Muscle damage, recovery, and the menstrual cycle

This article was written by on our our contributors; female health writer and founder of Period of the Period – Kelly McNulty.

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We often overlook the importance of recovery when it comes to planning our training programs, but ultimately recovery is what allows us to keep performing and training to the best of our ability^[1]. Specifically, any training you perform is a stimulus – whether that’s running or lifting weights – and the goal is to push your body just beyond what it can normally do so that you set off a cascade of messages and events in your body – so that you can get stronger/fitter/faster. However, to get to the good stuff, and prevent the likes of overtraining (which increases the risk of injury and illness) not only do we need to train hard but we need to recover harder. 

Do men and women respond and recover differently post-exercise?

Generally, it’s well known that women are more resistant to fatigue during exercise (i.e., tire slower during contractions at intensities relative to maximum force) in comparison to men^[2-5]. On top of this, recent studies have also shown that women might recover faster from exercise compared to men (even when training at the same relative workload)^[5]. Ultimately this might play a role in the prescription of training and recovery, but at the moment the majority of training programmes and plans are based on research conducted in men^[6], which means the current standard prescription of exercise might be sub-optimal for women! Despite this, one potential reason behind these sex differences could be the influence of female sex hormones, namely oestrogen.

The role of oestrogen on muscle damage and recovery

As well as its role in reproductive function, oestrogen has been shown to play a key role in the protection of muscle against damage, as well as muscle repair and regeneration. For example, studies have shown that oestrogen has antioxidant effects and helps membrane stability which might account for its ability to limit muscle damage^[7-9]. Likewise, it’s thought that oestrogen inhibits the inflammatory responses post-exercise which might help to reduce any muscle disruption, such as muscle soreness (aka DOMs), leading to a faster recovery. That said, some may argue that if oestrogen protects against muscle disruption that we might miss out on some of the important stages in the muscle recovery process and therefore adaptation – but that’s yet to be decided^[7-9]. On top of reducing any damage, oestrogen might also help muscle repair and regenerative processes^[7-9]. But – time for the caveat – most of the research so far has been conducted in animals. Given these potential effects it’s possible that changes in oestrogen concentration might influence the responses to, and recovery from, exercise in premenopausal women. This leads us nicely to our next question – does muscle damage and recovery differ across the menstrual cycle?

The menstrual cycle and recovery

*To recap the basics of the menstrual cycle, see article ‘Strength Training & The Menstrual Cycle’. Theoretically if oestrogen reduces muscle damage and helps to promote muscle repair, then we might expect to see a quicker recovery following exercise when oestrogen is rising/high during the mid to late follicular phase of the menstrual cycle, whereas when oestrogen is low during the early follicular phase then recovery might take longer. But what does the research so far say^[10-18]?

Overall, and as you can see from the figure above, whilst oestrogen might play an important role in recovery, the significance of this, particularly the potential effects on reduced or enhanced recovery in women across menstrual cycle phases, are not yet fully known. As such, more research is needed before we can make accurate conclusions on the optimal prescription of training for naturally menstruating women.

Takeaway message

Recovery is an essential aspect when it comes to performing and training, as well as health and well-being. Whilst the potential role of changes in female sex hormones across the menstrual cycle on enhancing or reducing recovery is fascinating, we don’t have enough evidence yet to start making phase specific recommendations. That said, it might be something you want to consider on an individual level until more research is available. Specifically, if you’re interested in knowing if your recovery changes across your cycle, start by collecting your own data. For example, begin to track measures, such as fatigue, muscle soreness, and perceived recovery in the days post training, across your cycle, and use this information to inform any adjustments to your training plan (i.e., when it’s good to push yourself and when you should take time for optimal recovery).

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References 

1. Kellmann, M., Bertollo, M., Bosquet, L., Brink, M., Coutts, A. J., Duffield, R., … & Beckmann, J. (2018). Recovery and performance in sport: consensus statement. International Journal of Sports Physiology and Performance, 13(2), 240-245.
2. Hunter, S. K. (2009). Sex differences and mechanisms of task-specific muscle fatigue. Exercise and Sport Sciences Reviews, 37(3), 113.
3. Hunter, S. K. (2014). Sex differences in human fatigability: mechanisms and insight to physiological responses. Acta Physiologica, 210(4), 768-789.
4. Hunter, S. K. (2014). Sex differences in human fatigability: mechanisms and insight to physiological responses. Acta Physiologica, 210(4), 768-789.
5. Ansdell, P., Brownstein, C. G., Škarabot, J., Hicks, K. M., Howatson, G., Thomas, K., … & Goodall, S. (2019). Sex differences in fatigability and recovery relative to the intensity–duration relationship. The Journal of Physiology, 597(23), 5577-5595.
6. Cowley, E. S., Olenick, A. A., McNulty, K. L., & Ross, E. Z. (2021). “Invisible sportswomen”: the sex data gap in sport and exercise science research. Women in Sport and Physical Activity Journal, 29(2), 146-151.
7. Tiidus, P. M. (2003). Influence of estrogen on skeletal muscle damage, inflammation, and repair. Exercise and Sport Sciences Reviews, 31(1), 40-44.
8. Tiidus, P. M. (2005). Can oestrogen influence skeletal muscle damage, inflammation, and repair?. British Journal of Sports Medicine, 39(5), 251-253.
9. Enns, D. L., & Tiidus, P. M. (2010). The influence of estrogen on skeletal muscle. Sports  Medicine, 40(1), 41-58.
10. Hackney, A. C., Kallman, A. L., & Ağgön, E. (2019). Female sex hormones and the recovery from exercise: Menstrual cycle phase affects responses. Biomedical Human Kinetics, 11(1), 87.
11. Sims, S. T., Ware, L., & Capodilupo, E. R. (2021). Patterns of endogenous and exogenous ovarian hormone modulation on recovery metrics across the menstrual cycle. BMJ Open Sport & Exercise Medicine, 7(3), e001047.
12. Sipavičienė, S., Daniusevičiutė, L., Klizienė, I., Kamandulis, S., & Skurvydas, A. (2013). Effects of estrogen fluctuation during the menstrual cycle on the response to stretch-shortening exercise in females. BioMed Research International.
13. Anderson, L. J., Baker, L. L., & Schroeder, E. T. (2017). Blunted myoglobin and quadriceps soreness after electrical stimulation during the luteal phase or oral contraception. Research Quarterly for Exercise and Sport, 88(2), 193-202.
14. Romero-Parra, N., Alfaro-Magallanes, V. M., Rael, B., Cupeiro, R., Rojo-Tirado, M. A., Benito, P. J., & Peinado, A. B. (2020). Indirect markers of muscle damage throughout the menstrual cycle. International Journal of Sports Physiology and Performance, 16(2), 190-198.
15. Romero-Parra, N., Barba-Moreno, L., Rael, B., Alfaro-Magallanes, V. M., Cupeiro, R., Díaz, Á. E., … & Peinado, A. B. (2020). Influence of the menstrual cycle on blood markers of muscle damage and inflammation following eccentric exercise. International Journal of Environmental Research and Public Health, 17(5), 1618.
16. Oosthuyse, T., & Bosch, A. N. (2017). The effect of gender and menstrual phase on serum creatine kinase activity and muscle soreness following downhill running. Antioxidants, 6(1), 16.
17. Chaffin, M. E., Berg, K. E., Meendering, J. R., Llewellyn, T. L., French, J. A., & Davis, J. E. (2011). Interleukin-6 and delayed onset muscle soreness do not vary during the menstrual cycle. Research Quarterly for Exercise and Sport, 82(4), 693-701.
18. Markofski, M. M., & Braun, W. A. (2014). Influence of menstrual cycle on indices of contraction-induced muscle damage. The Journal of Strength & Conditioning Research, 28(9), 2649-2656.