Exercise and Your Menstrual Cycle: How to Work With Your Body, Not Against It

For decades, women's exercise guidance was largely based on research conducted in men. The menstrual cycle — with its complex hormonal fluctuations affecting energy, strength, recovery, and mood — was treated as an inconvenience rather than a physiological reality worth understanding. Thankfully, this is changing. A growing body of research now recognises that hormonal shifts throughout the cycle genuinely influence how women feel during exercise and how their bodies respond to training.

As a gynaecologist, I see many women who feel frustrated because their performance varies from week to week, or who push through pain and fatigue without understanding why their body is responding differently. Understanding your cycle is not about limiting what you can do — it is about optimising your approach so that you can train more effectively, recover better, and enjoy movement throughout the month.

How your hormones change through the cycle

A typical menstrual cycle lasts approximately 28 days, though anywhere between 21 and 35 days is considered normal. The cycle is divided into distinct phases, each driven by different hormonal profiles that affect far more than just your reproductive system.

• Menstrual phase (days 1–5): The cycle begins with menstruation. Oestrogen and progesterone are at their lowest levels. Many women experience fatigue, cramps, and lower motivation during this phase, though some feel a sense of relief and renewed energy once bleeding begins
• Follicular phase (days 1–13): Overlapping with menstruation, this phase sees a gradual rise in oestrogen as follicles develop in the ovaries. Oestrogen promotes muscle repair, supports tendon and ligament health, and has a positive effect on mood and cognitive function. Energy and strength tend to increase steadily through this phase
• Ovulation (around day 14): Oestrogen peaks just before ovulation, often coinciding with the highest levels of energy, confidence, and physical performance. A surge in luteinising hormone triggers the release of an egg. Some women experience brief mid-cycle pain (mittelschmerz)
• Luteal phase (days 15–28): After ovulation, progesterone rises significantly while oestrogen fluctuates. Progesterone increases core body temperature, can promote fluid retention, and may reduce exercise tolerance. Many women notice lower energy, increased fatigue, and premenstrual symptoms during the late luteal phase

Adapting your training to each phase

While every woman is different, and I always encourage listening to your own body above any prescriptive framework, the following general principles can help you structure your training around your cycle:

• Early follicular phase (menstruation): This is often a good time for lighter activity — gentle yoga, walking, swimming, or low-intensity steady-state cardio. If you feel well, there is no medical reason to avoid exercise during your period. Some women find that movement actually helps relieve cramps and improve mood
• Late follicular phase: As oestrogen rises, you may notice improved strength, endurance, and motivation. This is an excellent time to schedule high-intensity interval training, heavy resistance work, or personal bests. Your body is primed for performance and recovery during this window
• Ovulation: Peak oestrogen supports strength and power output. However, it is worth noting that research suggests a slightly increased risk of ligament injury around ovulation due to oestrogen's effect on connective tissue laxity. Warming up thoroughly and focusing on control during high-impact movements is advisable
• Luteal phase: As progesterone rises and oestrogen drops, you may feel warmer, more fatigued, and less resilient to intense training. Moderate-intensity exercise, steady-state cardio, Pilates, and strength maintenance sessions tend to suit this phase well. In the days before your period, prioritising recovery, sleep, and stress management can be more productive than pushing through a punishing training session

Exercise and period pain

Many of my patients ask whether exercise helps or worsens period pain. The evidence is encouraging: regular physical activity has been shown to reduce the severity of dysmenorrhoea (painful periods) over time. Exercise promotes the release of endorphins, improves pelvic circulation, and may help reduce the prostaglandin levels responsible for uterine cramping.

That said, severe period pain that stops you from exercising, attending work, or going about your daily life is not normal and should not simply be managed with more exercise. If your periods are significantly painful, it is important to have an assessment to rule out underlying conditions such as endometriosis or adenomyosis, both of which are treatable.

RED-S and the danger of under-fuelling

Relative Energy Deficiency in Sport (RED-S) is a serious condition that occurs when energy intake is insufficient to support the demands of exercise and normal bodily functions. It is far more common than many women realise and is not limited to elite athletes — recreational exercisers and women following restrictive diets are also at risk.

RED-S can affect virtually every system in the body, including:

• Menstrual function — irregular or absent periods (amenorrhoea)
• Bone health — increased risk of stress fractures and early osteoporosis
• Cardiovascular health, immune function, and metabolic rate
• Mental health — increased anxiety, depression, and impaired concentration
• Athletic performance — paradoxically, training more while eating less leads to declining rather than improving results

If your periods have become irregular or stopped altogether since increasing your exercise volume or changing your diet, this is a clear signal that your body is under-fuelled. I would strongly encourage you to seek both nutritional and gynaecological assessment. Amenorrhoea from over-exercising is not a sign of fitness — it is a sign of physiological stress that requires attention.

Pelvic floor considerations during exercise

The pelvic floor is a group of muscles that supports the bladder, uterus, and bowel, and it plays a crucial role in continence, core stability, and sexual function. Certain types of exercise can place significant load on the pelvic floor, and it is important to consider this when planning your training.

High-impact activities such as running, jumping, and heavy lifting increase intra-abdominal pressure, which is transmitted to the pelvic floor. For most women with a well-functioning pelvic floor, this is not problematic. However, if you experience urinary leakage during exercise, a sensation of heaviness or dragging in the pelvis, or difficulty controlling wind during physical activity, these symptoms deserve attention.

Pelvic floor rehabilitation with a specialist physiotherapist can make a remarkable difference. In many cases, women can return to high-impact exercise with confidence once their pelvic floor is properly supported. I always encourage women not to simply accept leakage as normal or to abandon activities they love — instead, seek assessment and targeted treatment.

When exercise helps hormonal conditions

For several common gynaecological conditions, exercise is a genuinely powerful therapeutic tool:

• Polycystic ovary syndrome (PCOS): Regular exercise improves insulin sensitivity, which is a key driver of PCOS symptoms. Both aerobic exercise and resistance training have been shown to help regulate cycles, reduce androgen levels, and support weight management in women with PCOS
• Endometriosis: While exercise does not treat endometriosis directly, regular movement can help manage pain, reduce inflammation, and improve mental wellbeing. Low-to-moderate intensity activities such as yoga, swimming, and walking are often well-tolerated and beneficial
• Premenstrual syndrome (PMS): Consistent aerobic exercise has been shown to reduce the severity of PMS symptoms including mood changes, bloating, and fatigue. The key is regularity rather than intensity

When to see a gynaecologist about exercise-related symptoms

I would recommend a gynaecological assessment if you are experiencing any of the following in relation to exercise:

• Periods that have become irregular or stopped altogether
• Severe period pain that limits your ability to exercise
• Urinary leakage or pelvic heaviness during physical activity
• Persistent fatigue that does not improve with rest and adequate nutrition
• Recurrent stress fractures or unexplained injuries
• Significant mood changes or anxiety linked to your cycle and training

Understanding the relationship between your cycle and your training is empowering. It allows you to plan your exercise in a way that respects your physiology, prevents injury, and supports long-term health. You do not need to fight your body — you simply need to understand it.