Effects of Female Reproductive Hormones on Performance, Injury Risk, and Recovery: Implications for Evidence-Based Practice
DOI:
https://doi.org/10.12775/QS.2026.56.72577Keywords
menstrual cycle, female athletes, athletic performance, ACL injury, recovery, hormonal contraceptionAbstract
Background. Women's participation in sport has grown substantially, yet female athletes remain underrepresented in sport science research, with much of the existing evidence derived from male populations. Fluctuations of estrogen and progesterone across the menstrual cycle, together with widespread use of hormonal contraceptives, are increasingly recognised as factors that may influence athletic outcomes.
Aim. To synthesise current evidence on the effects of female reproductive hormones on athletic performance, injury risk, and recovery, and to translate it into practical, individualised recommendations for coaches, practitioners, and athletes.
Methods. PubMed was searched for systematic reviews, meta-analyses, and original studies on the menstrual cycle, hormonal contraceptives, and athletic outcomes.
Results. Group-level effects of menstrual cycle phase on objective performance outcomes such as strength, power, and endurance are generally small and inconsistent. Evidence linking cycle phase to anterior cruciate ligament injury risk is suggestive but limited by methodological heterogeneity, whereas hormonal contraceptive use does not appear to be protective against musculoskeletal injuries. Outcomes related to recovery appear more sensitive to hormonal context than objective performance measures, with recent evidence converging on menstrual symptom burden as a predictor of disturbed recovery in female athletes.
Conclusions. Female reproductive hormones influence multiple physiological systems relevant to sport, but their effects on athletic outcomes are predominantly individual rather than uniform. The strongest evidence-based approach for supporting female athletes combines individualised, symptom-led monitoring with established principles of training periodisation, injury prevention, and athlete education. Progress in this field will depend on longitudinal research with biochemical phase verification and a focus on individual response patterns.
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Copyright (c) 2026 Aleksandra Malcher, Zuzanna Zofia Kamińska, Agnieszka Zielińska, Igor Zydlewski, Aleksandra Jakimowicz, Martyna Pacanowska-Trawnicka, Martyna Mrozek, Małgorzata Blecharczyk
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