National Journal of Physiology, Pharmacy and Pharmacology

RESEARCH ARTICLE
Muscle strength variations and rate of fatigue in various phases of the
menstrual cycle in young adult females of Jammu

Sadaf Ashraf, Nabeela Yousuf, Sabah Nisar, Ranjana Gupta, Mrityunjay Gupta

Department of Physiology, Government Medical College, Jammu, Jammu and Kashmir, India
Correspondence to: Sabah Nisar, E-mail: saba.nisar114@gmail.com

Received: September 02, 2022; Accepted: January 12, 2023

ABSTRACT

Background: Phasic hormonal changes during menstrual cycle affect the exercise performance. Earlier studies
about the changes in muscle strength and rate of fatigue during different phases of the menstrual cycle have been
inconclusive. Aims and Objectives: The aims of this study were to study the muscle strength variations and rate of fatigue
during various phases of the menstrual cycle in young adult females. Materials and Methods: A prospective study was
conducted on 120 eumenorrheic female volunteers in the age group of 18–25 years female from GMC, Jammu. Handgrip
dynamometer and Mosso’s Ergograph were used, respectively, to assess muscle strength and muscle fatigue. Recording of
the test parameters was done in three phases of the menstrual cycle: Early follicular phase (Phase 1), late follicular phase
(Phase 2), and mid luteal phase (Phase 3). Results: Muscle strength was significantly higher in Phase 2 (Late Follicular
phase) than in Phase 1 (Early Follicular Phase) and Phase 3 (Mid Luteal Phase). The subjects showed less fatigability and
higher work done during the late follicular phase (Phase 2) compared to mid luteal phase (Phase 3) and early follicular
phase (Phase 1). Conclusion: Muscle functions are better in late follicular phase compared to mid-luteal or early follicular
phases.

KEY WORDS: Ergograph; Fatigue Rate; Handgrip Strength; Menstrual Cycle

INTRODUCTION In the past decades, it has repeatedly been verified that

serum concentrations of luteinizing hormone, follicle-
The human reproductive system shows marked differences stimulation hormone, estradiol, and progesterone (Prog)
between males and females. In case of females, it is fluctuate during the menstrual cycle and the levels of
characterized by regular cyclic changes in the ovaries androstenedione and testosterone peak before, or at the time
and other sexual organs during their reproductive years. of ovulation.[1,2]
Changes in hormone levels can produce profound alterations
in homeostasis. Phasic changes in levels of female sex Fluctuations in female steroid hormones affect the autonomic
hormones – estrogen and progesterone affect their physical nervous system and metabolic functions.[3] Therefore, certain
physiological parameters and athletic performance could
performance and also the psychological status.
change along with the menstrual cycle phases.[4]
Access this article online
Website: www.njppp.com Quick Response code The female sex steroid hormones estrogen and progesterone
potentially affect numerous parameters of exercise physiology
mechanisms such as exercise capacity, cardiovascular
DOI: 10.5455/njppp.2023.13.09422202212012023 function during exercise performance, thermoregulation,
psychological factors, and injury. For this reason, variations
in the level of these hormones throughout the menstrual cycle

National Journal of Physiology, Pharmacy and Pharmacology Online 2023. © 2023 Sabah Nisar, et al. This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (http://creative commons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix,
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1663 National Journal of Physiology, Pharmacy and Pharmacology 2023 | Vol 13 | Issue 08
Ashraf et al. Muscle strength and rate of fatigue in various phases of the menstrual cycle

can, at different times, have either a performance enhancing Rate of muscle fatigue was calculated from the record
or a performance reducing effect.[5-7] obtained on Mosso’s Ergograph.

In our study, each subject was evaluated in all three phases,

Statistical Analysis
namely, early follicular phase (Phase 1), late follicular
phase (Phase 2), and mid luteal phase (Phase 3), because The data obtained were compiled and tabulated using
they represent main events occurring during the menstrual Microsoft Excel. Statistical software SPSS 23 was used for
cycle, that is, menses, pre-ovulation, and peak progesterone the analysis of the data. Differences in the performance across
concentration, respectively. three phases of the menstrual cycle were tested by one-way
analysis of variance. P < 0.05 was considered as significant.
MATERIALS AND METHODS
RESULTS
This study was conducted over a span of 1 year from
November 2020 to October 2021 in the Research Laboratory Age of the subjects ranged from 18 to 25 years. Their body
of Department of Physiology, Government Medical College, mass index (BMI) was in the range of 16.26–32.50 kg/m2
Jammu, J&K, India. One hundred and twenty healthy female [Table 1]. BMI of 71.7% subjects in our study was normal.
volunteers aged between 18 and 25 years were selected to Among the rest, 17 (14.16%) subjects were underweight; 15
participate. A thorough medical history was recorded. subjects (12.5%) were overweight, while two were obese
(1.7%). Handgrip muscle strength was significantly higher in
late follicular phase than in the early follicular or mid luteal
Inclusion Criteria
phases, as shown in Table 2. Less fatigability and highest
Healthy females with regular and normal menstrual cycles work done were observed during the late follicular phase
lasting between 24 and 32 days, for the past 6 months were compared to mid luteal and early follicular phases, as shown
included in the study. in Figure 1.

Exclusion Criteria DISCUSSION

Female students having polycystic ovarian disease, irregular
To investigate the changes in muscle strength and rate
menstrual cycles, with history of oral contraceptive use,
of fatigue during various phases of the menstrual cycle in
history of musculoskeletal disorders, psychiatric illness, and
young adult females, 120 moderately active Medical College
chronic diseases were excluded from the study.
students were chosen as subjects.
The Institutional Ethics Committee clearance was obtained
Regular fluctuations in ovarian hormone levels, particularly
vide their letter no: IEC/GMC/2021/686 Dated: November
estrogen and progesterone during the normal ovulatory cycle,
29, 2021.
produce profound alterations in the body homeostasis of
The aim and methodology of the study were explained women between the ages of 13 and 50 years.[8]
to the female students of Government Medical College
Jammu. Out of 300 students approached, 147 gave consent Table 1: Baseline characteristics of the subjects (n=120)
to participate. One hundred and twenty eligible subjects Parameters Range Mean±SD
were left after applying the exclusion criteria. A written Age (years) 18–25 21.71±2.27
informed consent was taken from those who agreed to take Height (meters) 135–175 160.17±7.04
part in the project. To familiarize them with the procedure,
Weight (kg) 40–87 56.02±7.97
frequent demonstrations were given. The tests were carried
BMI (kg/m )
2
16.26–32.50 21.87±3.23
out thrice in each individual, once each in the three phases
BMI: Body mass index
of the menstrual cycle: Early follicular phase (Phase 1), late
follicular phase (Phase 2), and mid luteal phase (Phase 3).
Average value was recorded. Table 2: Handgrip strength during three phases of
menstrual cycle
The duration of the menstrual cycle and the onset of each Phase of Handgrip strength (kg) P‑value
phase were determined using a free period tracker application menstrual cycle
named clue period tracking. Phase 1 24.36±4.58 0.005
Phase 2 25.69±4.54
An electronic handgrip dynamometer (Constant model no:
Phase 3 23.85±4.45
EH 101) with maximum capacity of 90 kg was used.

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Ashraf et al. Muscle strength and rate of fatigue in various phases of the menstrual cycle

These results are in agreement with various other

studies.[10,19,20]

On the other hand, Fridén et al.; De Jonge et al.; Lebrun et al.,

and Shultz et al. have reported no differences in maximal
force across different menstrual cycle phases.[10,15,21,22]
Tsampoukos et al., who examined the effects of menstrual
cycle on sprinting performance, have proposed that hormonal
fluctuations in a menstrual cycle do not interfere with
maximal intensity sprinting.[23]

Another study with results not in agreement with the present

study was by Garcia-Pinillos et al.,[24] but their study was on
Figure 1: Mean values for work done by Mosso’s Ergograph
P = 0.000 a different set of subjects, namely, resistance-trained women
in contrast to our normal healthy young medical students.
Moreover, they have examined the effects of the menstrual
The early follicular phase begins with menstruation, which
cycle on vertical jumping, sprint performance, and force-
usually takes 4–6 days to complete. During this time, female velocity profiling. These parameters remained constant
sex hormone concentrations are all relatively low and stable. regardless of the phase of the menstrual cycle.
The follicular phase continues until ovulation occurs; during
the late follicular phase, there is an increase in estrogen as The results from our study will help in providing advice to
the ovarian follicles, each containing an egg, mature. The physically active females to organize their exercise regime
mid luteal phase coincides with a peak in progesterone in a way that will improve their physical performance and
level and the second, smaller peak in estrogen, to prepare also minimize the chances of injury that might occur during
the endometrium for the implantation of a fertilized egg.[9] strenuous physical effort.

Our study group comprised the subjects having age in the

range of 18–25 years with mean age of 21.71 ± 2.27 years. Limitations
It is on similar lines as the age parameters reported by This study was done among 120 medical students from
Shultz et al., Pallavi et al.[10,11] Government Medical College Jammu, further studies
covering a wider population will be more useful. Hormonal
Handgrip strength has been used to estimate explosive assay was not done. The muscle groups tested are a small part
strength since it is only slightly influenced by skills and of the body musculature so we cannot imply that the results
motivation of the subject.[12] would be similar for other muscle groups. Muscle lactic acid
levels should have been tested, but these facilities are not
Muscle strength as measured by handgrip dynamometer in available at present in our institute.
Phase 2 (Late follicular phase) was significantly higher than
Phase 1 (Early follicular phase) and Phase 3 (Mid luteal phase).
CONCLUSION
Various studies have demonstrated that muscle strength The present investigation demonstrates that in eumenorrheic
varies across the different phases of menstrual cycle.[11,13,14] females, muscle strength, as measured by handgrip
dynamometer, was higher in late follicular phase than in the
Studies not in agreement with the present work have also early follicular phase or the mid luteal phase.
been reported in literature.[8,15-17]
The subjects of our study showed less fatigability and highest
Rate of muscle fatigue in our study was calculated from the work done during the late follicular phase.
record obtained on Mosso’s Ergograph averaged over three
phases of menstrual cycle (Early follicular, late follicular, and
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Source of Support: Nil, Conflicts of Interest: None declared.
of menstrual phase-dependent resistance training frequency

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