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.

Context: In overweight women with polycystic ovary syndrome (PCOS), the benefits of the addition of exercise to an energy-restricted diet in further improving cardiometabolic risk factors and reproductive function has not been extensively studied. Objective: The objective was to evaluate the effects of aerobic and aerobic-resistance exercise when combined with an energy-restricted high protein diet (5000–6000 kJ/d) on metabolic risk factors and reproductive function in women with PCOS. Design and Setting: A 20-wk outpatient, randomized, parallel study was conducted in a metropolitan research clinic. Patients and Intervention: Ninety-four overweight and obese women with PCOS (age 29.3 ± 0.7 yr; body mass index 36.1 ± 0.5 kg/m²) were randomized to diet only (DO; n = 30), diet and aerobic exercise (DA; n = 31), or diet and combined aerobic-resistance exercise (DC; n = 33). Main Outcome Measures: Weight, body composition, cardiometabolic risk factors, hormonal status, menstrual cyclicity, and ovulatory function were assessed. Results: All interventions reduced weight (DO 8.9 ± 1.6%, DA 10.6 ± 1.7%, and DC 8.7 ± 1.7%; P < 0.001) with no difference between treatments (P = 0.7, time × treatment). Fat mass decreased more (3 kg) and fat-free mass decreased less (2 kg) in DA and DC compared with DO (P ≤ 0.03). Reductions in blood pressure (5.6/2.7 mm Hg), triglycerides (0.4 mmol/liter), total cholesterol (0.5 mmol/liter), low-density lipoprotein cholesterol (0.1 mmol/liter), glucose (0.2 mmol/liter), fasting insulin (4.3 mIU/liter), testosterone (0.4 nmol/liter), and free androgen index (2.8) (P < 0.001) and improvements in SHBG (7.0 nmol/liter) and reproductive function occurred in all groups, with no difference between treatments. Conclusion: In overweight and obese women with PCOS, the addition of aerobic or combined aerobic-resistance exercise to an energy-restricted diet improved body composition but had no additional effect on improvements in cardiometabolic, hormonal, and reproductive outcomes relative to diet alone.