Menstrual Cycle Phase, Premenstrual Symptoms, and Daily Physical Activity: A Longitudinal Study

Abstract

Introduction & Purpose: Subjective perceptions of the menstrual cycle (MC) and physical activity (PA) suggest that the MC may negatively affect PA, particularly when premenstrual symptoms are present (Kolic et al., 2021). However, most existing studies are cross-sectional (Goaplan et al., 2024), which limits causal interpretation and may introduce bias (Matsumoto et al., 2021). Therefore, this study aimed to examine daily fluctuations in PA and premenstrual symptoms across two consecutive MCs using a longitudinal design.

Methods: Participants were eligible if they were between 18–35 years old, had a natural MC lasting 21–35 days, and were not pregnant or breastfeeding for at least six months. Over two consecutive MCs, participants completed daily assessments via the m-path app (KU Leuven, Belgium). Data included MC tracking (MC day, basal body temperature, LH surge), premenstrual symptoms (Screening Instrument for Premenstrual Symptoms [SIPS]), and self-reported moderate-to-vigorous PA (MVPA, Godin–Shephard Leisure-Time Physical Activity Questionnaire). The MC was divided into five phases according to Elliott-Sale et al. (2025): menstrual (MP), follicular (FP), ovulatory (OP), luteal (LP), and premenstrual phase (PP). Linear mixed models were applied to examine differences in MVPA across MC phases, including premenstrual symptoms as covariates.

Results: Thirty-five participants (age: 26.5 ± 5.4 years) were included. The average MC length was 28.7 ± 2.6 days. Based on the SIPS, eight participants were classified as having PMS and two as having PMDD. Across 1,407 observations, no significant effect of MC phase on MVPA was found (MP: 51.0 ± 7.5 min/day; FP: 50.3 ± 7.0; OP: 52.2 ± 7.6; LP: 45.6 ± 7.7; PP: 54.5 ± 7.6; p > 0.05). Premenstrual symptoms showed no significant associations with PA.

Discussion: MVPA remained stable across MC phases, even when symptoms occurred. This suggests that the MC and subjective symptom perception may not substantially affect PA in active women. However, these effects may vary in populations with distinct activity levels, such as sedentary women or elite athletes. Future studies should incorporate objective PA measures and examine psychosocial mediators of PA behavior across the MC.

Conclusion: In active women, PA behavior appears consistent across MC phases, despite the presence of premenstrual symptoms.

References

Elliott-Sale, K. J., Altini, M., Doyle-Baker, P., Ferrer, E., Flood, T. R., Harris, R., ... & Burden, R. J. (2025). Why we must stop assuming and estimating menstrual cycle phases in laboratory and field-based sport related research. Sports Medicine, 55(6), 1339. https://doi.org/10.1007/s40279-025-02189-3

Gopalan, S. S., Mann, C., & Rhodes, R. E. (2024). Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review. Preventive Medicine, 184, 107980. https://doi.org/10.1016/j.ypmed.2024.107980

Kolić, P. V., Sims, D. T., Hicks, K., Thomas, L., & Morse, C. I. (2021). Physical activity and the menstrual cycle: A mixed-methods study of women’s experiences. Women in Sport and Physical Activity Journal, 29(1), 47-58. https://doi.org/10.1123/wspaj.2020-0050

Matsumoto, T., Egawa, M., Kimura, T., & Hayashi, T. (2021). Comparison between retrospective premenstrual symptoms and prospective late-luteal symptoms among college students. Gynecological and Reproductive Endocrinology and Metabolism, 1(2021), 31-41.