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Article

Oxygen, Hormones, and Performance: A Case Study of Menstrual Cycle Effects on Athletic Physiology

by
Almudena Martínez-Sánchez
,
Amalia Campos-Redondo
,
Sergio J. Ibáñez
and
Javier García-Rubio
*
Optimization of Training and Sports Performance Research Group (GOERD), Faculty of Sports Science, University of Extremadura, 10003 Cáceres, Spain
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(7), 3749; https://doi.org/10.3390/app15073749
Submission received: 11 February 2025 / Revised: 24 March 2025 / Accepted: 27 March 2025 / Published: 29 March 2025
(This article belongs to the Special Issue Sports Performance: Data Measurement, Analysis, and Improvement)
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Versions Notes

Abstract

:
The menstrual cycle represents a fundamental biological rhythm in a woman’s life. This study aims to analyse the potential influence of the menstrual cycle on female athletic performance, specifically focusing on variations in body composition, muscle oxygen saturation, and post-exertion recovery. The sample consisted of a 21-year-old female athlete (a former elite-level basketball player), who performed a Bulgarian Split Squat test once a week throughout a complete menstrual cycle. In the data analysis, the menstrual cycle was verified using biological and hormonal markers, the coefficient of variation in muscle oxygen saturation was calculated, and visual inspection was employed to assess the observed curves. The results indicated minor variations in muscle mass (ranging from 38.8 kg to 40.4 kg) and fat mass (10.7 kg to 11.9 kg) across different phases of the cycle. Additionally, an increase in force production (4–5 repetitions increasing to 13–14) was observed, likely due to elevated oestrogen levels in the bloodstream. In conclusion, the menstrual cycle should be considered when designing training programmes for female athletes, ensuring an individualised approach that accounts for hormonal fluctuations and their impact on performance.

1. Introduction

The menstrual cycle (MC) is a complex physiological process involving interactions between the hypothalamus, pituitary gland, ovaries, and uterus to prepare the body for gestation. It is divided into the ovarian cycle, which consists of the follicular and luteal phases, and the endometrial cycle, which comprises the proliferative, secretory, and menstrual phases [1]. The complex feedback system that regulates the MC involves key hormones such as oestrogen (E2), progesterone (P4), pituitary gonadotrophins (follicle-stimulating hormone, FSH; luteinising hormone, LH) and the hypothalamic gonadotropin-releasing hormone (GnRH) [2].
As mentioned above, the MC itself is divided into the ovarian cycle, which is related to the maturation and release of the mature oocyte from the ovaries [2]; and the endometrial cycle, which parallels the ovarian cycle and describes the process of the endometrium throughout the cycle.
MC [1] consists of four hormonally regulated phases (Figure 1). It begins with the follicular phase (day 1–14, varying individually), where menstruation occurs, and GnRH stimulates FSH and LH release, promoting follicle growth. The follicles produce E2, thickening the endometrium. Around day 14, a dominant follicle triggers ovulation, releasing an egg. In the luteal phase, the corpus luteum forms, releasing E2 and P4, which suppress FSH and LH, while the endometrium matures into the secretory phase. If pregnancy does not occur, the hormone levels drop, the corpus luteum regresses, and the menstrual phase begins with the shedding of the endometrium, restarting the cycle.
The study of the MC in female athletes requires important methodological considerations. One of them is to verify the phase of the MC during the study [3]. The scientific literature often lacks objective verification of the menstrual cycle, frequently relying on subjective methods that do not account for ovulation or potential luteal phase deficiencies. The occurrence of non-ovulatory cycles and luteal phase deficiencies is often overlooked due to the reliance on calendar-based tracking and the first day of menstrual bleeding as primary indicators. However, it is crucial to accurately determine the phase of the cycle, as the presence of regular menstrual bleeding does not necessarily indicate normal hormone concentrations.
Throughout the menstrual cycle, women experience hormonal fluctuations that can influence physical, psychological, physiological, and biomechanical factors. Reproductive hormones play a significant role in metabolism, ventilation, immune function, and cardiovascular regulation [4]. These hormones vary in concentration throughout life and the MC. This unique characteristic means that a woman, over the years, may experience numerous hormonal profiles and is therefore a variable that requires complex methodological considerations to study [4].
In terms of motivation and subjective perception [5], E2 levels have been recognised as playing a protective role against low-mood states. Consequently, during phases of lower E2 concentration, negative emotions may be amplified. Additionally, female athletes often associate the menstrual phase with sensations of discomfort, pain, and mood disturbances.
Fluctuations in hormones during MCs seem to be linked to a heightened vulnerability to injuries, particularly during ovulation [6]. Additionally, the levels of laxity, neuromuscular control, and strength vary throughout the MC, reaching their peaks during the ovulatory phase and aligning with a peak in E2 levels [6].
However, scientific evidence to date has yielded inconclusive results regarding the effects of the MC on physical exercise. Some studies have suggested a correlation between enhanced peak anaerobic power and elevated blood E2 levels. In particular, these studies propose that peak power output is increased during the ovulatory phase, potentially enabling female athletes to perform better in repeated sprints.
This performance enhancement, purportedly influenced by E2, may be attributed to its rise during the late follicular phase. Alternatively, it could be supported by a concurrent increase in testosterone levels during ovulation [7]. Some authors defend the idea that the increase in E2 levels just before ovulation leads to an increase in muscle strength [8]. Furthermore, acceleration capacity has been shown to be one of the main variables affected by the MC [9].
The assessment of muscle group strength can be somewhat subjective as motor neuron recruitment may vary between data collection sessions. Consequently, the only way to minimise measurement error is to ensure maximum muscle contraction at each data collection point.
Furthermore, the study of body composition in relation to the MC in women remains a topic of debate within the scientific community. To fully capture the evolution of body composition over an ovarian cycle, daily measurements would be required. Nevertheless, even with such frequent assessments, substantial changes may not necessarily be detected.
Conversely, daily body weight measurements have indicated that the highest peak occurs between the late luteal phase and the early days of ovulation, with a secondary peak observed post-ovulation. Furthermore, a subsequent marked weight loss was recorded following these phases [10].
Regarding muscle oxygen saturation (SmO2), studies have shown that the SmO2 of the quadriceps muscle usually shows mean values of approximately 60% in men, while in women, it is around 50% [11,12]. As for the values related to the hamstring muscle, there have been no studies focused on SmO2 at rest. Currently, there are no studies that show a relationship between the MC and variation in quadriceps’ and hamstring muscle’s SmO2 during exercise.
The main objective of this study was to observe the behaviour of body composition, SmO2, and muscle recovery after intense effort throughout the different phases of the MC. In recent years, this field of study has gained increasing attention in sports science research as it is essential for improving training methods and enhancing competitive performance in female athletes. Notably, this study includes SmO2 as a variable, which, until now, has not been directly associated with the MC. As a result, the present work may serve as a pilot study in this line of research. Thus, the hypothesis proposed is that fluctuations occur in body composition, SmO2, and the post-exertion recovery curve in the muscle depending on the phase and timing of the MC in which the subject is assessed.

2. Materials and Methods

2.1. Experimental Approach to the Problem

This research employs a descriptive methodology of variables throughout a complete menstrual cycle (MC) [13]. Thus, from a sample perspective, it presents a case study that describes the individual behaviour of the subject over a cycle with respect to specific tests [13]. This approach can enhance collaboration between sports scientists and coaches to optimise the performance of female athletes [14].

2.2. Subjects

The population of the research was a 21-year-old former player (tier 2: trained/developmental [15]) of an elite Spanish basketball team before the investigation (171 cm of height; 53.4 kg of starting weight) (Table 1). Among the medical data to be considered for this study, it should be known that she has a regular MC.
A total of 76 cases were analysed over a four-week period, corresponding to one MC. The sample selection was purposive as it enabled the generation of adequate and meaningful data using the available cases while operating within limited research resources [16]. This is because the variables required for this study must be individualised, making it challenging to identify similarities within the sample. Nevertheless, the current sporting landscape often results in a relatively small number of athletes being analysed. However, this should not be seen as a limitation to the validity of the findings in such investigations [17]. This is why a case study was carried out.

2.3. Variables

The ovarian cycle hormone profile was used as the independent variable in this study. Two dependent variables were examined: (i) Quadriceps’ and hamstring muscle’s oxygen saturation (SmO2; %) in both the dominant and non-dominant leg: four near-infrared spectroscopy (NIRS) sensors (MOXY, Fortiori Design LLC, Hutchinson, MN, USA) were placed in direct contact with the skin using a 5 cm cohesive band. SmO2 percentages and saturation curves were obtained by processing raw data in SPRO software 1.0.0 (Hudl, Nebraska, USA). (ii) Segmented body composition (kg; %): the participant was assessed using an electrical bioimpedance monitor (MC-780MA model; TANITA, Tokyo, Japan) before each measurement.

2.4. Procedure

Once the study design was finalised and approved by the Bioethics and Biosafety Committee of the local university (22/2023), the participant was provided with an informed consent form, which she was required to read and sign. Additionally, the benefits and risks associated with this study were explained in detail. At the time of the investigation, the participant was in mid-season and continued with her regular daily activities and diet throughout this study.
Serum concentrations of oestradiol (E2), progesterone (P4), luteinising hormone (LH), and follicle-stimulating hormone (FSH) were measured (blinded to researchers) using a chemiluminescent immunoassay (CLIA) on an automated analyser (Cobas e411 model, Roche Diagnostics, Mannheim, Germany). The samples were processed in a private clinical chemistry laboratory, following the manufacturer’s standard operating procedures.
After familiarisation with the protocol, weekly measurements were conducted throughout an entire MC, ensuring consistency by maintaining the same day of the week and time of day as a control variable. This approach effectively minimised the potential influence of fluid fluctuations within the body. On each measurement day, the participant underwent a segmented body composition analysis (MC-780MA model, TANITA, Tokyo, Japan), followed by the placement of four NIRS sensors (MOXY, Fortiori Design LLC, Hutchinson, MN, USA) on the thighs to obtain SmO2 data. The participant then changed into a sports suit specifically designed for the study.
After initial preparation, a general warm-up was performed, including mobility exercises and five minutes on a stationary bike at moderate–low intensity (50–60% of maximum heart rate). Before starting the specific warm-up for the Bulgarian Split Squat, bench height and leg positioning were verified according to the test protocol. The participant then performed progressive sets to approach the correct weight, ensuring proper technique and optimising the setup of the inertial devices.
The Bulgarian Split Squat (BSS) test was performed using a Smith machine, a 20 kg Olympic barbell, and a 47 cm high bench. The support leg was positioned 53 cm from the bench. The participant completed as many repetitions as possible until muscle failure, starting with the dominant leg, followed by the non-dominant leg. The number of repetitions was recorded, and the participant walked for one minute to assess active muscle recovery after strenuous exercise, adapted from [18,19].

2.5. Statistical Analysis

First, the results obtained from the blood tests were compared with normative values to determine the phase of the menstrual cycle (MC) in which the sample was at each measurement point. Subsequently, body composition values were assessed separately for each measurement taken throughout the MC. A descriptive statistical analysis was conducted using the mean and standard deviation, which were then related to the different phases of the MC. Next, the coefficient of variation (CV) in muscle recovery following muscle failure was calculated at five distinct time intervals: 0–10 s, 10–20 s, 20–30 s, 30–40 s, and 40–50 s [20]. Finally, the SmO2 variable curve was generated for each of the participating muscles during the test for visual analysis [21] and, subsequently, a descriptive analysis of that was carried out. SmO2 analysed data were obtained from SPRO software 1.0.0 (Hudl, Nebraska, USA), which shows the behaviour curves of the variable on the muscle that was measured.

3. Results

3.1. Verification of the Menstrual Cycle

Table 2 presents the results of the blood analysis conducted before (pre-test) and after (post-test) this study. These values confirmed that the participant commenced the protocol during the follicular phase of the menstrual cycle (MC), based on normative values. Furthermore, the onset of menstrual bleeding indicated that the first measurement was taken on day 0 of the cycle. The second analysis confirmed that the protocol concluded during the luteal phase of the MC, verifying the accurate execution of the protocol with measurements taken in each phase of the MC.

3.2. Body Composition

Table 3 presents the values obtained from the measurements of various body composition variables in the participants. These values indicate relatively minor differences between phases; however, it can be observed that total lean mass is higher during the follicular and ovulatory phases, while it decreases during the luteal phase and menstruation. Conversely, the values related to the dominant and non-dominant leg exhibit minimal variation.

3.3. Lower Body Power Production

The results obtained with respect to the repetitions performed by the participant in the different Bulgarian Split Squad (BSS) tests are shown in Table 4. These values show how the number of repetitions performed increases as the MC progresses. Furthermore, the dominant leg obtains higher values, except in the luteal phase, where the result is the same for both legs.

3.4. Muscle Oxygen Saturation

3.4.1. Post-Exercise Muscle Oxygen Saturation Recovery

The results obtained from calculating the coefficient of variation in the double moving average for muscle oxygen saturation (SmO2) during the one-minute recovery period indicated that the right quadricep muscle maintained stable recovery during the follicular and ovulatory phases but exhibited greater variability during the luteal phase following muscular failure (Figure 2a). The left quadriceps demonstrated highly inconsistent recovery throughout the menstrual cycle, with high coefficient of variation (CV) values observed during menstruation and the ovulatory phase (Figure 2a).
Figure 2b illustrates that the right hamstring muscle displayed high CV values during the luteal phase, similar to the right quadriceps, while showing minimal variation on the other measurement days. In contrast, the left hamstring exhibited the greatest variation during menstruation (similar to the left quadriceps), whereas variability was minimal during the other phases of the menstrual cycle (Figure 2b).

3.4.2. Dynamic Behaviour of Muscle Oxygen Saturation

As shown in Figure 3, Figure 4, Figure 5 and Figure 6, the curves generated using the SPRO software 1.0.0 (Hudl, Lincoln, NE, USA) illustrate the behaviour of the right quadriceps, right hamstring, left quadriceps and left hamstring during the execution of the Bulgarian Split Squat (BSS). The initial section of each figure represents the BSS test performed until muscular failure, followed by a one-minute recording of active recovery.
By analysing these curves, it is evident that, in most cases, the trend during the test is descending, with the lowest values occurring just before the one-minute recovery mark. Conversely, at the onset of active recovery, the trend shifts to an upward trajectory. This pattern remains consistent across all weeks.
The SmO2 curves for the right quadriceps during the Bulgarian Split Squat (BSS) test and one-minute recovery exhibit distinct patterns across the menstrual cycle phases (see Figure 3). During menstruation (Figure 3A), the initial SmO2 level is high, followed by a gradual decline throughout the test, reaching its lowest point just before recovery, which then follows a steady upward trend. In the follicular phase (Figure 3B), the initial SmO2 is lower compared to menstruation, and the decline during the test is more irregular, with fluctuations before reaching the minimum value. The recovery phase remains relatively stable before increasing towards the end. During ovulation (Figure 3C), the SmO2 starts at an intermediate value, followed by a sharp decline during the test and a smooth recovery phase. In contrast, the luteal phase (Figure 3D) shows a different pattern, with an initial slight increase in SmO2 before a pronounced drop during the test. The recovery phase demonstrates a rising trend, though the increase is less steep compared to other phases.
Referring to Figure 4, the curves illustrate the muscular behaviour of the right hamstring during the execution of the Bulgarian Split Squat (BSS) test and the subsequent minute of active recovery.
The SmO2 curves for the right hamstring also display phase-dependent variations during the BSS test and recovery period. During menstruation (Figure 4A), SmO2 starts at a relatively high level and decreases steadily throughout the test, reaching a low point before initiating a gradual recovery. In the follicular phase (Figure 4B), the SmO2 starts at a higher value than in menstruation, with a sharp decline occurring during the test, followed by a fluctuating yet increasing recovery trend. The ovulatory phase (Figure 4C) presents a similar pattern, with an initial moderate SmO2 level, a rapid decline during the test, and a pronounced recovery. The luteal phase (Figure 4D) displays the lowest initial SmO2 values, with a steep drop during the test leading to the lowest recorded SmO2 levels among all phases. However, the recovery phase shows a rapid increase, following a steeper trajectory compared to the other phases.
In Figure 5, the curves illustrate the response of the left quadriceps during the BSS test performed on the left leg.
The SmO2 curves for the left quadriceps during the Bulgarian Split Squat (BSS) test and one-minute recovery exhibit phase-dependent differences across the menstrual cycle. During menstruation (Figure 5A), the initial SmO2 level is high and remains stable for a period before experiencing a sharp decline during the test. The recovery phase follows a smooth upward trend. In the follicular phase (Figure 5B), the SmO2 starts at a lower value than in menstruation, and while it declines during the test, the curve presents fluctuations rather than a continuous drop. Recovery is gradual, showing an increasing trend over time. During ovulation (Figure 5C), the SmO2 begins at an intermediate level, followed by a steep decrease throughout the test, reaching a distinct low point. The recovery phase exhibits a steady upward trajectory. In contrast, the luteal phase (Figure 5D) shows a sharp SmO2 decline during the test with additional fluctuations near the lowest point, followed by an increase during recovery that stabilises over time.
Regarding the behaviour of the left hamstring muscle (Figure 6), SmO2 curves also display noticeable variations during the BSS test and recovery period depending on the menstrual cycle phase. During menstruation (Figure 6A), SmO2 begins at a high level and declines steadily throughout the test, reaching a low point before a gradual increase in the recovery phase. In the follicular phase (Figure 6B), the SmO2 starts at a slightly lower value and exhibits fluctuations before a sharp decline during the test, followed by a continuous increase in the recovery phase. The ovulatory phase (Figure 6C) presents an initial moderate SmO2 level, followed by a steep decline during the test and a gradual increase in recovery. In the luteal phase (Figure 6D), the SmO2 starts at a higher level than in the previous phases but experiences a pronounced drop during the test. However, the recovery phase shows a relatively smooth and sustained increase, with SmO2 values nearly returning to baseline.

4. Discussion

The aim of this study was to examine the potential influence of the menstrual cycle (MC) on variations in body composition, performance, and fatigue in female athletes. Notably, this research introduces a novel area of study in the field of sports science and women’s physiology, as no prior studies have investigated the relationship between muscle oxygen saturation (SmO2) and the MC. Furthermore, the application of near-infrared spectroscopy (NIRS; MOXY, Fortiori Design LLC, Hutchinson, MN, USA) offers a valuable tool for analysing oxygen consumption and recovery curves in various contexts [22], thereby contributing to the optimisation of training strategies for female athletes.
This study identified an increase in muscle mass and a reduction in fat mass during the follicular and ovulatory phases. Previous research suggests that elevated levels of oestrogen (E2) and progesterone (P4) in female athletes may contribute to increased muscle mass and muscle diameter [23,24], as well as enhanced muscle strength [25]. In one of the scarce interventions where hormonal milieu was taken into consideration [26], higher trainability of strength was found regarding the phase of the cycle, showing a wide inter-individual variability in all subjects. This effect is mainly dependent of the variations in steroid hormone levels during the cycle and their potential impact on protein synthesis. In fact, the significant decrease in muscle strength occurs during the perimenopausal and postmenopausal stages (24), when hormones must be replaced to maintain strength levels.
Notably, the highest peak of repetitions observed in this study occurred during the ovulatory phase, coinciding with the peak levels of both hormones. Furthermore, this phase was associated with greater muscle mass in both legs and a higher total muscle percentage.
Additionally, increased levels of motivation have been reported during ovulation compared to the follicular and luteal phases, whereas the most negative sensations were recorded in the late luteal phase, corresponding to the premenstrual period [5]. This association may partly explain the greater capacity for exertion and, consequently, the increased strength output observed. However, a recent study has indicated that there are no significant differences in the rate of perceived exertion (RPE) in strength-related tasks across different menstrual cycle phases [27].
A deep reflection on the behaviour of both legs during the BSS test shows that both muscles work in a similar manner throughout the cycle, except during the luteal phase. In this phase, the hamstrings exert a similar effort to that of the other phases, whereas the quadriceps barely lose saturation. This could suggest that they are scarcely engaged during the effort and, consequently, the agonist muscles would be more exposed to the load, potentially leading to greater fatigue.
This occurrence correlates with studies that observe asymmetries during the luteal phase due to increased laxity [28,29]. The rise in progesterone may lead to poorer performance in maximal efforts, resulting in an increased risk of injuries.
The non-dominant leg demonstrates greater variability in recovery during the menstruation phase, whereas the dominant leg exhibits more pronounced fluctuations during the luteal phase. The poorest performance is expected to occur in the late luteal and early follicular phases due to significant variations in E2 and P4 levels [30]. This may be associated with a slight reduction in total muscle mass and an increase in fat mass. However, muscle strength production is primarily dependent on the recruitment and firing capacity of motor units. On the other hand, there are also studies mentioning that the muscle exhibits a higher fatigue ratio during menstruation compared to the follicular and luteal phases [31]. Conversely, some studies suggest that muscle experiences a higher fatigue ratio during menstruation relative to the follicular and luteal phases [32]; however, this trend is not reflected in the SmO2 curves observed in this study. Mechanisms underlying the development of fatigue during exercise are complex and depend on exercise modality [33]. Aerobic- and anaerobic-based training have different implications in athlete response. Although speculative, SmO2 results may behave different in the MC because of its relation to aerobic capacity and the tests being anaerobic. More research is needed in this direction.
As a summary, the findings of this pilot study highlight the influence of the menstrual cycle on various physiological and performance-related parameters in female athletes. As illustrated in Figure 7, fluctuations in E2 and P4 levels appear to be associated with distinct variations in muscle composition, power output, recovery, and asymmetries. During the P4 peak (typically the luteal phase), an increase in recovery variability was observed, accompanied by a decrease in the muscle-to-fat mass ratio and an increase in SmO2 asymmetries, suggesting a phase where muscular function and oxygen saturation distribution may be less stable. Conversely, during the E2 peak (typically the ovulatory phase), muscle mass asymmetries and the muscle-to-fat mass ratio were elevated, indicating improved muscle development and potential strength benefits. However, this phase also demonstrated a decrease in power production, which may influence performance outcomes. These findings suggest that menstrual cycle fluctuations should be considered when designing training programmes for female athletes, particularly in optimising strength and recovery strategies throughout different phases of the cycle.
To the best of our knowledge, no studies have yet examined the relationship between the menstrual cycle and SmO2 curves of the quadriceps and hamstrings at rest and during exertion. Therefore, the protocol developed in this study may serve as a reference for the assessment and measurement of muscle oxygen saturation capacity in a broader population of female athletes across their individual menstrual cycles.
This study has some limitations. First, diet and sleep were not strictly controlled, which may have influenced body composition, performance, and muscle recovery. Future studies should standardise these factors. Additionally, it is important to highlight in the study of this case a significant asymmetry between both hemispheres, as well as possible muscular imbalances.
Some studies suggest that research on the menstrual cycle yields inconclusive results due to small sample sizes and the high degree of individual variability in study populations [34]. However, these reviews primarily consider articles published before 2009, and more recent advancements in methodologies and instrumentation may have enhanced the accuracy of such investigations. Notably, this study utilised near-infrared spectroscopy (NIRS; MOXY, Fortiori Design LLC, Hutchinson, MN, USA) and electrical bioimpedance analysis (MC-780MA model; TANITA, Tokyo, Japan), enabling the precise measurement of body composition and SmO2 fluctuations across different phases of the menstrual cycle.

5. Conclusions

The menstrual cycle is a key variable to consider in physical exercise and strength training for women. However, its influence is highly individualised, making it unadvisable to apply uniform training programs across different athletes.
Our findings indicate that muscle mass, strength, and exertion capacity tend to increase during the follicular and ovulatory phases, potentially due to higher oestrogen and progesterone levels. Moreover, muscle oxygen saturation and recovery capacity were found to be superior in the ovulatory phase compared to the follicular phase. Notably, the non-dominant leg exhibited greater variability in recovery during menstruation, whereas the dominant leg showed more fluctuations during the luteal phase, suggesting phase-specific physiological adaptations.
Although these findings may not be directly extrapolated to all individuals, this study serves as a pilot to develop new methodologies for assessing menstrual cycle-related performance variations. Recognising the individualised effects of the menstrual cycle is crucial for optimising training in female athletes. Future research should continue exploring the relationship between the menstrual cycle, body composition, muscle oxygenation, and post-exertion recovery, ensuring evidence-based strategies to enhance female athletic performance.

6. Practical Applications

Based on the findings of this study, it is advisable to consider a series of key recommendations to design an individualised and specific training programme tailored to the athlete:
  • The observed relationship between improvements in anaerobic peak power and increased oestrogen levels in the blood suggests that intensive anaerobic power training should be prioritised during the ovulatory phase to maximise performance.
  • Within the athlete’s menstrual cycle, maximal strength training is recommended during the preovulatory phase as this period is characterised by a significant rise in oestrogen levels, which may enhance strength adaptations.
  • The development of new methodologies for menstrual cycle assessment should be encouraged, aiming to enhance specificity in female athlete evaluations and facilitate the individualisation of training programmes.

Author Contributions

Conceptualisation, A.M.-S. and J.G.-R.; Formal Analysis, A.M.-S. and J.G.-R.; Investigation, A.M.-S. and A.C.-R.; Methodology, J.G.-R.; Project Administration, S.J.I.; Resources, S.J.I.; Supervision, S.J.I. and J.G.-R.; Writing—Original Draft, A.M.-S.; Writing—Review and Editing, A.C.-R. and J.G.-R. All authors have read and agreed to the published version of the manuscript.

Funding

This research has been partially subsidised by the Aid for Research Groups (GR21149) from the Regional Government of Extremadura (Department of Economy, Science and Digital Agenda), with a contribution from the European Union from the European Funds for Regional Development and the Spanish National Agency of Investigation through the project “Scientific and Technological Support to analyse the Training Workload of Basketball teams according to sex, level of the players and season period” (PID2019-106614GBI00). The author A. M.-S. was supported with a grant by the Valhondo Calaff Foundation (Caceres, Spain).

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Universidad de Extremadura (No. 22/2023).

Informed Consent Statement

Informed consent was obtained from the subject involved in this study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 15 03749 g001
Figure 1. Representation of the different phases of the normal menstrual cycle, illustrating the variation in hormone levels of oestrogen (E2), luteinising hormone (LH), follicle-stimulating hormone (FSH) and progesterone (P4). Figure made with the influence of Julie Kissow, Kamine J. Jacobsen, Thomas P. Gunnarsson, Søren Jessen and Morten Hostrup.
Figure 1. Representation of the different phases of the normal menstrual cycle, illustrating the variation in hormone levels of oestrogen (E2), luteinising hormone (LH), follicle-stimulating hormone (FSH) and progesterone (P4). Figure made with the influence of Julie Kissow, Kamine J. Jacobsen, Thomas P. Gunnarsson, Søren Jessen and Morten Hostrup.
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Figure 2. Evolution of the coefficient of variation (CV) of SmO2 during the minute of active recovery in: (a) above, the right quadriceps during the right Bulgarian Split Squat (BSS); below, the left quadriceps during the left BSS. (b) Above, the right hamstring during the right BSS; below, the left hamstring during the left BSS. F.P. (follicular phase); O.P. (ovulation phase); and L.P. (luteal phase).
Figure 2. Evolution of the coefficient of variation (CV) of SmO2 during the minute of active recovery in: (a) above, the right quadriceps during the right Bulgarian Split Squat (BSS); below, the left quadriceps during the left BSS. (b) Above, the right hamstring during the right BSS; below, the left hamstring during the left BSS. F.P. (follicular phase); O.P. (ovulation phase); and L.P. (luteal phase).
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Figure 3. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the right quadriceps during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
Figure 3. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the right quadriceps during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
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Figure 4. Curves obtained from the SPRO 1.0.0 software (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the right hamstring during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
Figure 4. Curves obtained from the SPRO 1.0.0 software (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the right hamstring during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
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Figure 5. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the left quadriceps during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
Figure 5. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the left quadriceps during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
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Figure 6. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the left hamstring during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
Figure 6. Curves obtained from the SPRO software 1.0.0 (Hudl, Nebraska, USA) depicting the evolution of muscle oxygen saturation (SmO2) in the left hamstring during the execution of the Bulgarian Split Squad (BSS) test: (A) menstruation; (B) follicular phase; (C) ovulatory phase; (D) luteal phase.
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Figure 7. Summary of the main findings of this study regarding the influence of the menstrual cycle on muscle function, body composition, and performance variables.
Figure 7. Summary of the main findings of this study regarding the influence of the menstrual cycle on muscle function, body composition, and performance variables.
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Table 1. Data on the segmented body composition of the sample obtained by means of the MC-780MA electrical bioimpedance monitor (TANITA, Tokyo, Japan).
Table 1. Data on the segmented body composition of the sample obtained by means of the MC-780MA electrical bioimpedance monitor (TANITA, Tokyo, Japan).
TLM 1TFM 2DLLM 3NDLLM 4
kg%kg%kg%kg%
39.573.9711.8022.106.8017.206.6016.70
1 Total lean mass; 2 total fat mass; 3 dominant-leg lean mass; 4 non-dominant-leg lean mass.
Table 2. Values obtained regarding hormonal levels in the blood analytical test performed on the subject at two different time points.
Table 2. Values obtained regarding hormonal levels in the blood analytical test performed on the subject at two different time points.
E2 1FSH 2LH 3P4 4
pg/mLpg/mLmUl/mLng/mL
Pre-test127.04.518.76.15
Post-test376.01.710.019.90
1 Oestrogen; 2 follicle-stimulating hormone; 3 luteinising hormone; 4 progesterone.
Table 3. Body composition values obtained through electrical bioimpedance (MC-780MA; TANITA, Tokyo, Japan).
Table 3. Body composition values obtained through electrical bioimpedance (MC-780MA; TANITA, Tokyo, Japan).
WeightTLM 1TFM 2DLMM 3NDLMM 4
kgkgkgkg%kg%
Menstruation53.439.511.806.8017.206.6016.70
Follicular phase53.440.410.806.8016.806.7016.60
Ovulation phase53.340.410.706.9017.106.7016.60
Luteal phase53.438.811.906.8016.806.7016.60
1 Total lean mass; 2 total fat mass; 3 dominant-leg muscle mass; 4 non-dominant-leg muscle mass.
Table 4. Repetitions of the Bulgarian Split Squad (BSS) test during this study.
Table 4. Repetitions of the Bulgarian Split Squad (BSS) test during this study.
MenstruationF.P. 1O.P. 2L.P. 3
Dominant Leg951419
Non-dominant Leg841319
1 Follicular phase; 2 ovulation phase; 3 luteal phase.
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MDPI and ACS Style

Martínez-Sánchez, A.; Campos-Redondo, A.; Ibáñez, S.J.; García-Rubio, J. Oxygen, Hormones, and Performance: A Case Study of Menstrual Cycle Effects on Athletic Physiology. Appl. Sci. 2025, 15, 3749. https://doi.org/10.3390/app15073749

AMA Style

Martínez-Sánchez A, Campos-Redondo A, Ibáñez SJ, García-Rubio J. Oxygen, Hormones, and Performance: A Case Study of Menstrual Cycle Effects on Athletic Physiology. Applied Sciences. 2025; 15(7):3749. https://doi.org/10.3390/app15073749

Chicago/Turabian Style

Martínez-Sánchez, Almudena, Amalia Campos-Redondo, Sergio J. Ibáñez, and Javier García-Rubio. 2025. "Oxygen, Hormones, and Performance: A Case Study of Menstrual Cycle Effects on Athletic Physiology" Applied Sciences 15, no. 7: 3749. https://doi.org/10.3390/app15073749

APA Style

Martínez-Sánchez, A., Campos-Redondo, A., Ibáñez, S. J., & García-Rubio, J. (2025). Oxygen, Hormones, and Performance: A Case Study of Menstrual Cycle Effects on Athletic Physiology. Applied Sciences, 15(7), 3749. https://doi.org/10.3390/app15073749

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