When working with female runners, it’s becoming increasingly evident that structuring training around the monthly hormonal cycle provides a useful framework that supports performance, recovery and injury prevention. As female participation in running continues to rise, understanding how the phases of the menstrual cycle influence neuromuscular control, ligament stiffness, fatigue and recovery is key.
Why the Menstrual Cycle Matters for Running and Injury Risk
The typical 28-day cycle is divided into roughly the menstrual phase (bleeding), the follicular phase (from the end of bleeding to ovulation), the ovulatory phase, and the luteal phase (post-ovulation until the next bleed). Hormones, primarily oestrogen and progesterone, fluctuate significantly and do more than modulate reproduction: they affect connective tissue laxity, neuromuscular control, fatigue and recovery. Research has linked these fluctuations to injury risk. For instance:
- A four-year study of elite footballers found muscle and tendon injuries in the late follicular phase were 88 percent greater than in the early follicular phase.
- A study of team sport athletes reported that 78.4 percent of injuries occurred during the luteal phase, particularly joint and ligament injuries (88.4 percent) and muscle and tendon injuries (71.4 percent).
- A systematic review found a clear association between certain menstrual phases and higher musculoskeletal injury risk among female athletes.
- Endurance runners with absent menstrual cycles had a 2.25 times greater incidence rate of bone stress injuries compared to those with regular cycles.
Why might certain phases carry higher injury risk? Several mechanisms have been suggested:
- During the late follicular phase, oestrogen peaks, and oestrogen has been shown to reduce connective tissue stiffness and increase ligament laxity, for example in the ACL context via the hormone relaxin.
- In the luteal phase, increased progesterone and associated changes such as increased fatigue, poorer sleep and fluid retention may reduce neuromuscular coordination and prolong recovery.
- Hormonal fluctuations may influence ligament and tendon micro-structure, muscle contractility and motor control, all of which mean the load a runner tolerates safely may vary across the cycle.
In short, tailoring a running programme to recognise these variations can help optimise performance, manage fatigue and reduce injury risk for female runners.
How to Structure Your Running Programme Around Cycle Phases
Below is an example four-week plan for those with a roughly 28-day cycle. Always individualise based on your own cycle length, any hormonal contraception, symptoms, training goals and history. A running assessment can help tailor this framework to your individual presentation.
| Phase | Approximate Days | Hormones & Physiology | Training Focus |
|---|---|---|---|
| Menstrual Phase (bleeding) | Days 1-4 | Low oestrogen and progesterone; possible cramps, fatigue, altered sleep | Light aerobic runs at easy pace; focus on recovery, mobility, core and bodyweight strength work. Avoid high volume and listen to your symptoms. |
| Early Follicular Phase | Days 5-10 | Rising oestrogen; improved energy and neuromuscular readiness | Gradually increase volume; include moderate runs, technique drills, and stability-based strength work such as single-leg work, glute strengthening and core. |
| Late Follicular / Ovulation | Days 11-15 | Peak oestrogen; potential ligament laxity; high neuromuscular capacity | Often a good time for tempo runs, intervals and hills, but be cautious of sudden load spikes given the documented higher injury risk in this phase. Ensure a proper warm-up and include strength and resistance training to support connective tissues. |
| Luteal Phase | Days 16-28 | Progesterone dominates; increased fatigue; possible sleep and energy dips; coordination may reduce | Keep runs moderate and reduce high-impact or very high volume work. Emphasise maintenance aerobic running, mobility, cross-training and strength. In the last one to two days before the next period, prioritise recovery and lower volume. |
Example Weekly Micro-Plan
For a recreational runner working through a four-week block:
Week 1 (Menstruation / Early Follicular): Three easy runs (30 to 40 minutes), two mobility or strength sessions (bodyweight, core, yoga). Swap runs for gentle walks if this feels better.
Week 2 (Mid-Follicular): One tempo run (around 20 minutes at a steady, moderate pace), one interval session (for example 5 x 3 minutes hard, 2 minutes easy), two easy runs, one strength session with a moderate load and technique focus, such as single-leg RDLs, step-ups, lunges and glute bridges.
Week 3 (Late Follicular / Ovulation): One interval run (for example 6 x 4 minutes hard, 2 minutes easy), one hill session, two moderate runs, one strength session with heavier loads than week 2, such as squats, deadlifts, upper body work and plyometrics.
Week 4 (Luteal): Two moderate aerobic runs, one easy run, two strength or mobility sessions with a lighter load and a focus on stability, optional cross-training such as bike or swim, and reduced volume with additional rest days if needed.
Summary and Take-Homes
By aligning your running programme with your menstrual cycle, you can:
- Make use of phases of higher physiological readiness, particularly the follicular phase, for sharper, more effective sessions.
- Help manage injury risk by reducing high-load spikes during more vulnerable phases, such as the late follicular and luteal phases.
- Support recovery and neuromuscular function during phases where hormones may reduce energy levels and coordination, particularly the luteal phase.
- Maintain consistency, rather than going all-out every week and risking overload.
It’s worth tracking your cycle, including bleeding, ovulation symptoms, fatigue, sleep and soreness, alongside your running performance, injuries or niggles. This can help guide load adjustments to your training. Emphasise warm-up, strength work (particularly hip, glute, hamstring and core), and consistent rest and recovery. A cycle-aware running plan can support greater longevity in training, reduced injury risk, and long-term performance and health.
How BeFit Can Help
Our Sports Physiotherapy team works with female runners to build individualised, cycle-aware training programmes, combining movement assessment, strength and conditioning principles, and injury-risk screening tailored to your training history and goals.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805
References
Martin, D., Timmins, K., Cowie, C., Alty, J., Mehta, R., Tang, A., & Varley, I. (2021). Injury Incidence Across the Menstrual Cycle in International Footballers. Frontiers in Sports and Active Living, 3.
Fort-Vanmeerhaeghe, A., Pujol-Marzo, M., Mila, R., Campos, B., Nevot-Casas, O., Casadevall-Sayeras, P., & Pena, J. (2025). Injury Risk and Overall Well-Being During the Menstrual Cycle in Elite Adolescent Team Sports Athletes. Healthcare, 13(10), 1154.
Martinez-Fortuny, N., Alonso-Calvete, A., Da Cuna-Carrera, I., & Albalo-Nunez, R. (2023). Menstrual Cycle and Sport Injuries: A Systematic Review. International Journal of Environmental Research and Public Health, 20(4), 3264.
Parker, E. A., Duchman, K. R., Meyer, A. M., Wolf, B. R., & Westermann, R. W. (2024). Menstrual Cycle Hormone Relaxin and ACL Injuries in Female Athletes: A Systematic Review. Iowa Orthopaedic Journal, 44(1), 113-124.
Hutson, M. J., O’Donnell, E., Petherick, E., Brooke-Wavell, K., & Blagrove, R. C. (2021). Incidence of Bone Stress Injury Is Greater in Competitive Female Distance Runners With Menstrual Disturbances Independent of Participation in Plyometric Training. Journal of Sports Sciences, 39(22), 2558-2566.
