Training Load and Menstrual Cycle Disorders in Female Athletes: A Narrative Review

Abstract

Menstrual cycle disorders are frequently reported in female athletes, but the association with training load remains inconsistent across studies. This review aimed to examine associations between training load dimensions—volume, frequency, duration, and intensity—and menstrual cycle disorders, together with plausible mechanisms and moderator factors. A narrative review with explicit eligibility criteria searched PubMed, ScienceDirect, SpringerLink, Google Scholar, Garuda, and DOAJ for studies published from January 2015 to December 2025, supplemented by reference-list and update searches. Of 28 full-text articles assessed, 10 observational studies involving 2,182 female athletes were synthesized. Five studies reported positive associations, but four relied on unadjusted bivariate analyses; five studies found no significant association. Evidence was concentrated on training volume, which was associated with menstrual disorders in four of seven studies that measured it. Frequency and session duration were not significantly associated in the studies that tested them, while intensity was rarely examined separately. Two studies showed a dose-response trend. Sport-specific patterns were inconsistent and based on few studies. Gynecological age, body image, energy intake, and low energy availability may modify the association, although energy availability was directly estimated in only one synthesized study. Overall, higher training load, particularly greater volume, was associated with menstrual cycle disorders in half of the studies, but the evidence is heterogeneous and does not establish causality. Monitoring menstrual cycles, training load, and energy intake remains appropriate for early detection.