Muscle Activity Varies Across The Menstrual Cycle

NewsBot · Oct 12, 2012

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Press Release:
Nerve and Muscle Activity Vary Across Menstrual Cycle
Finding may help explain higher rates of knee injuries in female athletes

WESTMINSTER, CO (October 10, 2012)—Numerous studies have shown that female athletes are more likely to get knee injuries, especially anterior cruciate ligament (ACL) tears and chronic pain, than their male counterparts. While previous research has focused on biomechanical differences as the main source of these problems, a new study suggests another distinction that could play a role: changes across the menstrual cycle in nerves that control muscle activity. The finding may eventually lead to new ways to prevent knee problems in female athletes.

Matthew Tenan, Yi-Ling Peng, and Lisa Griffin, all of the University of Texas-Austin, and Anthony Hackney, of the University of North Carolina-Chapel Hill, measured the activity of motor units—nerve fibers and the muscles they control—around the knees of female volunteers at various points of their menstrual cycles. They found that these bundles had firing rates that were significantly higher in the late luteal phase, about a week before a woman’s next period, compared to earlier in the menstrual cycle. This difference in firing rate could affect the stability of the joint, potentially affecting its susceptibility to injury.

Their poster presentation entitled, “Maximal Force and Motor Unit Recruitment Patterns are Altered Across the Human Menstrual Cycle,” will be discussed at The Integrative Biology of Exercise VI meeting being held October 10-13 at the Westin Westminster Hotel in Westminster, CO. This popular meeting is a collaborative effort between the American Physiological Society, the American College of Sports Medicine and the Canadian Society for Exercise Physiology. The conference is supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, an institute of the National Institutes of Health, GlaxoSmithKline, Inc., Stealth Peptides, Inc., and Seahorse Biosciences. The full program is online at http://bit.ly/OrMFtN.

More Than Biomechanics?
Differences in muscle structure around female athletes’ knees have typically gotten the blame for disparities in knee injuries between the sexes, especially for athletes who play sports such as soccer or basketball that involve a substantial amount of knee twisting, turning, and jerking, says study leader Tenan. However, he adds, it’s been unclear whether other factors, such as differences in motor unit firing patterns, might also play a part. Since female athletes’ hormones fluctuate across the menstrual cycle, Tenan and his colleagues decided to investigate whether these changes affect motor unit activity.

Working with seven female volunteers, all between the ages of 19 and 35, the researchers asked these study participants to chart their menstrual cycles using basal body temperature. This method involves taking body temperature every morning upon waking over the course of the menstrual cycle. Because temperature increases slightly after ovulation (the luteal phase), then dips to pre-ovulation temperatures just before the start of a new cycle (the follicular phase), it’s possible to track where each volunteer was in her menstrual cycle on any given day.

The researchers also asked each volunteer to visit their facility five different times at various points of the menstrual cycle. At each visit, they inserted a fine wire electrode, no thicker than a human hair, into two muscles around one of each of the volunteers’ knees. The women then did knee extensions while the researchers used these electrodes to measure the activity of motor units in those muscles.

Avoiding Injury
Results showed that motor unit firing patterns varied significantly across the menstrual cycle. Most notably, Tenan and his colleagues found that the rate of firing jumped in the late luteal phase compared to rates earlier in the cycle. Though they’re not sure whether these results coincide with a difference in knee injury rates at different points in the menstrual cycle—a topic for future research. Tenan notes that changes in motor unit activity could make women more vulnerable to injury in general.

“Our results suggest that muscle activation patterns are altered by the menstrual cycle,” he says. “These alterations could lead to changes in rates of injury.”
The findings, he adds, could prompt a closer look at the neuroendocrine system in addition to biomechanics as a possible cause for knee injuries in female athletes—potentially leading to new ways to help female athletes avoid these problems.

About the American Physiological Society (APS)
The American Physiological Society (APS) is a nonprofit organization devoted to fostering education, scientific research, and dissemination of information in the physiological sciences. The Society was founded in 1887 and today has more than 11,000 members. APS publishes 13 scholarly, peer-reviewed journals covering specialized aspects of physiology.
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Admin2 · Oct 12, 2012

Re: Muscle Activity Vary Across Menstrual Cycle

Related Threads
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Females respond differently to foot orthotics than males
Menopause? muscle changes? Effect on biomechanics?

admin · Oct 4, 2013

The Muscle Stretch Reflex throughout the Menstrual Cycle
Casey, Ellen; Hameed, Farah; Dhaher, Yasin Y.
Medicine & Science in Sports & Exercise: 2 October 2013

Introduction: The significant sex-disparity in sports-related knee injuries may be due to underlying differences in motor control. While the development of sex-specific movement patterns is likely multi-factorial, this study specifically focuses on the potential modulatory role of sex hormones.

Purpose: To investigate the muscle stretch reflex (MSR) across the menstrual cycle. We hypothesized that the MSR would fluctuate throughout the menstrual cycle, and that the lowest response would correspond with peak concentrations of estrogen.

Methods: Nineteen healthy women ages 18-35 participated in this study: 8 eumenorrheic women and 11 women taking oral contraceptives. Serum estradiol and progesterone concentrations, anterior knee laxity (AKL) and the MSR response of the quadriceps muscles were measured three times during the menstrual cycle.

Results: The MSR response of the RF varied significantly across the menstrual cycle in both groups. Specifically, the RF MSR response was 2.4 times lower during the peri-ovulatory phase when compared to the luteal phase (P = 0.007). The same trend was seen in the VM, but this did not reach statistical significance (P = 0.070). The MSR response of the VL did not change significantly across the menstrual cycle (P = 0.494). A mixed model comparison did not show an association between endogenous concentrations of estradiol and progesterone, exposure to hormonal contraceptives or AKL and the MSR response for any muscle.

Conclusions: Our results demonstrate that the RF MSR response varies throughout the menstrual cycle with the lowest response around the time of ovulation. Additional research is needed to clarify the exact relationship between sex hormones, AKL and the MSR response and to determine the specific origin of the change along the monosynaptic reflex arc.
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NewsBot · Feb 20, 2014

Influence of menstrual cycle on indices of contraction-induced muscle damage
Markofski, Melissa M.; Braun, William A.
Journal of Strength & Conditioning Research; 18 February 2014

Limited evidence suggests women exhibit a dampened response to contraction-induced muscle damage (CIMD). The purpose of this study was to examine if differences in symptoms of CIMD exist when induced in the menstrual cycle follicular or luteal phase. Sixteen resistance exercise-trained women between the ages of 18-37 completed 75 eccentric-biased extension exercises with their non-dominant arm. Creatine kinase (CK), elbow joint angles, arm volume, strength, and soreness were measured over seven days. Estrogen was higher (P<0.001) in the luteal group. The high estrogen group (luteal) had an overall greater strength decrement and higher CK concentration at 96 h. Significant time effects were present for CK, elbow extension, elbow flexion, arm volume, and soreness. With the exception of strength and CK, signs and symptoms of CIMD were independent of menstrual cycle phase. Estrogen concentration in women may have limited effects on symptoms associated with muscle damage, but further research in this area is warranted.
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NewsBot · Mar 6, 2014

Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction.
David R. Bell, J. Troy Blackburn, Anthony C. Hackney, Stephen W. Marshall, Anthony I. Beutler, and Darin A. Padua
Journal of Athletic Training In-Press.

Context: Of the individuals able to return to sport participation after an anterior cruciate ligament(ACL) injury, up to 25% will experience a second ACL injury. This population may be more sensitive to hormonal fluctuations, which may explain this high rate of second injury.

Objective: To examine changes in 3-dimensional hip and knee kinematics and kinetics during a jump landing and to examine knee laxity across the menstrual cycle in women with histories of unilateral noncontact ACL injury.

Design: Controlled laboratory study.

Setting: Laboratory.

Patients or Other Participants: A total of 20 women (age = 19.6 ± 1.3 years, height = 168.6 ± 5.3 cm, mass = 66.2 ± 9.1 kg) with unilateral, noncontact ACL injuries.

Intervention(s): Participants completed a jump-landing task and knee-laxity assessment 3 to 5 days after the onset of menses and within 3 days of a positive ovulation test.

Main Outcome Measure(s): Kinematics in the uninjured limb at initial contact with the ground during a jump landing, peak kinematics and kinetics during the loading phase of landing, anterior knee laxity via the KT-1000, peak vertical ground reaction force, and blood hormone concentrations (estradiol-β-17, progesterone, free testosterone).

Results: At ovulation, estradiol-β-17 (t = −2.9, P = .009), progesterone (t = −3.4, P = .003), and anterior knee laxity (t = −2.3, P = .03) increased, and participants presented with greater knee valgus moment (Z = −2.6, P = .01) and femoral internal rotation (t = −2.1, P = .047). However, during the menses test session, participants landed harder (greater peak vertical ground reaction force; t = 2.2, P = .04), with the tibia internally rotated at initial contact (t = 2.8, P = .01) and greater hip internal-rotation moment (Z = −2.4, P = .02). No other changes were observed across the menstrual cycle.

Conclusions: Knee and hip mechanics in both phases of the menstrual cycle represented a greater potential risk of ACL loading. Observed changes in landing mechanics may explain why the risk of second ACL injury is elevated in this population
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NewsBot · Jan 22, 2015

Comments by Paula Radcliffe about periods and elite athletes performance:
Paula Radcliffe: Sport has not learned about periods

NewsBot · Jul 19, 2015

Tibial acceleration profiles during the menstrual cycle in female athletes
Erik Hohmann, Adam L. Bryant, Elisabeth Livingstone, Peter Reaburn, Kevin Tetsworth, Andreas Imhoff
Archives of Orthopaedic and Trauma Surgery; July 2015

Purpose
Fluctuating levels of endogenous estrogen are thought to have an adverse effect on lower limb biomechanics, given the observed higher rate of ACL injury at certain phases of the menstrual cycle. The purpose of this study was to investigate the effects of fluctuating endogenous estrogen levels during the menstrual cycle on acceleration transients at the proximal tibia in young physically active females.
Methods
Eleven females aged 16–18 years participated in this study and were compared to a male control group. Female subjects were tested at each of the four phases of the menstrual cycle: menses, follicular, ovulation and luteal. On each test occasion, acceleration transients at the proximal tibia were measured while subjects performed an abrupt deceleration task (simulated netball landing).
Results
No significant differences were found between the different phases of the menstrual cycle for peak tibial acceleration (PTA; P = 0.57), and time to zero tibial acceleration (TZTA; P = 0.59). However, there was a significant difference for time to peak tibial acceleration (TPTA) between menstruation and follicular (P = 0.04), menstruation and ovulation (P = 0.001), menstruation and luteal phase (P = 0.002), and follicular phase and ovulation (P = 0.007). In the male control group, no significant between-test session differences were observed for PTA (P = 0.48), TZTA (P = 0.08) and TPTA (P = 0.29). While there were no significant between-group differences for PTA (P = 0.21) and TZTA (P = 0.48), significant between-group differences were observed for TPTA (P = 0.001).
Conclusion
The results of this project strongly suggest that serum estrogen fluctuations have an effect on tibial acceleration profiles in young female athletes during different phases of the menstrual cycle.
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NewsBot · Feb 10, 2016

Influence of Menstrual Cycle and Oral Contraceptive Phase on Spinal Excitability
Ellen Casey, Maria Reese, Ezi Okafor, Danielle Chun, Christine Gagnon, Franz Nigl, Yasin Y. Dhaher
PM&R; Article in Press

Background
Rates of musculoskeletal injury differ substantially between the sexes, with females more likely to experience conditions such as anterior cruciate ligament (ACL) injuries than males in the same sports. Emerging evidence suggests a significant hormonal contribution. Most research has focused solely on how hormonal fluctuations affect connective tissue, but a direct link between hormonal shifts, ligamentous laxity, and ACL injury has not been borne out. There is also evidence to suggest that sex hormones can modulate the central nervous system, but how this affects neuromuscular control is not well-understood. To begin to fill this gap, we aim to determine if changes in sex hormone concentrations alter spinal excitability.

Objective
To measure spinal excitability across the menstrual and oral contraceptive pill cycle. We hypothesized that spinal excitability would fluctuate across the menstrual cycle (with increased excitability during the peri-ovulatory phase due to peak estradiol concentration), but there would be no fluctuation in oral contraceptive users.

Design
Prospective cohort study.

Setting
Biomechanics laboratory at a rehabilitation hospital.

Participants
Thirty healthy women ages 18-35 similar in age, body composition, and exercise-training status were included. Fifteen of the women were eumenorrheic and non-users of oral contraceptives (non-users) and 15 of the women were taking oral contraceptives (users).

Main outcome measures
H Reflex (Hmax/Mmax ratio), serum estradiol and progesterone concentrations were measured at three time points during the menstrual and contraceptive pill cycle.

Results
The H Reflex (Hmax/Mmax ratio) remained stable across the menstrual and contraceptive pill cycle. Spinal excitability was lower in the users compared to the non-users across all testing sessions, but this was not statistically significant.

Conclusions
Our results suggest that acute fluctuations of endogenous estradiol and progesterone do not modulate spinal excitability. However, long-term exposure to exogenous estrogen and progesterone (oral contraceptives) might impact spinal excitability and neuromuscular control. Further research is necessary to better understand the potential differential effect of endogenous and exogenous sex hormones on spinal excitability.
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NewsBot · May 5, 2020

How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players
Rebekka J Findlay et al
British Journal of Sports Medicine Published Online First: 29 April 2020

Objectives To explore athletes’ past and current experiences and perceptions of the menstrual cycle in relation to its impact on sporting performance.

Methods 15 international female rugby players participated in individual semi-structured interviews (age: 24.5±6.2 years). All interviews were recorded and transcribed verbatim, resulting in 37 376 words of text for descriptive and thematic analysis. Inter-rater reliability checks resulted in a concordance of agreement of 83%.

Results Almost all athletes (93%) reported menstrual cycle-related symptoms. Thirty-three per cent perceived heavy menstrual bleeding and 67% considered these symptoms impaired their performances. Two-thirds of athletes self-medicated to alleviate symptoms. Thematic analysis generated 262 meaning units, 38 themes, 10 categories and 4 general dimensions. The four general dimensions were: (1) symptoms: physiological and psychological menstrual cycle-related symptoms such as dysmenorrhoea, flooding, reduced energy levels, worry, distraction, fluctuating emotions and reduced motivation; (2) impact: perceived impact of menstruation on different aspects of daily lives and performance including negative and neutral responses; (3) resolution: the methods/approaches in dealing with menstruation-related concerns including accepting, or adapting and managing symptoms with self-medication or expert treatment; (4) support: available support and comfortability in discussing menstrual cycle-related issues.

Conclusions This study provides the first in-depth insight into athlete’s experiences of the menstrual cycle and perceived impact on training and competition. It highlights individual responses to menstrual ‘issues’ and emphasises the need for clinicians and support staff to undertake menstrual cycle profiling, monitoring and continue to develop awareness, openness, knowledge and understanding of the menstrual cycle.
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NewsBot · Nov 19, 2020

Exercise-induced muscle damage during the menstrual cycle: A systematic review and meta-analysis.
Romero-Parra, N, Cupeiro, R, Alfaro-Magallanes, VM, Rael, B, Rubio-Arias, JA, Peinado, AB, and Benito, PJ, IronFEMME Study Group.
J Strength Cond Res XX(X): 000–000, 2020

A strenuous bout of exercise could trigger damage of muscle tissue, and it is not clear how sex hormone fluctuations occurring during the menstrual cycle (MC) affect this response. The aims of this study were to systematically search and assess studies that have evaluated exercise-induced muscle damage (EIMD) in eumenorrheic women over the MC and to perform a meta-analysis to quantify which MC phases display the muscle damage response. The guidelines of the Preferred Reported Items for Systematic Reviews and Meta-Analysis were followed. A total of 19 articles were analyzed in the quantitative synthesis. Included studies examined EIMD in at least one phase of the following MC phases: early follicular phase (EFP), late follicular phase (LFP), or midluteal phase (MLP). The meta-analysis demonstrated differences between MC phases for delayed onset muscle soreness (DOMS) and strength loss (p < 0.05), whereas no differences were observed between MC phases for creatine kinase. The maximum mean differences between pre-excercise and post-exercise for DOMS were EFP: 6.57 (4.42, 8.71), LFP: 5.37 (2.10, 8.63), and MLP: 3.08 (2.22, 3.95), whereas for strength loss were EFP: −3.46 (−4.95, −1.98), LFP: −1.63 (−2.36, −0.89), and MLP: −0.72 (−1.07, −0.36) (p < 0.001). In conclusion, this meta-analysis suggests that hormone fluctuations throughout the MC affect EIMD in terms of DOMS and strength loss. Lower training loads or longer recovery periods could be considered in the EFP, when sex hormone concentrations are lower and women may be more vulnerable to muscle damage, whereas strength conditioning loads could be enhanced in the MLP.
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NewsBot · Mar 25, 2021

A preliminary study exploring the change in ankle joint laxity and general joint laxity during the menstrual cycle in cis women
Tomomi Yamazaki, Sae Maruyama, Yuki Sato, Yukako Suzuki, Sohei Shimizu, Fumiya Kaneko, Masahiro Ikezu, Kanta Matsuzawa & Mutsuaki Edama
Journal of Foot and Ankle Research volume 14, Article number: 21 (2021)

Background
The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit.

Methods
Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase.

Results
There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase.

Conclusions
Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.
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NewsBot · Aug 22, 2021

Follicular phase of menstrual cycle is related to higher tendency to suffer from severe injuries among elite female futsal players
CarlosLago-FuentesabAlexisPadrón-CabobMariánFernández-VillarinobMarcosMecías-CalvoacIkerMuñoz-PérezadFelipeGarcía-PinillosefEzequielReyb
Physical Therapy in Sport; 21 August 2021

Highlights
•Injury incidence and injury burden did not show statistical differences among follicular, ovulatory and luteal phases.
•Two of each three sprains happened during the follicular phase.
•No differences in injury incidence were shown in type of session, day of the week neither phase of the season according to the menstrual phase.
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Objective
To describe the injury incidence according to each phase of menstrual cycle (MC) in professional futsal players along two consecutive season and, secondly, to compare the injury incidence and frequency between different phases of the MC.

Design
Prospective cohort study.

Settings
Elite futsal players.

Participants
179 players.

Main outcome measure
Players were registered along two consecutive seasons.

Results
191 injuries were reported throughout both seasons. The injury incidence was 30.63 days-off during the follicular phase, 23.6 during ovulatory phase and 17.59 days-off in luteal phase, showing higher incidence during the follicular phase. No statistical differences (p > 0.05) were reported for any variable comparing among the three phases of MC.

Conclusions
This study suggests the relevance to track the MC, but reduces its possible relationship or influence on the injury distribution during each phase of the MC. The knowledge of injury incidence, burden and etiology is a key factor to design injury prevention programs with the focus on the most common injuries, where MC could be included as a complementary factor.
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NewsBot · Jul 15, 2022

How Your Menstrual Cycle Affects Your Injury Risk

NewsBot · Dec 31, 2023

Balance test results in different hormonal statuses of the menstruation cycle. Are females more susceptible to lower extremities injuries on different days of their menstruation cycles?
Masoumeh Baghban Baghdadabad, Shahram Mohaghegh
Physical Therapy in Sport Volume 65, January 2024, Pages 54-58

Background
The Star Excursion Balance Test (SEBT) and its modification(mSEBT) as dynamic tests have been shown to have high reliability and validity for the prediction of lower extremities injuries including ACL ones. No previous study has compared mSEBT performance measures in different hormonal statuses of the menstrual cycle in naturally menstruating women. So aim of the study was comparison of mSEBT performance measures in days of the menstruation cycle with the peak of estrogen and progesterone hormones in naturally menstruating women.

Methods
After a pilot study for estimation of sample size, mSEBT performance measures in a sample of 18 healthy women with regular menstrual cycles were compared two times in their cycles, first in the peak of estrogen (mid-cycle) and second in time of peak of progesterone (one week later). The test was performed 2 times using either the right or left leg as the stance and reach limb.

Findings
No significant difference between days with estrogen and progesterone peaks with right or left reach limb was seen for the percentage of reach in any direction or the composite reach on the mSEBT performance.

Conclusion
It seems that there is the same risk for lower extremities injuries in estradiol and progesterone peak days of normal menstruating women.
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NewsBot · Feb 26, 2024

Injury Incidence, Severity and Type across the Menstrual Cycle in Female Footballers: A Prospective Three Season Cohort Study
Barlow, Ally et al
Medicine & Science in Sports & Exercise ():10.1249/MSS.0000000000003391, February 8, 2024. | DOI: 10.1249/MSS.0000000000003391

Purpose
The aim of the study was to assess the influence of menstrual cycle phase on injury incidence, severity and type in elite female professional footballers over three seasons.

Methods
Time-loss injuries and menstrual cycle data were prospectively recorded for 26 elite female football players across three seasons. The menstrual cycle was categorised into four phases using a standardised model: menstruation (phase 1; P1), remainder of follicular phase (phase 2; P2), early luteal (phase 3; P3), and pre-menstrual phase (phase 4; P4). Injury incidence rates (IRR) and ratios (IIRR) were calculated for overall injuries, injury severity, type, contact vs non-contact and game/training.

Results
593 cycles across 13,390 days were tracked during the study and 74 injuries from 26 players were eligible for analysis. When comparing IRR between phases (reference: P1), overall injury rates were highest in P4 (IIRR: 2.30 [95% CI: 0.99-5.34; p = 0.05]). When examining rates by injury severity and type, IRR were also highest in P4 for ≤7 days’ time-loss (4.40 [0.93-20.76; p = 0.06]), muscle-specific (6.07 [1.34-27.43; p = 0.02]) and non-contact (3.05 [1.10-8.50; p = 0.03]) injuries. Muscle-specific (IIRR P31: 5.07 [1.16-22.07; p = 0.03]) and ≤ 7 days’ time-loss (4.47 [1.01-19.68; p = 0.05]) injury risk was also significantly higher in P3. Muscle injuries were the most prevalent sub-type (n = 41). No anterior cruciate ligament injuries were recorded across the monitoring period.

Conclusions
Injury risk was significantly elevated during the luteal phase of the menstrual cycle (P3 and P4) among elite female professional footballers. Further research is urgently needed to better understand the influence of the menstrual cycle on injury risk and to develop interventions to mitigate risk.
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NewsBot · Sep 19, 2024

The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review
Candice MacMillan, Benita Olivier, Carel Viljoen, Dina Christa Janse van Rensburg & Nicola Sewry
Sports Medicine

Background
The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated.

Objective
This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded.

Methods
This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to “menstrual cycle”, “hormonal contraception” and “injury.” Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form.

Results
The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated.

Conclusions
Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs.
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NewsBot · Dec 1, 2024

Hormonal Fluctuation and Ankle Instability in Women-Is There a Correlation?
Hayden Hartman et al
Foot Ankle Orthop. 2024 Nov 27;9(4)

Background: With higher incidences of ankle sprains and chronic ankle instability in women, it has been postulated that hormonal modulation and ligamentous laxity influences injury propensity. The purpose of this study is to investigate the impact of hormonal fluctuation on ankle stability and ligamentous laxity and their potential contribution to injury propensity in the female athlete.

Methods: In November 2023, a systematic review of the MEDLINE, Embase, and Cochrane Library databases was performed following PRISMA guidelines. Articles were included if they were published after the year 2000, evaluated outcomes related to the impact of hormones on ankle stability in healthy patients, and included menstrual tracking. The following search terms were used: "(sex or gender) AND (ankle stability)" and "(hormone) AND (ankle)."

Results: Thirteen articles were included, with 253 (76.4%) women at a weighted mean age of 21.9 ± 2.0 years (range, 20.0-25.9). Five studies evaluated postural sway and balance noting greater sway rates during ovulation compared with the follicular phase. Greater muscle tone (P < .001) was observed in the follicular phase than ovulation for the tibialis anterior, peroneus longus, and lateral gastrocnemius. Significantly higher ankle joint laxity was observed in ovulation (P = .016).

Conclusion: This review found that during ovulation, when estrogen peaks, subjects showed impaired balance with higher postural sway rates, greater ankle joint laxity, and decreased muscle and ligamentous tone and stiffness-an indicator of laxity. An underlying hormonally mediated etiology for the increased propensity to ankle instability in the female athlete is suggested. Syncing an athlete's workout type and intensity around menstrual cycle phase may be an advantageous strategy for injury prevention.
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NewsBot · Feb 12, 2025

The Effect of Sex Hormones on Joint Ligament Properties: A Systematic Review and Meta-analysis
Gabrielle Gilmer et al
Source

Background:
Sex differences exist in injury rates, and one contributing factor may be sex hormone effects on the musculoskeletal system.
Purpose/Hypothesis:
The goal of this systematic review and meta-analysis was to understand the effects of sex hormones on ligaments in females as determined by preclinical and clinical studies. The hypothesis was that sex hormones would affect ligament mechanical properties, histological features, cellular function, and clinically measurable outcomes.
Study Design:
Systematic review and meta-analysis; Level of evidence, 4.
Methods:
A literature search of PubMed, PEDro, CINAHL, and CENTRAL was performed to identify preclinical and clinical studies assessing sex hormone effects on ligament properties. Overall, 2 independent reviewers performed title, abstract, and full-text screening. Rigor and reproducibility were assessed using the ARRIVE guidelines and the modified Downs and Black checklist. Meta-analyses were also performed.
Results:
There were 54 articles included in this review. The majority of studies focused on the anterior cruciate ligament (ACL; n = 27), the menstrual cycle (n = 23), and 17β-estradiol (n = 35). Meta-analyses revealed that there was no effect of the menstrual cycle on knee laxity or anterior tibial translation but that 17β-estradiol decreased the production of types I and III procollagen in ACL fibroblasts in vitro. In examining other ligaments, data suggest that sex hormone changes may affect the mechanical and cellular properties of the medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum. Additionally, the literature suggests that hormonal shifts that occur with oral contraceptive pill use, pregnancy, and menopause can affect ligament properties. These effects appear to be mediated, at least in part, by the hormone relaxin.
Conclusion:
Of the sex hormones examined in this body of literature, 17β-estradiol and relaxin appear to have the most effect on both the mechanical and cellular properties of ligaments in females. The ACL, medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum may be impacted by changes in sex hormone concentrations. The menstrual cycle does not likely affect ligament laxity in a clinically meaningful way, but pregnancy, oral contraceptive pill use, and menopause may.
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NewsBot · Feb 19, 2025

Incidence of Sports Injuries Across Menstrual Phases in Eumenorrheic and Abnormal Cycles in Japanese Female Athletes: A Prospective Cohort Study
Suzuki-Yamanaka, Miwako et al
Medicine & Science in Sports & Exercise ():10.1249/MSS.0000000000003679, February 17, 2025. | DOI: 10.1249/MSS.0000000000003679

To examine the incidence of injuries among different menstrual phases in eumenorrheic cycles and abnormal menstrual cycles in female athletes.
Methods

This prospective cohort study recruited female athletes involved in collegiate, semi-professional, or professional team sports. Participating athletes self-reported their menstruation during the follow-up period. Menstrual cycles were classified as polymenorrhea, oligomenorrhea/amenorrhea, and eumenorrhea. Eumenorrheic cycles were further divided into estimated follicular phase (EFP), estimated ovulatory phase (EOP), and estimated luteal phase (ELP). Time-loss injuries and sports participation status were recorded by team medical staff. Incidence rates for each cycle and phase category were calculated per 1,000 athlete-days with 95% confidence intervals (CI). Incidence rate ratios (IRR) were utilized to compare risks among cycle and phase categories.
Results

Data from 316 female athletes were analyzed over a median follow-up period of 337 days. The incidence rates during eumenorrheic, oligomenorrheic/ amenorrheic, and polymenorrheic cycles were 3.10 (95% CI, 2.61-3.67), 2.11 (95% CI, 1.44-2.98), and 4.84 (95% CI, 2.77-7.86) per 1,000 athlete-days, respectively. Among eumenorrheic phases, the highest incidence rate was in the EOP at 5.14 (95% CI, 3.26-7.7), followed by the EFP at 3.19 (95% CI, 2.47-4.04) and the ELP at 2.52 (95% CI, 1.85-3.35). The incidence rate ratios (IRRs) for EOP compared to EFP and ELP were 1.61 (95% CI, 1.004-2.586) and 2.04 (95% CI, 1.238-3.357), respectively.
Conclusions

Injury risk is significantly higher during the EOP compared to the EFP and ELP in eumenorrheic cycles. Injury incidence was found to be lower during oligomenorrheic/amenorrheic cycles than during eumenorrheic cycles. Future studies should explore the factors contributing to the heightened injury risk during the EOP and the observed reduction in injury rates during oligomenorrheic/amenorrheic cycles.
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NewsBot · Feb 19, 2025

Incidence of Sports Injuries Across Menstrual Phases in Eumenorrheic and Abnormal Cycles in Japanese Female Athletes: A Prospective Cohort Study
Suzuki-Yamanaka, Miwako et al
Medicine & Science in Sports & Exercise ():10.1249/MSS.0000000000003679, February 17, 2025. | DOI: 10.1249/MSS.0000000000003679

To examine the incidence of injuries among different menstrual phases in eumenorrheic cycles and abnormal menstrual cycles in female athletes.
Methods

This prospective cohort study recruited female athletes involved in collegiate, semi-professional, or professional team sports. Participating athletes self-reported their menstruation during the follow-up period. Menstrual cycles were classified as polymenorrhea, oligomenorrhea/amenorrhea, and eumenorrhea. Eumenorrheic cycles were further divided into estimated follicular phase (EFP), estimated ovulatory phase (EOP), and estimated luteal phase (ELP). Time-loss injuries and sports participation status were recorded by team medical staff. Incidence rates for each cycle and phase category were calculated per 1,000 athlete-days with 95% confidence intervals (CI). Incidence rate ratios (IRR) were utilized to compare risks among cycle and phase categories.
Results

Data from 316 female athletes were analyzed over a median follow-up period of 337 days. The incidence rates during eumenorrheic, oligomenorrheic/ amenorrheic, and polymenorrheic cycles were 3.10 (95% CI, 2.61-3.67), 2.11 (95% CI, 1.44-2.98), and 4.84 (95% CI, 2.77-7.86) per 1,000 athlete-days, respectively. Among eumenorrheic phases, the highest incidence rate was in the EOP at 5.14 (95% CI, 3.26-7.7), followed by the EFP at 3.19 (95% CI, 2.47-4.04) and the ELP at 2.52 (95% CI, 1.85-3.35). The incidence rate ratios (IRRs) for EOP compared to EFP and ELP were 1.61 (95% CI, 1.004-2.586) and 2.04 (95% CI, 1.238-3.357), respectively.
Conclusions

Injury risk is significantly higher during the EOP compared to the EFP and ELP in eumenorrheic cycles. Injury incidence was found to be lower during oligomenorrheic/amenorrheic cycles than during eumenorrheic cycles. Future studies should explore the factors contributing to the heightened injury risk during the EOP and the observed reduction in injury rates during oligomenorrheic/amenorrheic cycles.
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NewsBot · Mar 3, 2025

News Release 3-Mar-2025
Researchers debunk common belief that women get better muscles by timing their workouts to their menstrual cycles

Hamilton, ON, Mar. 3 – New research from kinesiologists at McMaster University is challenging the internet belief that timing resistance training to specific phases of the menstrual cycle boosts the body’s ability to build muscle and strength.

The researchers have shown that exercising at various points in the cycle had no impact—positive or negative—on the synthesis of new muscle proteins, a process essential to building and maintaining muscle.

The results, published in the print edition of the Journal of Physiology, debunk the popularly touted practice of cycle syncing, or tailoring workouts to align with the way hormones change throughout a woman’s menstrual cycle.

“Our findings conflict with the popular notion that there is some kind of hormonal advantage to performing different exercises in each phase. We saw no differences, regardless of cycle timing,” explains Lauren Colenso-Semple, lead author of the study and a former graduate student in the Department of Kinesiology, who conducted the work while at McMaster.

For the study, researchers monitored the menstrual cycles of participants—all healthy young women—for three months to confirm their cycles were normal. Contrary to popular belief, only a small percentage of women—about 12 per cent—have a consistent 28-day cycle and ovulate regularly on day 14 or the ‘textbook’ menstrual cycle.

Participants then ingested a tracer molecule, a benign substance designed to track and monitor muscle protein levels. They performed heavy resistance exercise during two distinct phases of their menstrual cycles: the follicular phase, when estrogen levels are at their peak, and luteal phase, characterized by peak progesterone levels.

Researchers observed no effect of either menstrual cycle phase on the production of muscle proteins.

Cycle syncing has been made popular by internet influencers to co-ordinate workouts, certain diets and lifestyle behaviours with the menstrual cycle. There are fitness apps for tracking cycles, and social media channels are rife with advice and recommendations.

Proponents routinely cite a handful of scientific studies on animals as evidence that fluctuations in ovarian hormones can affect how human muscles respond to exercise, but this study shows that not to be correct.

“Our work shows that women who want to lift weights and recondition their muscles should feel free to do so in any phase of their cycle. There is no physiological difference in response to the exercise,” says Stuart Phillips, the Canada Research Chair in Skeletal Muscle Health at McMaster who supervised the study. “It is important to tailor your training to how you feel.”

Scientists highlight the need for further research, particularly studies that focus on women’s health. This includes investigating how training, in relation to the menstrual cycle, affects women and how both oral and non-oral contraceptives influence their responses to exercise.

Muscle Activity Varies Across The Menstrual Cycle

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Effect of foot type and foot orthoses on gluteus medius muscle activity

Lower Limb Muscle Activity Control by using Jamming Footwear.

Foot orthoses induce immediate changes in intrinsic foot muscle EMG activity during walking

The effect of different running shoes on treadmill running mechanics and muscle activity

Calf muscle activity alteration with foot orthoses

Effects of two types of foot orthoses on lower limb muscle activity before and after a one-month per

Dose response effects of customised foot orthoses on lower limb muscle activity and plantar pressure

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Muscle Activity Varies Across The Menstrual Cycle

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Effect of foot type and foot orthoses on gluteus medius muscle activity

Lower Limb Muscle Activity Control by using Jamming Footwear.

Foot orthoses induce immediate changes in intrinsic foot muscle EMG activity during walking

The effect of different running shoes on treadmill running mechanics and muscle activity

Calf muscle activity alteration with foot orthoses

Effects of two types of foot orthoses on lower limb muscle activity before and after a one-month per

Dose response effects of customised foot orthoses on lower limb muscle activity and plantar pressure

Share This Page

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