Female players get 6 times more severe injuries than men.

The effect of the menstrual cycle on female sports performance is a growing interest area in sports and athletics (Oleka, 2019). Of women who exercise regularly, 41.7% believe their menstrual cycle has a negative effect on exercise training and performance (Bruinvels et al., 2016).

The female body uses carbohydrates more efficiently in the follicular phase and is better at using fats and amino acids in the luteal phase. The latter part of the first half of the menstrual cycle is also a vulnerable time for anterior cruciate ligament (ACL) injuries (Martin et al.,2021) because of the effect of hormonal fluctuations on biomechanics and laxity of ligaments (Deie et al., 2002). Indeed, research shows that women sustain more severe injuries than men when playing football (Mufty et al., 2015).

Specifically, female football players are reported to have 21% more absence due to injury compared to men, primarily due to greater incidence of severe knee and ankle ligament injuries, with ACL injuries occurring 2–8 times more often for female football players (Larruskain et al., 2018; Lin et al., 2018). As a sad example, one of the best football clubs in women football, Juventus FC, reported 12 ACL injuries in less than two years during their first seasons in Serie A (2017-2019; personal communication).

However, at the 2019 World Cup, the US Women's National Soccer Team had their menstrual cycles and symptoms tracked, and the coaches designed specific workouts tailored toward the anabolic effects of the follicular phase and the catabolic effects of the luteal phase. Ultimately, the team won the World Cup. Fortunately, there is a growing understanding of the need to design specific workouts tailored toward the anabolic effects of women's follicular phase.

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Bruinvels,G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2016). Theprevalence and impact of heavy menstrual bleeding (Menorrhagia) in elite andnon-elite athletes. PLoS ONE, 11(2), 1–8.https://doi.org/10.1371/journal.pone.0149881

Deie,M., Sakamaki, Y., Sumen, Y., Urabe, Y., & Ikuta, Y. (2002). Anterior kneelaxity in young women varies with their menstrual cycle. InternationalOrthopaedics, 26(3), 154–156.https://doi.org/10.1007/s00264-001-0326-0

Larruskain,J., Lekue, J. A., Diaz, N., Odriozola, A., & Gil, S. M. (2018). Acomparison of injuries in elite male and female football players: A five-seasonprospective study. Scandinavian Journal of Medicine and Science in Sports,28(1), 237–245. https://doi.org/10.1111/sms.12860

Lin,C. Y., Casey, E., Herman, D. C., Katz, N., & Tenforde, A. S. (2018). SexDifferences in Common Sports Injuries. PM and R, 10(10),1073–1082. https://doi.org/10.1016/j.pmrj.2018.03.008

Martin,D., Timmins, K., Cowie, C., Alty, J., Mehta, R., Tang, A., & Varley, I.(2021). Injury Incidence Across the Menstrual Cycle in InternationalFootballers. Frontiers in Sports and Active Living, 3(March),1–7. https://doi.org/10.3389/fspor.2021.616999

Mufty, S., Bollars, P., Vanlommel, L., Van Crombrugge, K.,Corten, K., & Bellemans, J. (2015). Injuries in male versusfemale soccer players: epidemiology of a nationwide study. Acta OrthopaedicaBelgica, 81(2), 289–295. http://www.ncbi.nlm.nih.gov/pubmed/26280969

Oleka,C. T. (2019). Use of the Menstrual Cycle to Enhance Female Sports Performanceand Decrease Sports-Related Injury. Journal of Pediatric and AdolescentGynecology, 2–3. https://doi.org/10.1016/j.jpag.2019.10.002