Psychological outcomes across the natural menstrual cycle in active women and athletes: A systematic review

Psychological responses to training and competition can vary across the menstrual cycle, yet phase-specific patterns in active and trained women remain poorly characterised. To synthesise current evidence on psychological outcomes across the phases of the natural menstrual cycle in active women and athletes. This systematic review followed PRISMA guidelines. Studies were eligible if they assessed psychological outcomes across at least two menstrual cycle phases in women with natural menstrual cycles (≥18 years) who were engaged in structured training or physically active (≥150 min of moderate-to-vigorous activity per week) for at least 3 months. Five studies were identified through database searches (PubMed, Scopus, Web of Science, SPORTDiscus) and screened independently by two reviewers. Outcomes were analysed narratively due to the heterogeneity of results. The methodological quality of the included studies was independently assessed using the Quality Assessment Tool for Quantitative Studies. Across studies, the menstrual and luteal phases were associated with reductions in positive mood and motivation, increased somatic complaints, and elevated emotional tension. Cognitive-affective outcomes such as attention and perceived performance were also impaired, particularly in the late luteal phase. In contrast, the follicular phase showed more favourable psychological functioning. The ovulatory phase was often not verified in the studies. Perceived interference and negative menstrual attitudes moderated several outcomes independent of physiological measures. Psychological states may vary across the menstrual cycle, with evidence suggesting greater vulnerability during the luteal and menstrual phases. These findings support the relevance of cycle-informed monitoring and the potential value of individualised support strategies in sport contexts.