Written by Leah Morrow
Do you notice that your joint or muscle pain seems to flare at a particular point in your menstrual cycle?
For some women, physical symptoms can change noticeably throughout the month. For women experiencing premenstrual dysphoric disorder (PMDD), symptoms can include physical discomfort such as joint and muscle pain, alongside fatigue, mood changes and other premenstrual symptoms.
You might notice a pattern where pain, fatigue or general physical symptoms increase during the luteal phase of your cycle, before improving once your period begins.
If you've noticed this pattern, it is worth paying attention to.
It doesn't necessarily mean that you've damaged something — but it may provide an important piece of information about how your body is responding to training, stress, recovery and your menstrual cycle.
What is PMDD?
PMDD is a severe form of premenstrual disorder where symptoms occur during the luteal phase of the menstrual cycle and can significantly affect daily life.
While PMDD is often discussed in relation to mood and psychological symptoms, physical symptoms can also occur. These may include:
Joint or muscle pain
Fatigue
Breast tenderness
Headaches
Changes in appetite
Sleep disturbance
Increased physical discomfort
Research also suggests that hormonal fluctuations may influence pain sensitivity and pain processing in some women.
This doesn't mean that pain experienced around your period is automatically caused by your hormones. There are many factors that can influence pain, including training load, sleep, stress, previous injury and recovery.
This is why looking at the whole picture is important.
Should you change your exercise throughout your cycle?
This is where things get interesting.
There has been increasing interest in menstrual cycle-aware training — adjusting exercise based on where you are in your cycle.
However, current evidence does not support the idea that every woman should follow a specific training programme based on menstrual cycle phases.
A large systematic review found that any effects of menstrual cycle phase on exercise performance were generally small, and there was substantial variation between individuals.
So rather than thinking:
"I'm in this phase, therefore I should train this way."
A more useful approach may be:
"How am I feeling, and what is my body telling me today?"
Your menstrual cycle can be one piece of information that helps you answer that question.
Menstrual Phase: Listen to Your Body
The first few days of your cycle are often referred to as the menstrual phase.
Some women experience cramps, fatigue, lower energy or increased discomfort. Others feel completely capable of maintaining their usual training.
There is no requirement to stop exercising simply because your period has started.
If you feel good, you can continue your normal training.
If you are feeling more fatigued or uncomfortable, you might choose to reduce the intensity temporarily and focus on:
Walking
Gentle mobility
Yoga
Stretching
Lower-intensity exercise
Rest and recovery
Neither approach is wrong.
The aim is to respond to how you actually feel rather than following a rigid set of rules.
Follicular Phase: Build When You Feel Ready
The follicular phase begins when your period starts and continues towards ovulation.
Some women report feeling more energetic or motivated during this part of their cycle, which may make it feel like a good time to push training.
You might choose to include:
Strength training
Running
Cycling
Higher-intensity sessions
Sports-specific training
But this isn't a rule.
Research does not show that every woman automatically performs better during the follicular phase.
If you feel strong and recovered — train accordingly.
If you don't — adjust accordingly.
Your individual response matters more than the phase of your cycle.
Around Ovulation: Do You Need to Change Your Training?
Ovulation occurs around the middle of the cycle, although the exact timing varies significantly between individuals.
Some women report feeling energetic and physically capable around this time.
If that is your experience, there is no reason you cannot continue with your usual training, including higher-intensity exercise.
However, there is no universal "peak performance" window that applies to every woman.
So if your training is working well, you don't need to change it simply because your cycle-tracking app tells you that you are ovulating.
Luteal Phase: Where PMDD May Become Particularly Relevant
The luteal phase occurs after ovulation and before your next period.
For women with PMDD, this is often the phase where symptoms become particularly noticeable.
You may experience:
Increased joint or muscle pain
Fatigue
Reduced energy
Mood changes
Changes in sleep
Increased physical discomfort
Reduced tolerance to your usual training
If you notice that your symptoms consistently increase during this phase, it may be useful to temporarily modify your training.
That could mean reducing volume or intensity, increasing recovery time or choosing activities that feel more manageable, such as:
Walking
Swimming
Pilates
Yoga
Mobility work
Lower-intensity strength training
But again, you don't have to stop exercising if you feel well.
There is no reason to avoid intense exercise simply because you're in the luteal phase.
So, Should You Train According to Your Cycle?
Not necessarily.
The evidence for prescribing completely different training programmes according to menstrual cycle phase remains limited.
Instead, consider your menstrual cycle as another source of information.
Think about tracking:
Cycle
When symptoms occur and how long they last.
Pain
Joint, muscle or previous injury symptoms.
Energy
How energetic or fatigued you feel.
Training
Your training load, intensity and perceived effort.
Sleep
How well you're sleeping and whether this changes across your cycle.
Stress
Life stress, work, recovery and other factors that may influence symptoms.
Performance
How your training sessions actually feel and how you are recovering.
Over several cycles, this can help you identify whether there is a genuine pattern.
What If Your "Injury" Keeps Flaring at the Same Point in Your Cycle?
This is where a women's health physiotherapy assessment can be particularly useful.
If you repeatedly experience the same pain at a similar point in your cycle, don't simply dismiss it as "just hormones."
Your symptoms are real.
And a cyclical pattern doesn't necessarily mean that you have damaged a joint, tendon or muscle.
There may be several factors contributing to what you are experiencing, including changes in symptoms, sleep, fatigue, stress, training load, recovery and pain sensitivity.
A physiotherapy assessment can help look at the bigger picture.
Rather than treating each flare-up as an isolated injury, we can ask:
Is there a pattern?
What changes before the pain starts?
How is your training load changing?
How are you sleeping and recovering?
Does the pain settle when your period starts?
What can we change to help you keep moving?
The Takeaway
Your menstrual cycle doesn't need to dictate your training.
You don't need a completely different workout for every phase.
And you certainly don't need to stop exercising because an app tells you that you're in a particular phase.
Instead, use your cycle as information.
If you consistently notice changes in pain, energy, recovery or performance, track them.
The goal isn't to restrict your training.
It's to understand your body better so that you can adapt when you need to and train confidently when you can.
Because women's health isn't one-size-fits-all.
And neither should your rehabilitation or training.
References
McNulty KL et al. (2020). The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis. Sports Medicine, 50, 1813–1827.
Ritva M & Keijo H. (2025). Evidence for Periodizing Strength and/or Endurance Training According to Menstrual Cycle Phases to Optimize Female Athlete Performance is Lacking. Strength and Conditioning Journal, 47(6), 630–642.
Li X et al. (2026). A systematic review of exercise interventions on negative affect, pain, and fatigue in women with premenstrual syndrome. BMC Women's Health, 26, 75.
Ravichandran H & Janakiraman B. (2022). Effect of Aerobic Exercises in Improving Premenstrual Symptoms Among Healthy Women: A Systematic Review of Randomized Controlled Trials. International Journal of Women's Health, 14, 1105–1114.
Ayyub S et al. (2025). The Effect of Physical Activity on Premenstrual Syndrome: A Systematic Review. Annals of Neurosciences, 32(4), 315–320.
Koçak M & Şevgin Ö. (2025). The effect of exercise on menstrual symptoms: a randomised controlled trial. BMC Women's Health, 25, 406.
Cycle phases and their approximate days vary between individuals. Ovulation does not necessarily occur on day 14, and cycle length can vary considerably.