases of the MC (ES0.5 = −0.14 [95%CrI: −0.26 to −0.03]). The lowest SUCRA value, which represents the likelihood that exercise performance is poor, or among the poorest, relative to other MC phases, was obtained for the early follicular phase (30%), with values for all other phases ranging between 53 and 55%. The quality of evidence for this review was classified as “low” (42%). Conclusion: The results from this systematic review and meta-analysis indicate that exercise performance might be trivially reduced during the early follicular phase of the MC, compared to all other phases. Due to the trivial effect size, the large between-study variation and the number of poor quality studies included in this review, general 3 guidelines on exercise performance across the MC cannot be formed; rather, it is recommended that a personalised approach should be taken based on each individuals’ response to exercise performance across the MC.

Journal Article Type Review
Journal Sports medicine
Print ISSN 0112-1642
Electronic ISSN 1179-2035
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Institution Citation MCNULTY, K.L., ELLIOTT-SALE, K.J., DOLAN, E., SWINTON, P.A., ANSDELL, P., GOODALL, S., THOMAS, K. and HICKS, K.M. 2020. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports medicine [online], OnlineFirst. Available from:
Keywords Women; Menstrual cycle; Exercise; Methodological; Performance; Physical activity


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