Exploring the relationship between

nutritional intake and menstrual cycle in

elite female athletes
Mana Miyamoto1,2 and Kenichi Shibuya1,2
1
Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan
2
Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan

ABSTRACT
This study aimed to examine potential variations in nutritional intake among female
athletes, including top-level, throughout the menstrual cycle. A total 122 female
athletes participated in the study, documenting their food consumption over a 3-day
period. The menstrual status of female athletes was also assessed, and using the
survey results, the phase of the menstrual cycle (the follicular, early luteal, or late
luteal) during which each meal was recorded was determined. Consequently, the
meal records were categorized into the respective three phases. The findings of this
study indicated that there were no notable disparities in nutritional intake,
encompassing energy, protein, fat, carbohydrate, calcium, iron, and fiber, across the
three phases of the menstrual cycle. The results imply that female athletes may
experience comparatively smaller variations in nutrient intake related to the
menstrual cycle. This could be attributed to the higher energy requirements of female
athletes because of their rigorous training. This study underscores the significance of
accounting for the population when examining nutrient intake changes associated
with the menstrual cycle.

Subjects Food Science and Technology, Andrology, Nutrition, Women’s Health, Sports Medicine
Keywords Elite athletes, Cortisol, Estrogen, Progesterone, Menstrual cycle
Submitted 20 June 2023
Accepted 25 August 2023 INTRODUCTION
Published 25 September 2023 Preserving optimal menstrual cycle function plays a vital role in safeguarding female
Corresponding author reproductive health (Rogan & Black, 2022). The menstrual cycle encompasses a
Mana Miyamoto,
mana-miyamoto@nuhw.ac.jp
multifaceted sequence of events that primes the uterus for potential pregnancy. It is
categorized into two primary phases, namely the follicular and luteal phases, distinguished
Academic editor
Russell Kabir by the onset of menstruation, follicular maturation, ovulation, and the formation of the
Additional Information and corpus luteum (Reed & Carr, 2000).
Declarations can be found on Nevertheless, solely dividing the menstrual cycle into these two phases does not offer
page 8
sufficient insight to comprehensively grasp the diverse hormonal fluctuations that
DOI 10.7717/peerj.16108 transpire within them. Consequently, researchers frequently employ sub-phases, such as
Copyright follicular, ovulatory, early luteal, and late luteal phases, to categorize the menstrual cycle
2023 Miyamoto and Shibuya
with greater precision (Hirschberg, 2012). These sub-phases are characterized by notable
Distributed under
Creative Commons CC-BY 4.0
shifts in hormone levels, including estrogen, progesterone, follicle-stimulating hormone
(FSH), and luteinizing hormone (LH) (McLay et al., 2007). The menstrual cycle

How to cite this article Miyamoto M, Shibuya K. 2023. Exploring the relationship between nutritional intake and menstrual cycle in elite
female athletes. PeerJ 11:e16108 DOI 10.7717/peerj.16108
 commences with the follicular phase, triggered by the onset of menstruation. During this
initial phase, ovarian follicles gradually mature in response to follicle-stimulating hormone
(FSH) released by the pituitary gland. As these follicles develop, the production of estrogen
increases. This estrogen surge exerts a profound influence on diverse bodily systems,
encompassing metabolism, thermoregulation, and neurotransmission. Furthermore,
heightened estrogen levels prompt the pituitary gland to release luteinizing hormone (LH),
a pivotal trigger for ovulation. Subsequent to ovulation, in the early luteal phase, the
secretion of progesterone commences, accompanied by sustained estrogen production.
Simultaneously, the secretion of FSH and LH is repressed. As the menstrual cycle
progresses into the late luteal phase, the corpus luteum, once vibrant, initiates regression.
Consequently, levels of both estrogen and progesterone gradually wane.
Moreover, it is widely recognized that both estrogen and progesterone influence feeding
behavior. Estrogen is thought to have appetite-suppressing effects, whereas progesterone
has been demonstrated to increase appetite, particularly when combined with estrogen
(Devries et al., 2006; Elliott-Sale et al., 2021; Giersch et al., 2020). Research conducted on
the non-athlete individuals in the general population has indicated a noteworthy reduction
in energy intake during the follicular phase of the menstrual cycle compared to the luteal
phase. These variations are attributed to the hormonal effects observed during this period
(Elliott-Sale et al., 2021; Giersch et al., 2020; Kammoun et al., 2017; Barr, Janelle & Prior,
1995; Cheikh Ismail et al., 2009). To clarify, during the follicular phase, we anticipate a
decrease in appetite attributed to estrogen’s influence. Conversely, in the early luteal phase,
we expect a notable increase in appetite due to the combined effects of estrogen and
progesterone. However, during the late luteal phase, while the impact of these hormones is
somewhat diminished, the presence of menstrual cramps might further dampen the
appetite. Indeed, prior investigations have unveiled a noteworthy rise in nutrient
consumption during the initial half of the luteal phase when contrasted with the follicular
phase within the broader female population (Bowen & Grunberg, 1990; Tucci et al., 2009;
Martini et al., 1994; Tarasuk & Beaton, 1991).
However, fluctuations in energy intake during the menstrual cycle can exert a
considerable influence on the sports performance of female athletes. Hence, it is imperative
to examine the variability of energy intake across the menstrual cycle within this
population. It is widely recognized that the menstrual cycle can impact athletic
performance (Freemas et al., 2021; Lebrun et al., 1995) as well as exercise metabolism
(Oosthuyse & Bosch, 2010). Moreover, it is well-established insufficient energy intake,
considering the elevated energy expenditure of female athletes, could lead to menstrual and
other physiological dysfunction (Miyamoto, Hanatani & Shibuya, 2021a). However,
despite the unique challenges faced by female athletes in this aspect compared to their male
counterparts, there is a dearth of research in sports science that specifically focuses on
female athletes (Carmichael et al., 2021; Cowley et al., 2021). Consequently, it remains
unclear whether the impact of sex hormones on energy intake is significant among female
athletes.
The objective of this study was to examine variances in nutrient intake throughout the
menstrual cycle among female elite athletes. Considering the augmented energy

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 2/10

 expenditure associated with physical exercise, top-level athletes possess higher greater
energy demands compared to the general population. Therefore, we hypothesized that
there would be no significant difference in nutrient intake during the menstrual cycle.
To assess the validity of this hypothesis, the current study scrutinized the dietary intake
and menstrual cycles of 122 female athletes, encompassing individuals competing at the
international level. These data were subjected to analysis through a generalized linear
mixed model. This study would provide fundamental data for developing measures to
maintain the condition of female athletes.

METHODS
Participants
The present study recruited 122 female athletes between the ages of 15 and 24 years, who
were intercollege-level track and field athletes and international-level rowing athletes.
All athletes included in the study provided their consent to participate. The study was
approved by the Ethics Committee of Niigata University of Health and Welfare (Approval
#17982-180606), and each participant provided written informed consent after receiving a
comprehensive explanation of the study procedures and the non-invasive nature of the
research.

Dietary intake, body mass, and body composition

The participants utilized a meal-recording method to document their dietary intake. Every
athlete independently selects 3 days per week, comprising two training days and one
designated rest day. They captured photos of each meal, including breakfast, lunch, dinner,
and snacks, which were then sent to the team dietitian. The dietitians analyzed the nutrient
content of these meals using information obtained from the Japan National Nutrient
Database or specific nutrition facts panels provided by the products. Daily nutrient intake
data, such as total energy (kcal), macronutrients (grams and percentage), and fiber (in
grams), were averaged. Participant measurements of body mass (BM) and body fat
percentage (%BF) were taken using a commercially available home scale (BC-314; Tanita
Co., Tokyo, Japan). Body mass index (BMI) was calculated by dividing weight (in
kilograms) by height squared (in meters). Height, BM, and %BF were measured only once
during the investigation. All these methods were consistent with those used in previous
studies (Miyamoto, Hanatani & Shibuya, 2021a, 2021b; 2022).

Menstrual cycle
The participants documented their menstrual cycles by utilizing a paper and pen calendar
and provided the information through reporting. Using the data of the last menstrual
period and the length of each individual’s menstrual cycle, we determined the phase of the
menstrual cycle to which the meal survey period corresponded. In cases where a clear
determination could not be made, or if an athlete had an irregular menstrual cycle, the data
were excluded from the analysis.

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 3/10

 Table 1 Mean values of physical characteristics and state anxiety (Mean ± S.E).
Height (cm) Body mass (kg) %BF (%) BMI
168.0 ± 0.4 62.0 ± 0.5 21.7 ± 0.5 21.9 ± 0.1
Note:
BF, body fat; BMI, body mass index.

Statistical analyses
The data were expressed as mean ± standard error. We conducted statistical analyses using
the lmerTest package in R (version 4.2.3) (R Core Team, 2023). We used Akaike’s
Information Criterion (AIC) to validate the parameters for the linear mixed model
(LMM). For the LMM analysis, subject ID was set as a random effect, and fixed effects were
identified based on the AIC score, which served as an indicator. Then, we performed the
analysis of variance using the results of this LLM, and we estimated the degrees of freedom
using the Kenward-Roger method. The significance level was set as 0.05.

RESULTS
Physical characteristics
Table 1 shows the physical characteristics of athletes. The average body fat percentage
(%BF) among the athletes was 21.7%, with a 95% confidence interval (CI) of [20.7–22.7%].
Out of the 122 athletes, 45 had a %BF below 20%. The average body mass index (BMI) was
21.9, with a 95% CI of [21.7–22.2]. None of the athletes had a BMI below 18.5, but 17 had a
BMI below 20.

Macronutrient intake
The mean energy intake of all athletes was 2,626.1 kcal (95% CI [2,532.6–2,719.7 kcal])
(Fig. 1) During the dietary survey period, 61 of 122 athletes were in the follicular phase, 40
were in the early luteal phase, and 21 were in the late luteal phase. The mean energy intake
for these phases was 2,732.6 kcal (95% CI [2,601.5–2,863.8 kcal]), 2,492.7 kcal (95% CI
[2,322.6–2,662.8 kcal]), and 2,571.1kcal (95% CI [2,379.3–2,762.9 kcal]), respectively
(Table 2).
The mean protein intake was 112.0 g (95% CI [107.3–116.7 g]). The mean protein
intake per body mass (Pro/BM) was 1.8 g/kg (95% CI [1.7–1.9 g/kg]). Among the athletes,
Pro/BM values of 1.0 or above, 1.5 or above, and 2.0 or above were found in 122, 88, and 43
athletes, respectively. The mean carbohydrate (CHO) intake was 343.8 g (95% CI
[328.7–359.0 g]). The mean CHO intake per body mass (CHO/BM) was 5.6 g/kg (95% CI
[5.3–5.8 g/kg]). CHO/BM values of five or above, and six or above were found in 70 and 44
athletes, respectively.

Micronutrient intake
The mean calcium (Ca) intake was 831.8 mg (95% CI [767.3–896.4 mg]) (Table 2). Among
the athletes, 46 athletes had a Ca intake of more than 900 mg, and 18 athletes had a Ca

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 Figure 1 Changes in nutrient intake per menstrual cycle. There were no statistically significant dif-
ferences in nutrient intake between menstrual cycles (p > 0.05).
Full-size  DOI: 10.7717/peerj.16108/fig-1

Table 2 Nutritional intake during the menstrual cycle.

Explanatory variables Total Follicular Luteal early Luteal late F value p value
95% CI n = 122 n = 61 n = 40 n = 21
Energy (kcal/day) 2,626.1 2,732.6 2,492.7 2,571.1 1.574 0.212
95% CI [2,532.6–2,719.7] [2,601.5–2,863.8] [2,322.6–2,662.8] [2,379.3–2,762.9]
CHO (g/day) 343.8 360.6 319.2 342.3 1.886 0.157
95% CI [328.7–359.0] [338.2–382.9] [294.5–343.8] [308.8–375.7]
Protein (g/day) 112.0 116.3 107.2 108.7 1.213 0.301
95% CI [107.3–116.7] [109.6–122.9] [98.6–115.7] [99.3–118.2]
Fat (g/day) 84.9 87.1 82.9 82.6 0.562 0.572
95% CI [81.2–88.7] [81.6–92.5] [76.1–89.7] [75.2–89.9]
Ca (mg/day) 831.8 885.9 776.8 799.6 1.007 0.369
95% CI [767.3–896.4] [779.1–992.7] [689.0–864.7] [656.3–902.8]
Fe (mg/day) 12.5 13.2 11.7 12 1.322 0.271
95% CI [11.8–13.2] [12.2–14.1] [10.4–13.0] [10.7–13.4]
(Continued )

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 Table 2 (continued )
Explanatory variables Total Follicular Luteal early Luteal late F value p value
95% CI n = 122 n = 61 n = 40 n = 21
Fiber (g/day) 16.6 17.2 15.6 16.3 0.734 0.497
95% CI [15.6–17.5] [15.7–18.7] [14.1–17.2] [14.4–18.1]
Vitamin B1 (mg/day) 1.77 1.8 1.67 1.85 0.724 0.487
95% CI [1.37–1.87] [1.66–1.94] [1.51–1.84] [1.57–2.13]
Vitamin B2 (mg/day) 2.13 2.17 2.07 2.12 0.004 0.962
95% CI [1.98–2.27] [0.95–2.38] [1.83–2.30] [1.74–2.51]
Vitamin C (mg/day) 181.3 178.5 179.9 191.9 0.498 0.609
95% CI [164.6–197.9] [154.7–202.3] [151.2–208.5] [149.9–233.9]
Note:
Total: Encompassing the entire dataset, this category includes all 122 athletes who were part of the study. Follicular: This category includes 61 athletes whose study period
falls within the follicular phase of the menstrual cycle. Luteal Early: The category includes 40 athletes whose study period falls within the initial half of the luteal phase of
the menstrual cycle. Luteal Late: The category includes 21 athletes whose study period falls within the latter half of the luteal phase of the menstrual cycle.

intake of more than 1,200 mg. The mean iron (Fe) intake was 12.5 mg (95% CI
[11.8–13.2 mg]). Among the athletes, 34 athletes had a Fe intake below 10 mg, 94 athletes
had a Fe intake below 15 mg, and 110 athletes had a Fe intake below 18 mg.

Effect of the menstrual cycle

Table 2 shows that there was no significant difference in energy intake between the
follicular, early luteal, and late luteal phases (F = 1.573, p = 0.212). Additionally, there were
no significant differences in protein, fat, or carbohydrate intakes between these phases
(F = 1.213, p = 0.301; F= 0.562, p = 0.572; F = 1.886, p = 0.157, respectively). There were
also no significant differences in Ca, Fe, or fiber intakes between these phases (F = 1.007,
p = 0.369; F = 1.322, p = 0.271; F = 0.734, p = 0.497, respectively).

DISCUSSION
This study stands as a pioneering endeavor in elucidating the intricate interplay between
the menstrual cycle and nutritional intake among female athletes, encompassing those of
elite caliber. As such, we consider this contribution to hold substantial significance in the
field. The present study revealed no significant variation in nutritional intake among
female elite athletes throughout the menstrual cycle. This finding diverges from numerous
studies conducted on the general female population, which have consistently
demonstrated higher nutrient intake during the luteal phase compared to the follicular
phase (Bowen & Grunberg, 1990; Tucci et al., 2009; Martini et al., 1994; Tarasuk & Beaton,
1991). Moreover, feeding behavior is known to be influenced by both estrogen and
progesterone, with estrogen speculated to suppress appetite and progesterone recognized
for increasing appetite in the presence of estrogen (Hirschberg, 2012; McLay et al., 2007;
Devries et al., 2006). Previous research has also highlighted that during the luteal phase,
when both estrogen and progesterone levels rise, food intake tends to be elevated,
particularly for sweet foods, while during the follicular phase, when estrogen levels rise

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 6/10

 alone, food intake decreases (Bowen & Grunberg, 1990; Racine et al., 2012, 2013; Klump
et al., 2013, 2008).
The female body is highly susceptible to the influence of sex hormones, as they play a
vital role in maintaining optimal reproductive function. Surprisingly, the current study
discovered no significant alterations in nutritional intake throughout the menstrual cycle
among the selected group of female elite athletes. These findings imply that the impact of
the menstrual cycle on nutritional intake might be mitigated in female athletes due to their
heightened energy requirements resulting from rigorous daily training.
Furthermore, previous research has indicated that athletes experience increased cortisol
secretion due to the heightened stress associated with exercise (Schaal, Van Loan &
Casazza, 2011).
The hypothalamic-pituitary-adrenal (HPA) axis is widely recognized as the primary
mediator of physiological stress responses and may play a role in the connection between
stress and food intake. When a perceived threat or challenge arises, corticotropin-releasing
hormone (CRH) is released from the hypothalamus, triggering the subsequent release of
adrenocorticotropic hormone (ACTH) from the pituitary gland, and ultimately leading to
the release of glucocorticoids (GCs) from the adrenal cortex (Tsigos & Chrousos, 2002).
Glucocorticoids, such as cortisol in humans and corticosterone in animals, promote
glucose availability by stimulating protein breakdown, gluconeogenesis, and lipolysis, thus
facilitating energy mobilization and adaptation. While cortisol is acknowledged for its
contribution to increased adiposity during periods of energy surplus, it also serves as a
critical catabolic hormone secreted by the adrenal cortex in response to prolonged
exercise, starvation, glycogen depletion, and stress (Schaal, Van Loan & Casazza, 2011).
Consequently, in athletes, cortisol secretion in response to stress may be a significant factor
influencing appetite. This could potentially account for the relatively modest impact of sex
hormone secretion, which fluctuates with each menstrual cycle, on appetite. In athletes, the
secretion of cortisol induced by exercise can be regarded as a factor contributing to anxiety
and the sustenance of elevated nutrient intake. Notably, heightened levels of psychological
anxiety have been documented among female athletes with comparable profiles
(Miyamoto, Hanatani & Shibuya, 2022).
The results of the present study found no significant changes in nutritional intake with
the menstrual cycle in female athletes, including top-level female athletes. While the
mechanisms enabling female athletes to uphold elevated nutrient intake while
circumventing the influences of sex hormone production linked to the menstrual cycle
remain ambiguous, we contend that this study holds noteworthy significance in its
examination of nutrient intake patterns across each menstrual cycle among female
athletes. Nevertheless, the underlying causal connections remain uncertain, and for a more
precise comprehension of the impact of the menstrual cycle on nutrient consumption,
forthcoming research should encompass assessments of sex hormone levels and pinpoint
the ovulation timeframe. An inherent constraint within the study design was the inability
to directly assess blood levels of female hormones in concordance with the natural
menstrual cycle. We posit that a more comprehensive discourse could have ensued had
these specific measurements been incorporated. Nevertheless, it is worth noting that the

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 7/10

 study’s chosen design effectively facilitated the collection of data from a diverse cohort of
female athletes, encompassing individuals of elite standing. Despite these limitations, the
present study provides valuable insights into the relationship between the menstrual cycle
and nutritional intake in female athletes, which may guide future research in this area.

ADDITIONAL INFORMATION AND DECLARATIONS

Funding
The authors received no funding for this work.

Competing Interests
Kenichi Shibuya is an Academic Editor of PeerJ.

Author Contributions
 Mana Miyamoto conceived and designed the experiments, performed the experiments,
analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the
article, and approved the final draft.
 Kenichi Shibuya conceived and designed the experiments, performed the experiments,
analyzed the data, prepared figures and/or tables, and approved the final draft.

Human Ethics
The following information was supplied relating to ethical approvals (i.e., approving body
and any reference numbers):
All participating athletes provided their consent for the study. The Ethics Committee of
Niigata University of Health and Welfare provided approval to carry out the study
(Approval #17982-180606).

Data Availability
The following information was supplied regarding data availability:
The raw data is available in the Supplemental File.

Supplemental Information
Supplemental information for this article can be found online at http://dx.doi.org/10.7717/
peerj.16108#supplemental-information.

REFERENCES
Barr SI, Janelle KC, Prior JC. 1995. Energy intakes are higher during the luteal phase of ovulatory
menstrual cycles. The American Journal of Clinical Nutrition 61(1):39–43
DOI 10.1093/ajcn/61.1.39.
Bowen DJ, Grunberg NE. 1990. Variations in food preference and consumption across the
menstrual cycle. Physiology and Behavior 47(2):287–291 DOI 10.1016/0031-9384(90)90144-S.
Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. 2021. The impact of menstrual cycle
phase on athletes’ performance: a narrative review. International Journal of Environmental
Research on Public and Health 18(4):1667 DOI 10.3390/ijerph18041667.

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 8/10

 Cheikh Ismail LI, Al-Hourani H, Lightowler HJ, Sldhaheri AS, Henry CJ. 2009. Energy and
nutrient intakes during different phases of the menstrual cycle in females in the United Arab
Emirates. Annals of Nutrition and Metabolism 54(2):124–128 DOI 10.1159/000209395.
Cowley ES, Olenick AA, McNulty KL, Ross EZ. 2021. “Invisible sportswomen”: the sex data gap in
sport and exercise science research. Women in Sport and Physical Activity Journal 29(2):146–151
DOI 10.1123/wspaj.2021-0028.
Devries MC, Hamadeh MJ, Phillips SM, Tarnopolsky MA. 2006. Menstrual cycle phase and sex
influence muscle glycogen utilization and glucose turnover during moderate-intensity
endurance exercise. The American Journal of Physiology-Regulatory, Integrative and
Comparative Physiology 291(4):R1120–R1128 DOI 10.1152/ajpregu.00700.2005.
Elliott-Sale KJ, Minahan CL, de Jonge X, Ackerman KE, Sopilla S, Constantini NW,
Lebrun CM, Hackney AC. 2021. Methodological considerations for studies in sport and
exercise science with women as participants: a working guide for standards of practice for
research on women. Sports Medicine 51(5):843–861 DOI 10.1007/s40279-021-01435-8.
Freemas JA, Baranauskas MN, Constantini K, Constantini N, Greenshields JT,
Mickleborough TD, Raglin JS, Schlader ZJ. 2021. Exercise performance is impaired during the
midluteal phase of the menstrual cycle. Medicine and Science in Sports and Exercise
53(2):442–452 DOI 10.1249/MSS.0000000000002464.
Giersch GEW, Morrissey MC, Katch RK, Colburn AT, Sims ST, Stachenfeld NS, Casa DJ. 2020.
Menstrual cycle and thermoregulation during exercise in the heat: a systematic review and meta-
analysis. Journal of Science and Medicine in Sport 23(12):1134–1140
DOI 10.1016/j.jsams.2020.05.014.
Hirschberg AL. 2012. Sex hormones, appetite and eating behaviour in women. Maturitas
71(3):248–256 DOI 10.1016/j.maturitas.2011.12.016.
Kammoun I, Ben Saada W, Sifaou A, Haouat E, Kandara H, Salem LB, Salma CB. 2017. Change
in women’s eating habits during the menstrual cycle. Annals of Endocrinology 78(1):33–37
DOI 10.1016/j.ando.2016.07.001.
Klump KL, Keel PK, Burt SA, Racine SE, Neale MC, Sisk CL, Boler S. 2013. Ovarian hormones
and emotional eating associations across the menstrual cycle: an examination of the potential
moderating effects of body mass index and dietary restraint. International Journal of Eating
Disorders 46(3):256–263 DOI 10.1002/eat.22084.
Klump KL, Keel PK, Culbert KM, Edler C. 2008. Ovarian hormones and binge eating: exploring
associations in community samples. Psychology and Medicine 38(12):1749–1757
DOI 10.1017/S0033291708002997.
Lebrun CM, McKenzie DC, Prior JC, Taunton JE. 1995. Effects of menstrual cycle phase on
athletic performance. Medicine and Science in Sports and Exercise 27(3):437–444
DOI 10.1249/00005768-199503000-00022.
Martini MC, Lampe JW, Slavin JL, Kurzer MS. 1994. Effect of the menstrual cycle on energy and
nutrient intake. The American Journal of Clinical Nutrition 60(6):895–899
DOI 10.1093/ajcn/60.6.895.
McLay RT, Thomson CD, Williams SM, Rehrer NJ. 2007. Carbohydrate loading and female
endurance athletes: effect of menstrual-cycle phase. International Journal of Sport Nutrition and
Exercise Metabolism 17(2):189–205 DOI 10.1123/ijsnem.17.2.189.
Miyamoto M, Hanatani Y, Shibuya K. 2021a. Dietary intake and menstrual cycle changes in
international level young athletes. The Journal of Sports Medicine and Physical Fitness
61(6):851–856 DOI 10.23736/S0022-4707.20.11392-6.

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 9/10

 Miyamoto M, Hanatani Y, Shibuya K. 2021b. Relationship among nutritional intake, anxiety, and
menstrual irregularity in elite rowers. Nutrients 13(10):3436 DOI 10.3390/nu13103436.
Miyamoto M, Hanatani Y, Shibuya K. 2022. Increased vitamin D intake may reduce psychological
anxiety and the incidence of menstrual irregularities in female athletes. PeerJ 10(21):e14456
DOI 10.7717/peerj.14456.
Oosthuyse T, Bosch AN. 2010. The effect of the menstrual cycle on exercise metabolism:
implications for exercise performance in eumenorrhoeic women. Sports Medicine 40(3):207–227
DOI 10.2165/11317090-000000000-00000.
R Core Team. 2023. R: a language and environment for statistical computing. Vienna, Austria: R
Foundation for Statistical Computing. Available at https://www.R-project.org/.
Racine SE, Culbert KM, Keel PK, Sisk CL, Burt SA, Klump KL. 2012. Differential associations
between ovarian hormones and disordered eating symptoms across the menstrual cycle in
women. International Journal of Eating Disorder 45(3):333–344 DOI 10.1002/eat.20941.
Racine SE, Keel PK, Burt SA, Sisk CL, Neale M, Boker S, Klump KL. 2013. Individual differences
in the relationship between ovarian hormones and emotional eating across the menstrual cycle: a
role for personality? Eating Behavior 14(2):161–166 DOI 10.1016/j.eatbeh.2013.02.007.
Reed BG, Carr BR. 2000. The normal menstrual cycle and the control of ovulation. South
Dartmouth, MA, USA: MDText.com, Inc.
Rogan MM, Black KE. 2022. Dietary energy intake across the menstrual cycle: a narrative review.
Nutritional Review 81(7):869–886 DOI 10.1093/nutrit/nuac094.
Schaal K, Van Loan MD, Casazza GA. 2011. Reduced catecholamine response to exercise in
amenorrheic athletes. Medicine and Science in Sports and Exercise 43(1):34–43
DOI 10.1249/MSS.0b013e3181e91ece.
Tarasuk V, Beaton GH. 1991. Menstrual-cycle patterns in energy and macronutrient intake. The
American Journal of Clinical Nutrition 53(2):442–447 DOI 10.1093/ajcn/53.2.442.
Tsigos C, Chrousos GP. 2002. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and
stress. Journal of Psychosomatic Research 53(4):865–871 DOI 10.1016/S0022-3999(02)00429-4.
Tucci SA, Murphy LE, Boyland EJ, Halford JC. 2009. Influence of premenstrual syndrome and
oral contraceptive effects on food choice during the follicular and luteal phase of the menstrual
cycle. Endocrinology and Nutrition 56(4):170–175 DOI 10.1016/S1575-0922(09)70981-7.

Miyamoto and Shibuya (2023), PeerJ, DOI 10.7717/peerj.16108 10/10