From ACL tears to fatigue-related strains, women face unique injury risks when exercising, and hormone fluctuations throughout the menstrual cycle may play a key role. #
As part of our #madetomove campaign, we speak to experts to learn how women can train safer.
Whether you’re training for a marathon, chasing PBs in the gym or showing up for your weekly five-a-side, getting injured is frustrating at best — and at worst, completely derails your progress.
But what many women don’t realise is that their menstrual cycle could be influencing how, and when, those injuries happen.
While male athletes tend to follow consistent hormonal patterns, women’s hormone levels fluctuate significantly throughout the month, affecting everything from energy and coordination to joint stability and recovery.
And ignoring those shifts may be putting your body at risk.
Read more: “I’m running my first marathon — why are there no training plans with menstrual cycle syncing?”
Are women more likely to get injured than men?
Yes, and the gap is significant. Female athletes are up to six times more likely to experience anterior cruciate ligament (ACL) injuries than their male counterparts. ACL is a part of the knee that attaches the upper and lower parts of the leg together. Injuries can be brutal and take a year to recover from.
But it’s not just the knee joint that’s at risk. Women are more prone to muscle strains, non-contact ligament injuries and bone stress fractures than men, particularly in sports and high-impact training environments.
So, what’s driving this disparity?
While anatomical differences such as wider hips and variations in joint alignment are part of the picture, experts point to the menstrual cycle as a major contributor.
Hormonal fluctuations can influence ligament laxity (hypermobility), neuromuscular coordination, energy levels and sleep quality — all of which affect performance and injury risk.
Research from the University of Vigo in Pontevedra, Spain also indicates that female athletes have a harder time balancing, or building and rebuilding muscle tissue, when hormones like oestrogen and progesterone increase in the body.
What stage of the cycle are women more likely to injure themselves?
While every woman’s experience is unique, research and expert opinion suggest that certain phases of the menstrual cycle may carry a higher risk of injury.
Ovulation (mid-cycle):
This is when oestrogen levels peak, potentially increasing ligament laxity — particularly in the knees.
“Some studies suggest knee joint laxity rises around ovulation, which could make women more vulnerable to ligament injuries like ACL tears,” says GP and women’s health specialist Dr Deepali Misra-Sharp.
Early luteal phase (just after ovulation):
Some studies also point to a higher frequency of muscle strains during this window, particularly in high-impact sports.
Still, the science isn’t completely conclusive. “There’s growing interest in how different phases impact injury risk, but the evidence is mixed,” says Dr Misra-Sharp. “While hormones likely play a role, we can’t yet pinpoint exact days of peak risk for everyone.”
Fitness coach Chloe Thomas adds: “I recommend that you stay hydrated and prioritise good sleep as this will support muscle recovery and your overall performance during this phase.”
Late luteal phase (the days before your period):
This is often marked by fatigue, disrupted sleep and reduced coordination.
“Sleep disruption and increased fatigue can impair neuromuscular coordination, increasing the potential for injuries,” explains personal trainer and Oner Active athlete Hayley Madigan.
As an avid runner, I’ve experienced luteal fatigue first hand. One week, I was able to run 16km at a good pace — just days later, I was struggling to do 7km and frequently needed to stop. It was frustrating and demoralising but understanding that it’s my body’s natural fluctuations makes it easier to accept and be kinder to myself.
Read more: Experts say this is how you should be exercising at each stage of your menstrual cycle
How are women most likely to injure themselves?
Certain injury patterns are more common in active women:
- Non-contact ACL tears and knee ligament injuries
- Muscle strains, especially in the hamstrings, calves and groin
- Bone stress injuries, such as shin splints and stress fractures
These are often linked to hormonal changes, energy imbalance or training loads that don’t account for the body’s natural fluctuations.
“Hormonal shifts can affect joint stability, coordination and recovery,” says marathon runner and PT Sarah Campus. “That’s why so many injuries happen when we’re tired or under-fuelled.”
Energy deficiency is another major concern. When calorie intake doesn’t match training demands, it can lead to Relative Energy Deficiency in Sport (RED-S). This disrupts the menstrual cycle and compromises bone health, significantly increasing injury risk.
Read more: How active women should really be fuelling
Is there anything women can do to better prevent injuries?
Definitely, and it starts with knowing your body and adjusting your training accordingly.
Adapt your workouts to your cycle
“I regularly adjust my clients’ programmes depending on where they are in their cycle,” says Chloe. “If your body wants rest, it’s important to listen.”
Modify training around higher-risk phases
“Around ovulation, when joints may feel less stable, it’s wise to limit high-impact moves like plyometrics or agility drills,” says Hayley.
Emphasise warm-ups and mobility
During the luteal phase in particular, Sarah lengthens her warm-ups and includes mobility and joint stability exercises. “This helps offset the effects of fatigue and ligament laxity,” she explains.
Maintain consistent strength training
Dr Misra-Sharp recommends year-round strength work, especially for the glutes, hamstrings and calves, to support joint integrity. Structured warm-up programmes like FIFA 11+ (for football) and Activate (for rugby) have been shown to cut lower-limb injury risk by up to 40%.
Fuel your body properly
Nutrition is non-negotiable. “Low energy availability can shut down menstrual function, impair recovery and increase injury risk,” says Dr Misra-Sharp.
She also flags iron deficiency as a common issue, especially in women with heavy periods. If you’re experiencing fatigue or frequent injuries, blood tests and nutritional support are worth exploring.
Read more: This is what you should be eating at each stage of your menstrual cycle, according to the experts
Is there anything in the gym women should avoid at certain times of the month?
There’s no need to skip the gym altogether, or specific exercises, but certain adaptations can help you train more safely and effectively.
“There isn’t strong evidence that women should avoid specific movements at specific times,” says Dr Misra-Sharp. “But your own symptoms can be a useful guide.”
During ovulation
Focus on control, balance and technique, especially in exercises that stress the knees.
Pay extra attention to landing mechanics and avoid excessive twisting or cutting movements if joints feel unstable.
During the late luteal phase
If fatigue is high or sleep is disrupted, reduce intensity. Avoid going for personal bests or introducing new technical lifts. “This isn’t the time to chase a one-rep max,” notes Chloe.
Read more: TikTokers say it makes you ugly — does the luteal phase really change how you look?
During menstruation
If cramps, bloating or low energy hit hard, opt for lighter sessions, mobility work or active recovery. “It’s OK to pull back for a few days — progress doesn’t always mean pushing harder,” says Hayley.
However, every woman is different. Paula Radcliffe famously first broke the marathon world record in Chicago in 2002 while suffering period cramps in the last third of the race. It’s important to listen to your body, to your unique needs and energy levels.
As Chloe says: “The key thing is that this isn’t about limiting yourself, try and see the phases of your cycle as an opportunity to work with your body rather than against it.
“Getting to know your body is key; we all have different cycle phase lengths and hormone levels. So I would like to stress that every woman is different so this may not be the case for you — but it is good to be aware and get to know your cycle and body and make training work for you.”
More research needs to be done
We’re only just beginning to scratch the surface when it comes to understanding how the menstrual cycle impacts women’s injury risk, performance and recovery — and that’s a problem.
A 2021 study by researchers Emma Cowley, Alyssa Olenick, Kelly McNulty and Emma Ross revealed a glaring gap: of more than 5,200 sports science studies published between 2014 and 2020, just 6% focused solely on women. And only 34% of the 12 million study participants were women.
This lack of representation matters because women’s bodies aren’t just smaller versions of men’s. Hormonal fluctuations throughout the cycle can affect everything from joint stability to muscle strength, and ignoring that reality puts women at higher risk.
It’s time we close the gender data gap in sports science. Until then, listening to your body, tracking your cycle and working with professionals who understand female physiology can help you train smarter and stay stronger — every day of the month.
Feature image: Canva
