A case study to understand the impact of menstruation on training

Published on : December 1, 2022

Tags: periodstoriesTraining

Menstruation has long been subject to uninformed preconceived notions in our society and as a result of the same, has also been largely overlooked with regard to its interplay with the journey of female athletes. While it is quite intuitive to acknowledge that there would be a physical & mental impact of menstrual cycles, it is imperative to also tangibly measure the same thereby empowering athletes as well as coaches to better manage training protocols and overall performance. 


In an attempt to understand this phenomenon better, Simply Periods team did a case study with two female athletes. An initial analysis into the above has presented some primary directional trends that are surely worthy of a far deeper exploration

Image Courtesy- Deposit Photos




  • Primary analysis was performed on the 80-day data for two selected athletes to assess the potential impact of menstruation on their training performance
    • High degree of correlation was found across parameters such as Sleep, Stress, Recovery & Motivation in the case of one athlete while for the other the correlations were not as strong
    • The variation in the parameters was found to spike considerably during the menstrual cycle for both the selected athletes
    • All in all, it seemed quite evident that while there is a very clear interplay between the physical & mental parameters during menstruation, there also might be a high degree of uniqueness pertaining to each athlete
  • While the data collected does offer a great initial starting point into the topic, there were some fundamental gaps in the current design, which if fixed could lead us to conclusive ends for the current hypotheses
    • Inadequate sample size & lack of heterogeneity in the data
    • Lack of standardisation in the response collection process
    • Need for higher degree of subject matter expertise
  • A potential skeleton for a Phase II of the exercise has been laid to help us validate the initial findings on a wider scale in a more reliable manner


Learnings from Phase I (please check the link for detailed analysis)

Over the course of 80 days, athletes were asked to provide responses daily on two separate forms tracking certain parameters relating to their training & menstrual cycles.


Training Tracker Sleep duration, Resting heart rate, Hydration intake, Urine colour charting, Levels of Recovery/Soreness/Stress/Motivation/Appetite & Rate of perceived exertion
Period Tracker Whether period started, Flow type, Physical symptoms, Whether practice session was missed or curtailed & Other comments


Based on the regularity of the responses received, the data for two athletes was shortlisted for further analysis into the trends. The pertinent questions that were sought to be explored:


  • How do the overall parameters vary across the athletes in general?
  • How do these parameters & the deviation therein change during menstruation?
  • How do the parameters vary in correlation with each other?
  • How do the results differ across athletes for the above trends?


Since the data for only two athletes was sizable & clean enough to dissect, the answers to all of the above would have to be treated as directional rather than conclusive.

Brief summary (detailed analysis in Appendix)


Some of the parameter averages were drastically different for the two athletes
Sleep duration Athlete II: 5.4hr vs Athlete VI: 8hr
Recovery score Athlete II: 9.8 vs Athlete VI: 7.7 despite an opposite trend on sleep duration (possibly indicating differing physiological templates)
Stress score Athlete II: 4.5 vs Athlete VI: 7 opposite to the Recovery score trend as expected
While the average values remained constant for most parameters during the period of menstruation, the deviation seemed to increase dramatically in most
Athlete II Only Soreness (52%) & Stress (29%) scores were significantly higher during menstruation, while other parameters averaged nearly the same
Both athletes The Stdev values were significantly higher possibly indicating a higher degree of unpredictability of the parameters
The correlation scores between various parameters for the two athletes had very divergent findings again possibly pointing towards variability in response to certain triggers 
Athlete II Reasonably strong correlation was found between three parameters – Sleep, Hydration & Motivation – especially important since the average sleep duration for the athlete was just 5.4hr
Stress had a very strong correlation to Flow type, RPE & Soreness
Athlete VI No positive/negative correlation was found for the athlete in the data except that of Stress & Soreness vs level of Recovery


Thus, it seems to be quite clear that while many of the performance related parameters are very closely linked to the physical/mental impact of menstruation, it is also evident that there might be a large variability in terms of the unique response of every athlete to the same.


The way ahead – Phase II

A good starting point to think about the possible structure of a Phase II study on the topic would be to enlist the key drawbacks of the current analysis that can be improved:


Possible improvements Description
Adequate sample size Involvement of a wider cross section of athletes/coaches ranging across different disciplines, regions & age groups to test the existence of actual correlation as well as individuality
Higher heterogeneity
Standardisation in response collection process Fixed time slot of the day to measure/record parameters
Higher degree of quantification especially for responses pertaining to mental factors & menstrual symptoms
Guided definitions for athletes to improve accuracy of the self assessment across all the parameters
Template for physical performance assessment A fixed set of exercises/activities to be performed by athletes to gauge actual levels of Recovery/Soreness
Usage of technology (Fitbit-equivalent) to ensure a common source of truth for physiological data
Expert collaboration Involvement of subject matter experts to help better formulate the right questions & parameters


Based on the above, following may be the skeleton helping us design the Phase II exercise:


Areas of measurement Physical performance Mental health Menstruation input
[to be formalised]
Revolving around vitals like agility, endurance etc Revolving around levels of stress, anxiety etc Degree of symptoms being experienced
Mode of measurement Performance monitoring device (eg. Fitbit) Standardised Google form with purely MCQ input to be filled during the same time slot each day
SME required Sports science expert to help define the common physical assessment regimen across disciplines Sports psychologist to help create a fixed psychometric questionnaire to be filled in by the athletes Gynaecologist to help quantify the primary physical symptoms
Design of the analysis
Parameters Heterogeneity Trends to be identified
TBD Age Strong correlations (0.7+) among all combinations
Sports discipline Variation in the Avg/Stdev across the heterogeneity
Region Movement in the Avg/Stdev values over time
Primary physical attributes (weight, height etc) Variation in all of the above specifically during the period of menstruation – commonality & individuality


The Phase II exercise as described above surely offers a great opportunity to build an evolving playbook that can guide athletes & coaches alike to better understand the nature of the impact of menstruation on sports performance. With the participation of women being on the rise in the Indian sporting landscape, it is imperative for all stakeholders to be educated about this highly pertinent subject. The involvement of subject matter experts would have a far reaching impact in driving us to the desired codification of training protocol for female athletes across the country.





  1. I) Detailed analysis for Phase I


  • Average & standard deviation for the measured parameters


Athlete Athlete II Athlete VI
Overall Average Stdev Average Stdev
SLEEP (in hours) 5.4 0.4 8.0 0.8
RESTING HEART RATE 49.9 1.2 57.5 6.3
HYDRATION (in litres) 3.4 0.6 3.1 0.5
Urine Colour Score 1.7 0.5 2.7 1.2
RECOVERY 9.8 0.7 7.7 1.0
SORENESS 1.2 0.6 3.2 1.5
STRESS_score 4.5 1.1 7.0 2.4
MOTIVATION_score 8.0 1.4 8.3 1.9
APETITE_score 7.1 0.6 7.4 1.7
Rate of Perceived Exertion – RPE 7.3 1.3 5.0 2.3


  • Variation in Avg & Stdev during the period of menstruation


Athlete Athlete II Athlete VI
Delta Average Stdev Average Stdev
SLEEP (in hours) 0% 24% -7% 15%
RESTING HEART RATE 0% -8% 3% 81%
HYDRATION (in litres) -10% -9% 3% 72%
Urine Colour Score 0% 0% 1% -1%
RECOVERY -6% 0% 3%
SORENESS 52% 4% 13%
STRESS_score 29% 265% -3% -8%
MOTIVATION_score -2% -3% -4% 43%
APETITE_score 5% 6% -1%
Rate of Perceived Exertion – RPE -15% 292% 11% -5%


  • Correlation values between the parameters (only wherever strong/moderate)


Athlete II Sleep Hydration Recovery Soreness Stress RPE
Hydration 0.66
Soreness -0.08 -0.28 -0.90
Stress -0.07 -0.32 -0.60 0.69
Motivation 0.55 0.67 0.19 -0.20 -0.22
RPE 0.02 0.26 0.80 -0.75 -0.79
Flow Score 0.04 -0.20 -0.44 0.46 0.71 -0.59


Athlete VI Recovery
Soreness -0.59
Stress -0.53


  1. II) Selection of athletes for the analysis


Athlete Total Days Expected Responses Total Responses Same Day Responses
Athlete I 80 160 113 36
Athlete II 80 160 160 130
Athlete III 80 160 19 19
Athlete IV 80 160 32 22
Athlete V 80 160 7 7
Athlete VI 80 160 120 110

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