Influence of the menstrual cycle on sports performance and injury incidence in elite female football players
Keywords:
Menstrual cycle, women’s football, sports performance, sports injuries, hormonal health, individualized trainingAbstract
A systematic review was conducted to analyse the influence of the menstrual cycle on sports performance and injury incidence in elite female football players. The search and selection process followed the PRISMA 2020 guidelines, and methodological quality was assessed using the STROBE tool. Fifteen studies with different observational and experimental designs were included. Results showed high heterogeneity in physiological responses to the menstrual cycle, although common trends were identified, such as a higher incidence of injuries during the luteal and late follicular phases. Muscular and tendinous injuries were more prevalent in these phases, coinciding with relevant hormonal fluctuations. Several studies also highlighted that perceived symptoms (pain, fatigue, or sleep disturbances) influence performance more than the cycle phase itself, emphasizing the importance of individualized monitoring. Incorporating menstrual cycle tracking into training planning, alongside hormonal, physical, and emotional monitoring, may significantly contribute to injury prevention and performance optimization in elite women’s football.
Downloads
References
Abbott, W., Exall, Z., Walsh, L., & Clifford, T. (2024). Menstrual Cycle and Situational Match Variables: Effects on Well-Being in Professional Female Soccer Players. Research Quarterly for Exercise and Sport, 95(3), 688–696. https://doi.org/10.1080/02701367.2023.2298443
Agel, J., Bershadsky, B., & Arendt, E. A. (2006). Hormonal therapy: ACL and ankle injury. Medicine and science in sports and exercise, 38(1), 7-12. https://doi.org/10.1249/01.mss.0000194072.13021.78
Aguilar, A. S., Miranda, M.ª. A., & Quintana, A. (2017). La mujer, el ciclo menstrual y la actividad física. Revista Archivo Médico de Camagüey, 21(2), 294–307. https://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1025-02552017000200015
Anderson, R., Rollo, I., Randell, R. K., Martin, D., Twist, C., Grazette, N., & Moss, S. (2023). A formative investigation assessing menstrual health literacy in professional women’s football. Science and Medicine in Football. https://doi.org/10.1080/24733938.2023.2290074
Barlow, A., Blodgett, J. M., Williams, S., Pedlar, C. R., & Bruinvels, G. (2024). Injury incidence, severity, and type across the menstrual cycle in female footballers: A prospective three-season cohort study. Medicine & Science in Sports & Exercise, 56(6), 1151–1158. https://doi.org/10.1249/MSS.0000000000003391
Bradley, P. S., Archer, D. T., Hogg, B., Schuth, G., Bush, M., Carling, C., & Barnes, C. (2016). Tier-specific evolution of match performance characteristics in the English Premier League: It’s getting tougher at the top. Journal of Sports Sciences, 34(10), 980–987. https://doi.org/10.1080/02640414.2015.1082614
Carmichael, M. A., Thomson, R. L., Moran, L. J., Dunstan, J. R., Nelson, M. J., Mathai, M. L., & Wycherley, T. P. (2021). A pilot study on the impact of the menstrual cycle phase on elite Australian football athletes. International Journal of Environmental Research and Public Health, 18(18), 9591. https://doi.org/10.3390/ijerph18189591
Clausen, E., Flood, T. R., Okholm Kryger, K., Lewin, G., McCall, A., Stebbings, G. K., & Elliott-Sale, K. J. (2025). Auditing the representation of elite female players in football performance and injury research. Science and Medicine in Football. https://doi.org/10.1080/24733938.2025.2577442
Clausen, M. B., Krohn, L. M., Rathleff, M. S., Bandholm, T., Jensen, S. N., Christensen, K. B., Hölmich, P., & Thorborg, K. (2025). The effect of adding a large dose of shoulder strengthening to nonoperative care for subacromial impingement on shoulder disability, quality of life, sick days, and surgery rates: 1-year results from a pragmatic, double-blind randomized controlled trial (SExSI). Orthopaedic Journal of Sport Medicine, 13(10), 1–9. https://doi.org/10.1177/23259671251374314
Dragoo, J. L., Castillo, T. N., Braun, H. J., Ridley, B. A., Kennedy, A. C., & Golish, S. R. (2011). Prospective correlation between serum relaxin concentration and anterior cruciate ligament tears among elite collegiate female athletes. The American Journal of Sports Medicine, 39(10), 2175–2180. https://doi.org/10.1177/0363546511413376
Halson, S. L., Johnston, R. D., Pearson, M., & Minahan, C. (2024). Menstrual-cycle symptoms and sleep characteristics in elite soccer players. International Journal of Sports Physiology and Performance, 19(9), 914–920. https://doi.org/10.1123/ijspp.2023-0021
Del Coso, J., Herrero, H., & Salinero, J. J. (2018). Injuries in Spanish female soccer players. Journal of Sport and Health Science, 7(2), 183–190. https://doi.org/10.1016/j.jshs.2016.09.002
Dupont, G., Nedelec, M., McCall, A., McCormack, D., Berthoin, S., & Wisløff, U. (2010). Effect of 2 soccer matches in a week on physical performance and injury rate. The American Journal of Sports Medicine, 38(9), 1752–1758. https://doi.org/10.1177/0363546510361236
FIFA. (2023). Women ‘s Football Strategy Progress Report. Fédération Internationale de Football Association. https://inside.fifa.com/womens-football/strategy
Jiménez, M. R., & Aguilá, N. C. (2017). El ciclo menstrual y sus alteraciones. Pediatría Integral, 21(7), 304. https://www.pediatriaintegral.es/publicacion-2017-07/el-ciclo-menstrual-y-sus-alteraciones/
Julian, R., Skorski, S., Hecksteden, A., Pfeifer, C., Bradley, P. S., Schulze, E., & Meyer, T. (2021). Menstrual cycle phase and elite female soccer match-play: Influence on various physical performance outputs. Science and Medicine in Football, 5(2), 97–104. https://doi.org/10.1080/24733938.2020.1802057
Lanhers, C., Courteix, D., Valente-Dos-Santos, J., Ferry, B., Gracia-Marco, L., Pereira, B., Borda, I. M., Lespessailles, E., & Duclos, M. (2020). Gonadal hormones may predict structural bone fragility in elite female soccer players. Journal of Sports Sciences, 38(7), 827–837. https://doi.org/10.1080/02640414.2019.1656322
Martin, D., Sale, C., Cooper, S. B., & Varley, M. C. (2021). Period prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes. International Journal of Sports Physiology and Performance, 16(3), 335–342. https://doi.org/10.1123/ijspp.2019-0897
Martin, D., Timmins, K., Cowie, C., Alty, J., Mehta, R., Tang, A., & Varley, I. (2021). Injury incidence across the menstrual cycle in international footballers. Frontiers in Sports and Active Living, 3, 616999. https://doi.org/10.3389/fspor.2021.616999
McNulty, K. L., Elliott-Sale, K. J., Dolan, E., Swinton, P. A., Ansdell, P., Goodall, S., Thomas, K., & Hicks, K. M. (2020). The effects of the menstrual cycle phase on exercise performance in eumenorrheic women: A systematic review and meta-analysis. Sports Medicine, 50(10), 1813–1827. https://doi.org/10.1007/s40279-020-01319-3
Möller-Nielsen, J., & Hammar, M. (1989). Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Medicine & Science in Sports & Exercise, 21(2), 126–129.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Parker, L. J. F., Elliott-Sale, K. J., Hannon, M., Morton, J. P., & Close, G. L. (2022). Where do you go when your periods go?: A case-study examining secondary amenorrhea in a professional internationally-capped female soccer player through the lens of the sport nutritionist. Science & Medicine in Football, 6(5), 643–649. https://doi.org/10.1080/24733938.2022.2088979
Quigley, T., & Greig, M. (2025). The influence of menstrual cycle phase on isokinetic knee flexor and extensor strength in female soccer players: A pilot study. Research in Sports Medicine, 33(1), 87–96. https://doi.org/10.1080/15438627.2023.2230972
Read, P., Mehta, R., Rosenbloom, C., Jobson, E., & Okholm Kryger, K. (2021). Elite female football players’ perception of the impact of their menstrual cycle stages on their football performance: A semi-structured interview-based study. Science and Medicine in Football, 6(4), 362–371. https://doi.org/10.1080/24733938.2021.1914301
Robles-Palazón, F. J., López-Valenciano, A., De Ste Croix, M., Oliver, J. L., García-Gómez, A., Sainz de Baranda, P., & Ayala, F. (2022). Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis. Journal of Sport and Health Science, 11(6), 681–695. https://doi.org/10.1016/j.jshs.2022.06.003
Sanchez-Sanchez, J., Raya-González, J., Martín, V., & Rodríguez Fernández, A. (2025). Understanding injuries in young female soccer players: A narrative review on incidence, mechanism, location, risk factors, and preventive strategies. Applied Sciences, 15(3), 1612. https://doi.org/10.3390/app15031612
Santos, C., Lopes, M., Brito, J., Kryger, K. O., Wilke, C., & Travassos, B. (2025). Impact of the menstrual cycle and barriers to football and futsal performance in Portuguese players: A survey-based cross-sectional study. Frontiers in Psychology, 16, 1576752. https://doi.org/10.3389/fpsyg.2025.1576752
Söderman, K., Alfredson, H., Pietilä, T., & Werner, S. (2001). Risk factors for leg injuries in female soccer players: A prospective investigation during one outdoor season. Knee Surgery, Sports Traumatology, Arthroscopy, 9(5), 313–321. https://doi.org/10.1007/s001670100228
Von Porat, A., Roos, E. M., & Roos, H. (2004). High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatism, 50(10), 3145–3152. https://doi.org/10.1002/art.20589
Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine, 4 (10), Article e296. https://doi.org/10.1371/journal.pmed.0040296
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Leire Ronkal Uzqueda, Iyán Iván Baragaño
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This journal provides immediate open access to its content, based on the principle that providing the public with free access to research supports a greater global exchange of knowledge.
In addition, open arbitration papers are accepted, preferably from Research Gate.
