Menstruation affects the physical ability of women to perform blue-collar work
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Systematic reviews report mixed findings regarding the impact of the menstrual cycle on physical performance, showing trivial or inconsistent effects on strength and aerobic output while noting that some women experience perceived performance declines or pain affecting working ability.
<h4>Background</h4>Concentrations of endogenous sex hormones fluctuate across the menstrual cycle (MC), which could have implications for exercise performance in women. At present, data are conflicting, with no consensus on whether exercise performance is affected by MC phase.<h4>Objective</h4>To determine the effects of the MC on exercise performance and provide evidence-based, practical, performance recommendations to eumenorrheic women.<h4>Methods</h4>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for published experimental studies that investigated the effects of the MC on exercise performance, which included at least one outcome measure taken in two or more defined MC phases. All data were meta-analysed using multilevel models grounded in Bayesian principles. The initial meta-analysis pooled pairwise effect sizes comparing exercise performance during the early follicular phase with all other phases (late follicular, ovulation, early luteal, mid-luteal and late luteal) amalgamated. A more comprehensive analysis was then conducted, comparing exercise performance between all phases with direct and indirect pairwise effect sizes through a network meta-analysis. Results from the network meta-analysis were summarised by calculating the Surface Under the Cumulative Ranking curve (SUCRA). Study quality was assessed using a modified Downs and Black checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group.<h4>Results</h4>Of the 78 included studies, data from 51 studies were eligible for inclusion in the initial pairwise meta-analysis. The three-level hierarchical model indicated a trivial effect for both endurance- and strength-based outcomes, with reduced exercise performance observed in the early follicular phase of the MC, based on the median pooled effect size (ES<sub>0.5</sub> = - 0.
Objective To determine the effects of the MC on exercise performance and provide evidence-based, practical, performance recommendations to eumenorrheic women. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for published experimental studies that investigated the effects of the MC on exercise performance, which included at least one outcome measure taken in two or more defined MC phases. All data were meta-analysed using multilevel models grounded in Bayesian principles.
Background Over the last three decades, there has been a rise in the number of women participating in exercise, from physical activity to elite sport, attributable to the increasing development of, and investment in, women’s professional sport [ 1 – 4 ]. Specifically, the percentage of women competing at the Olympic Games has increased from 26% in Seoul in 1988 to 45% in Rio de Janeiro in 2016 [ 5 ]. Furthermore, Tokyo 2021 is set to be the most sex-balanced Games in history, with the same number of medals available for men and women, which is projected to see women participation in the Games rise to 49% [ 5 ].
Although the primary function of these hormones is to support reproduction, research has highlighted that the changing concentrations of oestrogen and
Study Inclusion and Exclusion Criteria Consideration of Population, Intervention, Comparator, Outcomes and Study design (PICOS) was used to determine the parameters within which the review was conducted: Population Participants included healthy women who were (a) between the ages of 18 and 40 years; (b) eumenorrheic; (c) not taking any hormonal contraceptives or medication known to affect the hypothalamic–pituitary–ovarian (HPO) axis; (d) free from any menstrual-related dysfunctions (such as, amenorrhea) or any other conditions (e.g., pregnancy, eating disorders or disordered eating) known to affect the HPO axis; and (e) free from any injury that would affect participation.
The relative size of nodes and relative thickness of connecting lines illustrate the frequency of outcomes measured in a given menstrual cycle phase and the number of direct comparisons between two phases, respectively Table 1 Summary of network meta-analysis results from 73 studies using the early follicular phase as a reference Comparison to early follicular phase Effect size [95% CrI] SUCRA (%) Early follicular − 30 Late follicular − 0.14 [− 0.26 to − 0.03] 54 Ovulation − 0.07 [− 0.15 to 0.07] 55 Early luteal − 0.07 [− 0.19 to 0.16] 54 Mid-luteal − 0.04 [− 0.11 to 0.08] 55 Late luteal − 0.01 [− 0.18 to 0.17] 53 Negative values for effect sizes favour all other menstrual cycle phases (late follicular, ovulation, early luteal, mid-luteal and late luteal) compared to the early follicular phase SUCRA the surface under the cumulative ranking curve, CrI credible intervals Discussion The aim of this review was to examine if MC phase affects exercise performance in eumenorrheic women.
Further, oestrogen is thought to have neuroexcitatory effects, whereby it reduces inhibition and increases voluntary activation [ 19 ]. Therefore, when oestrogen rises during the late follicular and ovulatory phases and remains elevated in the mid-luteal phase, it is plausible that this might affect muscular performance [ 24 , 25 ] or maximal and submaximal intensity exercise performance [ 26 ].
These recommendations echo recent publications in the area of women’s physiology [ 10 , 17 ], demonstrating an increasing awareness for the nuances of this type of research, and collectively provide researchers with ample tools to make methodological decisions for future investigations. To limit the influence of low quality papers on the analyses, a sensitivity analysis was conducted with data obtained from studies that were classified as either “moderate” or “high” in quality [ 19 , 27 , 31 , 35 , 37 , 54 , 57 , 58 , 67 , 71 , 75 , 85 , 90 , 99 , 106 , 115 ].
<h4>Objectives</h4>To systematically review the current body of research that has investigated changes in strength-related variables during different phases of the menstrual cycle in eumenorrheic women.<h4>Design</h4>Systematic review and meta-analysis.<h4>Methods</h4>A literature search was conducted in Pubmed, SPORTDiscus and Web of Science using search terms related to the menstrual cycle and strength-related measures. Two reviewers reached consensus that 21 studies met the criteria for inclusion. Methodological rigour was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Random effects meta-analyses were used to compare the early-follicular, ovulatory and mid-luteal phases for maximal voluntary contraction, isokinetic peak torque, and explosive strength.<h4>Results</h4>The assessment of study quality showed that a high level of bias exists in specific areas of study design. Non-significant and small or trivial effect sizes (p≥0.26, Hedges g≤0.35) were identified for all strength-related variables in each comparison between phases. 95% confidence intervals for each comparison suggested the uncertainty associated with each estimate extends to a small effect on strength performance with unclear direction (-0.42≤g≤0.48). The heterogeneity for each comparison was also small (p≥0.83, I<sup>2</sup>=0%).<h4>Conclusions</h4>Strength-related measures appear to be minimally altered (g≤0.35) by the fluctuations in ovarian sex hormones that occur during the menstrual cycle. This finding should be interpreted with caution due to the methodological shortcomings identified by the quality assessment.
The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies.
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/ ). Abstract The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women’s sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population.
Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors.
Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies. Keywords: sport, menstruation, female status released display-pdf yes is-olf no is-manuscript no is-preprint no is-journal-matter no is-scanned no is-retracted no Received 2020 Dec 23; Accepted 2021 Feb 5; Issue date 2021 Feb. 1.
Approximately 67%- 91% of elite female athletes are eumenorrheic [ 14 , 15 ] and about half of eumenorrheic athletes do not use HC [ 16 , 17 ]. This suggests that a considerable proportion of female athletes may experience cyclic hormonal fluctuations. 1.2. Proposed Mechanisms behind Menstrual Cycle Based Changes in Performance Physical performance has been postulated to change over the course of a MC due to various mechanisms, such as altered muscle activation, substrate metabolism, thermoregulation and body composition. Female sex hormone concentrations could be responsible for altered force production; this may affect muscle strength and power.
It was proposed that the increased basal body temperature in the luteal phase could enhance short duration performance;
Given the increasing use of MC monitoring in applied sport science settings, it is important that there is high-quality research to inform the best-practice guidelines for whether and how training, nutrition or recovery programs should be modified based on MC phase. 2. Aim of Narrative Review Two recent extensive systematic reviews and meta-analyses have examined the effect of MC phase on physical performance.
Effects of MC Phase on Aerobic Performance Six studies [ 53 , 88 , 91 , 92 , 104 , 109 ] demonstrated MC phase differences in aerobic exercise performance or applied physiological outcomes related to aerobic performance; two studies found some outcomes were affected by MC phase while others were unaffected [ 52 , 90 ], and the majority of studies ( n = 14) concluded MC phase had no affect [ 46 , 52 , 54 , 86 , 87 , 93 , 96 , 97 , 98 , 105 , 107 , 108 , 110 , 111 ].
Overall Impact of Menstrual Cycle Phase on Physical Performance The trivial effect of MC phase on performance observed in previous systematic reviews [ 5 , 67 ] is understandable as the findings from this narrative review are mixed, with 20 of the 35 relevant studies concluding that MC did not produce significant improvements or impairments to physical performance, and 15 studies finding that at least one outcome was affected by MC phase.
Further research on athletes’ performance in hot environments is necessary as many athletes are required to perform outdoors, in varying environmental conditions. Some studies have assessed lower body power, using tests such as countermovement jumps, which is correlated with agility in male athletes [ 129 ]. No studies included in this review have measured agility over the MC, despite agility being a significant performance determinant in field-based team sports [ 130 , 131 ].
Many studies have concluded that performance does not vary between MC phases. In the studies that did observe a MC effect to performance, there were inconsistencies in findings but strength and aerobic performance were most commonly reported to be impaired during the late luteal phase, and anaerobic performance was most frequently reduced in the late follicular phase. With regards to perceived performance, the late luteal phase was also one of the phases athletes perceived their performance declined [ 75 , 76 ]. The research that finds the MC does have a mediating role in physical performance shows that MC phases affect strength, aerobic and anaerobic performance differently.
Does a woman’s cognitive performance change throughout her menstrual cycle? Menstruation continues to be a taboo topic, subject to myths about how it affects women. Despite the considerable number of empirical studies, there have been few quantitative summaries of what is known. To address this gap, we conducted a meta-analysis of cognitive performance across the menstrual cycle, including the domains of attention, creativity, executive functioning, intelligence, motor function, spatial ability, and verbal ability. We included studies that measured women’s performance at specific points in the
Background: In elite athletes, training individualization is widely recommended to optimize competitive performance. Previous studies have evidenced the impact of hormonal fluctuations on different performance parameters among female athletes. While consideration of menstrual cycle (MC) phases as a parameter in training individualization strategies is necessary, systematic evidence identifying such impacts in elite athletes should be evaluated. Objective: Systematically review publications that have investigated the link between MC phases and performance in elite female athletes. The overarching aim is to identify whether a consensus across studies exists enabling evidence-based recommendations for training individualization depending on menstrual cycle phases. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three major scientific publication databases were searched from inception until November 3, 2020. Studies included focused on the influence of physiological or psychological parameters throughout at least one phase of the menstrual cycle of elite athletes. Results: A total of 780 search results were yielded and 26 references from a past bibliography were added manually. About 662 papers were reviewed of which 218 studies were assessed for eligibility. Of these, only seven (1%) precisely investigated the influence of a performance or physical parameter during at least one menstrual cycle phase. These seven studies included a total of 314 elite female participants (20.58 ± 1.91 years). Three used interviews, questionnaires or prospective analyses of reports. Four conducted several performance tests or included physical measures although only two performed tests during training or before/during competition. Among the seven studies, five performed hormonal testing through sampling of blood, saliva, or urine. The remaining relied on athletes' menstruation diaries. The current evidence suggests a variable association between menstrual cycle and a few performance-related outcomes, such as endurance or power resistance, ligament stiffness, decision making skills, psychology, or competitiveness. Conclusion: Different sports performance-related parameters are affected during the menstrual cycle among elite athletes, but the parameters themselves and the magnitude and the direction of the effects are inconclusive. Additional longitudinal and prospective studies to systematically monitor on-field performance parameters are urgently required in order to enable recommendations and training individualization in female elite athletes.
Abstract BACKGROUND: Primary dysmenorrhea is one of the major public health concerns that affects about 50%–90% of women. Even though the condition is associated with psychosomatic symptoms, conventional management is mainly focused on reducing pain only. This study is designed to evaluate the potential of Ayurvedic management in dysmenorrhea, addressing both physical and psychosomatic aspects of the condition. OBJECTIVE: The study aims to assess the effectiveness and tolerability of Rajapravartani Vati and Saraswatarishta in dysmenorrhea. MATERIALS AND METHODS: This study is a prospective, single-arm, open-label, and multicenter clinical study involving 10 centers. According to pre-defined selection criteria, a total of 460 participants with primary dysmenorrhea in the age range of 14–25 years will be enrolled from the study sites. All participants will receive Rajapravartani Vati 500 mg twice daily orally starting from 7 days before the expected date of the menstrual cycle up to the third day of menstruation for three consecutive menstrual cycles. Saraswatarishta will be given, a 10 mL dose with 20 mL of lukewarm water at bedtime for 84 days. The participants will be followed for further 3 months to assess the sustained effect of the intervention. The change in pain, disease-specific symptoms, and psychosomatic status will be assessed for three consecutive cycles by using the Visual Analog Scale score, Working Ability, Location, Intensity, Days of pain, Dysmenorrhea score,
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