Guthardt, Y., Sargent, D., & Julian, R. (2026). The influence of the menstrual cycle on muscle injuries - a systematic review and meta-analysis. Scientific reports, 16(1), 3035. https://doi.org/10.1038/s41598-026-36763-0
Guthardt Y, Sargent D, Julian R. The influence of the menstrual cycle on muscle injuries - a systematic review and meta-analysis. Sci Rep. 2026;16(1):3035. doi:10.1038/s41598-026-36763-0
Guthardt, Yannik, et al. "The influence of the menstrual cycle on muscle injuries - a systematic review and meta-analysis." Scientific reports, vol. 16, no. 1, 2026, pp. 3035.
Female athletes had no significant cycle-phase link to muscle injury
A systematic review of three studies in female professional football and futsal players found that muscle injuries showed no statistically significant difference between the luteal and follicular phases. The pooled risk ratio was 1.18. The authors rated the certainty of the evidence very low.
Study at a glance, systematic review and meta-analysis of 318 participants: No significant cycle-phase link to muscle injury in female athletes. Source: Guthardt Y et al., 2026, DOI 10.1038/s41598-026-36763-0.
Key Findings
Three studies met the inclusion criteria: two in professional football and one in professional futsal, with 205 participants in two studies and injury data from 113 participants in the third.
The random-effects pooled risk ratio for muscle injury in the luteal versus follicular phase was 1.18 (95% CI: 0.75 to 1.86, p = 0.46).
The common-effect model also gave a pooled risk ratio of 1.18 (95% CI: 0.86 to 1.60, p = 0.30). Heterogeneity was moderate (I² of 49.5%, 95% CI: 0.0% to 85.3%).
All three studies (100%) were at high risk of bias, and the certainty of the cumulative evidence was rated very low under the GRADE approach.
One study found muscle injuries about twice as common in the late follicular phase versus other phases. Another reported peak rates in the luteal phase. A third found a nonsignificant follicular trend.
Interpretation
This systematic review and meta-analysis pooled three studies of professional football and futsal players comparing muscle injury rates in the luteal and follicular phases. The authors note that studies in this field have classified cycle phases in different ways. The findings support further study using methods based on the body's own signs to classify cycle phase.
RRM Context
The authors recommend hormone tests or urine ovulation kits to verify cycle phase, and call calendar counting alone insufficiently accurate. Restorative reproductive medicine treats the ovulatory cycle as a vital sign. It reads that sign from charted data that follow the observed signs of each cycle.
Our editorial summary of this paper, not the article's abstract.
Abstract
This systematic review and meta-analysis examined the relationship between menstrual cycle phases and the incidence of muscle injuries in female team sport athletes, following PRISMA 2020 and PERSiST guidelines. A comprehensive search was conducted in PubMed, Scopus, and SPORTDiscus from inception to mid-January 2024. Studies were included if they examined female team sport athletes of reproductive age with regular menstrual cycles and compared the occurrence of muscle injuries across at least two menstrual phases. Studies involving hormonal contraceptive use, medications affecting the menstrual cycle or musculoskeletal system, or menstrual dysfunction were excluded. Three studies met the inclusion criteria, involving 318 participants. Meta-analysis yielded a pooled Risk Ratio of 1.18 (95% CI: 0.75 to 1.86, p = 0.46) for injury risk between the luteal and follicular phases, suggesting no statistically significant association. However, the certainty of the cumulative evidence was rated as very low due to methodological limitations, including inconsistent phase classifications and reliance on imprecise methods for identifying menstrual phases. Consequently, no practical or clinical recommendations can be made at this time. Future research employing standardised, physiologically accurate methods for classifying and detecting menstrual cycle phases is necessary to better understand the potential links between hormonal fluctuations and injury risk.
