HORMONES

OVERVIEW

Most people with a uterus will experience menstrual cycles. All women, assigned female at birth, will transition through the menopause during their life course (1). 

That’s a lot of time dealing with hormones. How much do you really know about this process? Do you know that symptoms of menstrual cycles change with time? What exactly is PMS? How does going through menopause change your body and exercise ability? What can you actually do about any of it? 

THE MENSTRUAL CYCLE

The average menstrual cycle lasts 28 days, with 2 to 7 days of bleeding. These lengths change with age, with the time between bleeding increasing until your mid 20s, then decreasing until about 45 when perimenopause starts and cycles become irregular. The time spent bleeding is the longest when you’re young, getting shorter until 45 where it increases again (2,3).

About 90% of women will have at least one menstrual cycle-related symptom each month. On average, a person’s 20s and 30s will see higher rates of breast tenderness and fatigue. Cramps are also more common in younger women, seeing a mild decline with age. Acne is very common while younger, not occurring as much in older women. Mood swings are seen in both the younger and older age groups (3). Digestive symptoms are pretty steady across the entire lifespan. 

PMS & PMDD

Premenstrual Syndrome (PMS) impacts 20–40% of people with ovaries. Symptoms can be emotional, physical, or a mix but they “impair daily function or affect work or school performance, or interpersonal relationships” (4,5).

Symptoms can include: cravings, change in appetite, anxiousness, feeling sad or down, bloating, headache, muscle pain, and fatigue just to name a few.

Sometimes those feelings occur because life happens, but to be PMS, it has to occur in the luteal phase (up to 14 days before bleeding) and symptoms go away after bleeding starts and stay away until sometime around or after ovulation (5).  

Premenstrual Dysphoric Disorder (PMDD) impacts about 5% of people who have cycles. The impact has to be severe and cyclic to qualify with at least 5 of 11 specific symptoms being met. The impact on a person’s daily life can be devastating with 15% of people with PMDD having attempted suicide. 

The 11 symptoms include: severe or sudden mood changes, increased anger or interpersonal conflicts, depression or similar, anxiety, decreased interest in your usual actives, decreased concentration, fatigue, changes in appetite or overeating, sleep changes, feelings overwhelmed, body symptoms like joint pain or breast tenderness (4,5).

Think you may have this or aren’t sure? Here is a free online screening tool.

Treatment is available. The first step is awareness and exercise. Therapy can also be helpful. Past that, different vitamins, hormonal medications, and non-hormonal medications can be tried. Please talk to your doctor about these options (4,5).

HORMONES & SPORT

Does the menstrual cycle impact sport performance?

The general consensus seems to be that some people are more impacted than others with most symptoms occurring around bleeding. Some may see a decrease in sport-specific performance during the menstrual and premenstrual phases (6). But there doesn’t appear to be any big changes in power, strength, anaerobic capacity, or performance over the cycle, but may cause a slight decrease in strength before and during bleeding (2).

Even if the ability doesn’t change, over half of athletes said they felt like their performance changed based on their cycle with the worst right before and right after bleeding occurs (2,7). If you feel like it's impacting your practice, you’re not alone, as 27–66% of athletes had to change what they were doing during practice because of their cycle (7). The flip side is that motivation increased during the ovulatory phase which can be a positive influence on performance (2).


What to do: 

  • Be aware and know what changes your body may experience. Do what you can to help with the symptoms.

  • Talk about it. Despite progress, a lot of athletes still don’t talk about their cycle, especially younger athletes (7).

  • Consider changing your workouts to fit your symptoms, if needed.

  • Think about your uniforms and playing fields, making sure everyone is comfortable (i.e. maybe not having white shorts) and bathrooms are available (7).

PERIMENOPAUSE &
MENOPAUSE

Perimenopause begins when periods start to become irregular. Menopause starts after the last period finishes at an average age of 51 (8). One year after the last period ends is when you enter post-menopause. 

Menopausal symptoms vary but can include: brain fog, forgetfulness, anxiety, night sweats, hot flashes, vaginal dryness, decreased sex drive, more UTIs, urinary incontinence, changes in sleep, depression, heart palpitations, muscle and joint pains, and weight gain (1,9). 

Menopause occurs from a loss of estrogen which increases a woman’s risk of cardiovascular disease, weight gain, metabolic disease (like diabetes), decreases bone health, changes bladder health, and even can cause changes in cognition or thinking. The younger a person is when they hit menopause, the higher risk of long-term issues (1,9).

Once symptoms start you should talk to your doctor about estrogen replacement options. It can provide multiple benefits but needs to be started before the age of 60. It is also going to be important to be screened for cancers and chronic disease (9).

You can set yourself up for success now by doing things you’re probably already doing. 

  • Don’t smoke. Smoking is associated with earlier menopause (9).

  • Keep a healthy weight. Weight gain is a part of aging, but if you’re at a better starting point, it’ll be easier to keep it with regular exercise (10).

  • Protect your bone health now (see Bone Health section). 

  • Continue your exercise and fitness habits, so if things start to get harder, you already have the foundations set for success.


REFERENCES

  1. Gatenby, C., & Simpson, P. (2024). Menopause: Physiology, definitions, and symptoms. Best Practice & Research Clinical Endocrinology & Metabolism, 38. https://doi.org/10.1016/j.beem.2023.101855 

  2. Carmichael, M. A., Thomson, R. L., Moran, L. J., & Wycherley, T. P. (2021). The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review. International Journal of Environmental Research and Public Health, 18(4), 1667. https://doi.org/10.3390/ijerph18041667 

  3. Cunningham, A. C., Pal, L., Wickham, A. P., Prentice, C., Goddard, F. G. B., Klepchukova, A., & Zhaunova, L. (2024). Chronicling menstrual cycle patterns across the reproductive lifespan with real‑world data. Scientific Reports, 14. https://doi.org/10.1038/s41598-024-60373-3 

  4. Cary, E., & Simpson, P. (2024). Premenstrual disorders and PMDD - a review. Best Practice & Research Clinical Endocrinology & Metabolism, 38. https://doi.org/10.1016/j.beem.2023.101858 

  5. Gnanasambanthan, S., & Datta, S. (2019). Premenstrual syndrome. Obstetrics, Gynaecology & Reproductive Medicine, 29(10), 281-285. https://doi.org/10.1016/j.ogrm.2019.06.003 

  6. Elorduy-Terrado, A., Torres-Luque, G., Radesca, K., Muñoz-Andradas, G., Saenz-Bravo, M., & Domínguez-Balmased, D. (2025). Evaluation the Impact of Hormonal Fluctuations During the Menstrual Cycle on the Performance of Female Athletes—Systematic Review. Muscles, 4(15). https://doi.org/10.3390/muscles4020015 

  7. Stitelmann, A., Bruyneel, A. V., Enea, C., & Boisseau, N. (2026). Menstrual Cycle‑Related Symptoms and Disorders and Their Impact on Physical, Psychosocial, and Environmental Determinants of Exercise Performance: A Scoping Review. Sports Medicine. https://doi.org/10.1007/s40279-026-02412-9 

  8. de Villiers, T. J. d. (2024). Bone health and menopause: Osteoporosis prevention and treatment. Best Practice & Research Clinical Endocrinology & Metabolism, 38. https://doi.org/10.1016/j.beem.2023.101782 

  9. Lobo, R. A., & Gompel, A. (2022). Management of menopause: a view towards prevention. The Lancet Diabetes & Endocrinology, 10, 457-470. https://doi.org/10.1016/ S2213-8587(21)00269-2 

  10. Littman, A. J., Kristal, A. R., & White, E. (2005). Effects of physical activity intensity, frequency, and activity type on 10-y weight change in middle-aged men and women. International Journal of Obesity, 29(5), 524-533. https://doi.org/10.1038/sj.ijo.0802886