Does the Menstrual Cycle Affect Attention, Anticipation, and Spatial Cognition in Female Athletes?

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In a recent study published in Neuropsychologia, researchers investigate whether cognitive performance fluctuates during the menstrual cycle and the potential impact athletic involvement and skill has on these variations.

Study: Attentional, anticipatory, and spatial cognition fluctuate throughout the menstrual cycle: potential implications for female sport. Image Credit: Hananeko_Studio /

The impact of the menstrual cycle on sports injuries

Previous research has observed that female athletes are more likely to experience sports injuries at certain stages of their menstrual cycle, depending on the type of injury. Poorer executive functioning, hormone abnormalities, and spatial cognitive alterations are all factors that may be negatively impacted during the menstrual cycle.

A deeper understanding of female physiology has the potential to improve athlete health assistance. According to recent research, certain forms of damage are more likely to occur during the ovulation or luteal stages than during menstruation or the mid-follicular phase.

About the study

The present study examined sport-related alterations in cognitive control, spatial cognition, and timed anticipation during menstruation. The associations between sporting knowledge and experience with performance in these activities was also explored.

Individuals between 18 and 35 years of age were recruited for the study through convenience and snowball sampling, as well as the online Prolific research platform, which used stratified samples. Individuals with irregular menstruation, amenorrhea, use of non-contraceptive hormones, perimenopause, pregnancy or nursing now or within the previous three months, and neurological disorders were excluded from the study.

At baseline, 394 participants completed an online questionnaire on their demographics, sporting engagement and competitive level, frequency of participation in various types of physical exercise, hormonal medicine or contraception use, and cycle characteristics, if female. The study participants subsequently completed cognitive tests, the Burgess Brief Mood Questionnaire, which was used to assess mood changes, and symptom questionnaires two weeks apart. Following exclusions, 241 individuals with a mean age of 28 years comprised the sample population.

Cognitive tests assessed response speeds, attention, visuospatial abilities, and timed anticipation. Three scores based on factor analysis, varimax rotations including reaction times, intra-individual variations, and errors were obtained.

Cognitive tasks included simple reaction time (SRT), sustained attention (SA), and inhibition tasks. During the SRT exercise, study participants hit the spacebar when a happy or winky face appeared in the center of their screen. During the SA task, participants pressed the spacebar when they saw a winky face, whereas they pressed the spacebar when they saw a happy face during the inhibition task.

In the three-dimensional (3D) spatial perception task, study participants counted cubes within a 3D object. During the 3D mental rotation task, one 3D object represented the primary stimulus and appeared with two other objects, one of which represented the primary stimulus whereas the other did not.

In the rhythmic timing anticipation test, a cat emerged frame by frame at regular intervals. Herein, study participants pressed the spacebar when they thought the picture should appear in the final window. In the spatial time anticipation test, study participants hit the space bar when they expected two footballs to clash.

To assess sports expertise, participants reported whether they had regularly participated in a sport, the type of sport, and information on their involvement or competitive level. The researchers used repeated-measures-type and mixed model Analysis of Variance (ANOVAs) to analyze the findings.

Study findings

Males and females had the same reaction speeds and accuracy, regardless of whether they used contraception. However, intra-subject studies indicated that females with regular menstrual cycles performed better during the menstruation phase than other phases, with faster time to react, fewer mistakes, and reduced within-individual variability.

Comparatively, females reacted slowly with worse timing anticipation during the luteal phase of their cycle, whereas they made more mistakes in the projected ovulatory phase. Self-reported emotional, physical, and cognitive symptoms were the worst during the menstruation phase. Many females also expressed beliefs that their symptoms negatively influenced their cognition on the test day, which contradicted their observed performance.

No significant correlations were observed between cognitive composite scores and endurance, power, ball, combat, coordination, or fine-motor sports. Cognitive performance on composite or individual tasks was unaffected by competitive level or sport type. Females with natural cycles had lower mood factor scores and reported more physical and cognitive symptoms than males.


Anticipatory and visuospatial processes, which may be involved in various sports, change through different phases of menstruation. Cognitive tests, particularly spatial time anticipation, perform better while menstruating and worse during the luteal phase, thus indicating that cognitive factors influence the risk of injury in some women.

The discrepancy between females' views of how their cycle affects their mood and their actual reporting of mood and symptoms may help modify perceptions of performance among naturally cycling females. Nevertheless, additional research is needed to validate these findings and create viable mitigating solutions.

Journal reference:

  • Ronca, F., Blodgett, J. M., Bruinvels, G., et al. (2024). Attentional, anticipatory, and spatial cognition fluctuate throughout the menstrual cycle: potential implications for female sport. Neuropsychologia. doi:10.1016/j.neuropsychologia.2024.108909.

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