Does Menstrual Cycle Phase Affect Physical Performance Of Female Team Handball Athletes?

PURPOSE: Team handball is characterized by positive and negative acceleration sprints, rapid directional changes. Research has highlighted the importance of strength, power capacity, and speed. Fluctuations in female sex hormones across the menstrual cycle may influence these performance factors. However, the effect of menstrual phase on handball performance remains equivocal. This study investigated if the menstrual cycle affected handball-relevant performance factors in naturally menstruating handball athletes, when compared to hormonal contraceptive using athletes. METHODS: Eighteen handball athletes were categorized into three groups: naturally-menstruating (NAT; n = 8); combined oral contraceptive (COCP; n = 4); and, progestin-only contraceptive (PO; n = 6). A test battery was undertaken on three separate days across the menstrual cycle. For NAT, these sessions were: early follicular (EF; day 1-4 of menses); ovulation (OV;<48 h of positive urinary ovulation test); and, mid-luteal (ML; 7-9 days after ovulation). For COCP, the first placebo pill was considered as day 1, with EF testing during days 1-4, OV during days 12-16, and ML in days 20-24. The PO group was similar for OV and ML, although the first testing session (EF) was considered ‘day 1’ of the cycle and completed whenever suitable. The test battery was identical for all sessions: maximal squat (1RM), counter-movement jumps (CMJ), agility T-test, and 15 m acceleration. Data were analyzed using Bayesian linear mixed models, with differences assumed if 95% credible interval (CI) excluded zero and probability of direction (pd) >97%. RESULTS: Higher 1RM was seen for NAT in OV and ML compared to EF(+15-21 kg; 95%CI[3, 34]; pd = 99.3-99.9%). PO reported higher 1RM in ML compared to EF (+17 kg; 95%CI[2,32]; pd = 98.6%). Within OV, both PO and NAT had higher 1RM than COCP (+18-22 kg; 95%CI[0,40]; pd = 97.3-99.4%) as well during ML for PO (+19 kg; 95%CI[0,38]; pd = 97.9%). CMJ was likely lower for NAT compared to COCP during EF (-4.6 cm; 95%CI[0.2,9.2]; pd = 97.7%). No evidence of differences was found for agility or acceleration. CONCLUSION: Maximal strength of naturally menstruating handball athletes may be impaired during EF (i.e., menstruation) compared to other phases. Athletes may consider periodizing strength training across the menstrual cycle.