FEMALE ATHLETES AND MENSTRUAL CYCLE MANAGEMENT IN ENDURANCE SPORTS

WOMEN | 07/08/2025 | 08:20
di Francesca Monzone

Contraceptive pills and IUDs are increasingly used in high-level women's sports not only to mitigate negative menstrual cycle effects but also to leverage hormonal peaks that can improve physical performance.


This is not doping, let's be clear from the start, but simply paying attention to and using the hormonal changes - testosterone and progesterone in particular - that occur in the female body during the 28-day menstrual cycle. These changes can sometimes even be comparable to the effects of high-altitude training.


Hormonal fluctuations are an integral part of female physiology, and ignoring them means overlooking an essential aspect of their athletic reality. For years, specialized doctors have been helping athletes maximize their hormonal potential while staying within anti-doping regulations.

For example, more and more athletes are opting for hormonal IUDs. Studies conducted in France and Belgium have shown that this device offers several physiological advantages, provided it is adequately supervised by a doctor. First, menstruation is eliminated in 8 out of 10 women, limiting iron loss. Consequently, hemoglobin levels - the molecule that transports oxygen in the blood - can naturally increase by up to one gram, improving endurance. This effect is entirely natural and permitted, but not negligible, and is comparable to high-altitude training effects, sometimes even better.

As we've seen, heavy menstruation leads to a physiologically normal iron deficiency in the blood, which is a significant disadvantage for an athlete and must be controlled.

Even a minimal iron loss during menstruation can affect muscle oxygenation. To limit these effects, some athletes opt for contraceptive pills that help regulate or reduce menstruation. However, studies among athletes demonstrate that not all pills have the same effect, and thus a slight anabolic effect can be leveraged.

There are contraceptive medications with slightly higher anabolic effects compared to others, but they pass anti-doping controls if their therapeutic use is mentioned. Anabolic dosages remain quite low, but any effect on the organism is justified and permitted.

Obviously, it must be remembered that each case is unique, and the pill is not suitable for all women. Before taking it, specific tests must be done to check for genetic alterations in blood coagulation, a high-risk factor for all women using contraceptives.

Analyzing and understanding one's menstrual cycle is a true performance enhancement for athletes, and today many specialized doctors are convinced that menstrual cycle control should become a routine for every athlete.

In conclusion, the menstrual cycle can become a performance or poor performance factor in sports, particularly in endurance disciplines like cycling. Intense physical activity interrupts the hormonal cycle with multiple risks such as stress fractures, loss of concentration that can even lead to depression and inferior performance. Conversely, when the cycle is regular, during the ovulation phase that occurs almost always 14 days before the next cycle, there's a surge of estrogen and progesterone, and also testosterone, which can have a significant impact on physical fitness.

This aspect is so important that in some sports like wrestling, swimming, or tennis, athletes manage their cycle to have that hormonal peak at a specific moment, such as an important competition.

We want to emphasize that all of this is absolutely legitimate but must always be monitored by specialized doctors who, first and foremost, are concerned with the athlete's health.


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