Effect of Menstrual Cycle Phases on Cognitive and Neuromuscular Performance

Isma Ishaq; Bilal Safdar; Seerat Husnain; Rawaal Amin; Aqsa Khan; Mahnoor Zia

doi:10.61919/jr0rb844

Authors

Isma Ishaq CMH Kharian Medical College, Kharian, Pakistan Author
Bilal Safdar CMH Lahore Medical and Dental College, Lahore, Pakistan Author
Seerat Husnain Forman Christian College, Lahore, Pakistan Author
Rawaal Amin Sandeman Provincial Hospital, Quetta, Pakistan Author
Aqsa Khan Bahria University, Islamabad, Pakistan Author
Mahnoor Zia Riphah International University, Faisalabad, Pakistan Author

DOI:

https://doi.org/10.61919/jr0rb844

Keywords:

Menstrual cycle, estrogen, progesterone, cognitive function, muscle strength, endurance, reaction time, women’s health

Abstract

Background: Fluctuations in estrogen and progesterone across the menstrual cycle may influence cognitive and neuromuscular performance, yet previous findings have remained inconsistent because many studies have assessed isolated outcomes or relied solely on calendar-based phase estimation. Objective: To evaluate variations in cognitive performance, muscle strength, and endurance across menstrual cycle phases and examine their association with circulating estrogen and progesterone levels in healthy young women. Methods: This descriptive repeated-measures study was conducted in Lahore, Pakistan, among 60 healthy women aged 18-30 years with regular menstrual cycles. Assessments were performed during the follicular, ovulatory, and luteal phases. Serum estrogen and progesterone concentrations were measured by enzyme-linked immunosorbent assay. Cognitive performance was assessed using the Stroop Color-Word Test and Digit Span Test, while neuromuscular performance was evaluated using quadriceps maximal voluntary isometric contraction and plank endurance. Data were analyzed using repeated-measures ANOVA and Pearson correlation tests. Results: Estrogen peaked during ovulation (187.5 ± 25.8 pg/mL), whereas progesterone was highest in the luteal phase (11.8 ± 2.7 ng/mL) (p < 0.001 for both). Stroop reaction time improved significantly during ovulation (689 ± 78 ms) compared with the follicular phase (732 ± 84 ms) (p = 0.012). Quadriceps strength was highest during ovulation (317.9 ± 34.5 N) and differed significantly across phases (p = 0.021). Digit Span scores and plank endurance also showed their highest mean values during ovulation. Estrogen correlated positively with cognitive performance (r = 0.42, p < 0.05), while progesterone correlated positively with muscular endurance (r = 0.39, p < 0.05). Conclusion: Cognitive and neuromuscular performance varied across menstrual cycle phases, with the most favorable overall outcomes observed during ovulation. These findings support consideration of menstrual physiology as a relevant biological variable in female performance research and individualized training or workload planning.

References

1. Bonilla IP, Abián P, Bravo-Sánchez A, Ramírez-De la Cruz M, Jiménez F, Abián-Vicén J. Influence of the menstrual cycle on physical and cognitive performance in eumenorrheic women. Arch Med Deporte. 2023;40(3):131-8.

2. Sawicka AK, Michalak KM, Naparło B, Bermudo-Gallaguet A, Mataró M, Winklewski PJ, et al. Menstrual cycle phase influences cognitive performance in women and modulates sex differences: a combined longitudinal and cross-sectional study. 2025;14(8):1060.

3. Wiggins BM. The effects of ovarian hormone fluctuations and hormonal contraceptives on the psychophysiological responses underpinning endurance performance [thesis]. 2025.

4. Piirainen JM, Nevanperä S, Tenan MS. Sex hormone effects on the nervous system and their impact on muscle strength and motor performance in women. In: Sex Hormones, Exercise and Women: Scientific and Clinical Aspects. Cham: Springer; 2023. p. 135-49.

5. Fridén C. Neuromuscular performance and balance during the menstrual cycle and the influence of premenstrual symptoms [thesis]. Stockholm: Karolinska Institutet; 2004.

6. Dam TV, Dalgaard LB, Sevdalis V, Bibby BM, De Jonge XJ, Gravholt CH, et al. Muscle performance during the menstrual cycle correlates with psychological well-being, but not fluctuations in sex hormones. 2022;54(10):1678.

7. Pesonen H. Associations of aging, menopause, and strength training on cortical somatosensory and motor functions [dissertation]. 2024.

8. Ekenros L. The influence of sex hormones on neuromuscular function and premenstrual symptoms [thesis]. Stockholm: Karolinska Institutet; 2017.

9. Piasecki J, Guo Y, Jones EJ, Phillips BE, Stashuk DW, Atherton PJ, et al. Menstrual cycle associated alteration of vastus lateralis motor unit function. 2023;9(1):97.

10. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

11. Habibi N, Huang MSL, Gan WY, Zulida R, Safavi SM. Correlation of oral contraceptive pill use and hormone replacement therapy with cognitive function, sleep, and health-related quality of life in women. Front Neurosci. 2015;9:688.

12. Silva AF, Clemente FM, Roriz MS, Azevedo JA, Jovanovic O, Adamovic M, et al. The effect of aerobic or strength training in elderly with cognitive decline: the Fit4Alz project. 2025;24(1):172.

13. Marshall K. Menstrual cycle literacy in varsity female athletes and coaches [thesis]. 2025.

14. Verhagen E, Ferrer E, da Silva Antero J, Bahtijarevic Z, Barlow A, Bolling C, et al. UEFA consensus statement on menstrual cycle tracking in women’s football. 2025;11(3).

15. Vigil P. Hormones and the female voice: an exploration of the female hormonal cycle from puberty to menopause and how it affects the vocal apparatus [thesis]. Philadelphia: Temple University; 2015.

16. Macutkiewicz D. The effect of tournament play and nutritional supplements on field hockey performance in elite female players [thesis]. Nottingham: Nottingham Trent University; 2011.

17. Onus K. The physiology of self-paced exercise: pharmacological intervention and cell stress response in the heat [thesis]. 2020.

18. Risco-Acevedo D, Subirós-Martínez N, Camacho-Rodríguez H, Ramírez-Sánchez J, Rodríguez-Virulich Y, Etchegoyen-Amoros A, et al. The impact of aging on cognitive and motor functions: a molecular and behavioral study in female C57BL/6 mice. 2025;243(12):1-13.