Fluid and electrolyte balance considerations for female athletes

Figures & data

Figure 1. Normal regulation of fluid and electrolyte balance showing usual processes for gain in body water (INPUT) and loss of body water (OUTPUT) with stimulation of hormonal controls of fluid and electrolyte regulation through arginine vasopressin (AVP) release, and activation of the renin-angiotensin-aldosterone system (RAAS).

Figure 2. Hormonal fluctuations of oestrogen and progesterone during the different phases of the menstrual cycle (A), and influence of oestrogen and progesterone on factors involved in regulation of body fluid and electrolyte balance (B).

Table 1. Differences in female sex hormone concentrations reported across menstrual cycle phases in a range of studies assessing menstrual cycle influences on fluid balance, sport performance, injury risk, and thermoregulation. Values are mean ± SD unless otherwise indicated. The overall mean (range) of values highlights the large inter-individual variability in responses across menstrual cycle phases.

Study	EF Phase Oestrogen (pmol/L)	EF Phase Progesterone (nmol/L)	LF Phase Oestrogen (pmol/L)	LF Phase Progesterone (nmol/L)	ML Phase Oestrogen (pmol/L)	ML Phase Progesterone (nmol/L)
Elliot, Cable, Reilly, and Diver (2003)	110.8 ± 61.6	3.3 ± 1.5	-	-	464.7 ± 83.5	36.2 ± 28.2
Kuwahara et al. (2005)	88.1 ± 13.1	1.1 ± 0.1	-	-	309.1 ± 45.5	21.8 ± 6.9
Abt et al. (2007)	-	-	501.5 ± 308.7	8.7 ± 3.4	447.9 ± 123.3	38.5 ± 12.4
Kubo et al. (2009)	-	-	481.6 ± 180.9	2.2 ± 1.3	303.9 ± 117.8	26.4 ± 16.9
De Souza et al. (2010)	153.4 ± 71.3	1.5 ± 0.8	-	-	549.2 ± 258.2	40.7 ± 13.9
Tsampoukos, Peckham, James, and Nevill (2010)	170.0 ± 21.0	2.2 ± 0.01	731.0 ± 70.1	5.1 ± 0.4	508.0 ± 64.0	29.4 ± 3.5
Montgomery and Shultz (2010)	184.3 ± 93.6	2.8 ± 1.3	-	-	440.8 ± 135.0	43.5 ± 16.2
Jarvis et al. (2011)	-	-	481.6 ± 180.9	2.2 ± 1.3	303.9 ± 117.8	26.4 ± 16.9
Janse de Jonge, Thompson, Chuter, Silk, and Thom (2012)	123.8 ± 37.6	1.3 ± 0.8	-	-	394.1 ± 65.6	38.5 ± 12.4
Janse de Jonge et al. (2012)	123.4 ± 35.9	1.3 ± 0.8	-	-	376.0 ± 99.4	36.8 ± 18.1
Lei et al. (2017)	184.9 ± 165.9	1.7 ± 1.2	-	-	364.1 ± 258.9	53.5 ± 51.8
Notley et al. (2019)	98.0 ± 20.0	1.9 ± 0.6	273.0 ± 24	1.7 ± 0.8	354.0 ± 42.0	21.2 ± 3.2
Ansdell et al. (2019)	910.4 ± 473.6	4.0 ± 1.6	1204.1 ± 587.4	4.4 ± 2.2	1251.8 ± 682.1	14.0 ± 14.6
Rodriguez-Giustiniani and Galloway (2019)	-	-	851.9 ± 235.4	9.5 ± 6.1	337.8 ± 40.6	60.6 ± 12.3
Beidleman et al. (1999)	143.2 ± 80.1	1.6 ± 0.6	-	-	411.1 ± 139.5	44.4 ± 29.6
Beidleman et al. (1999)	194.6 ± 44.1	2.2 ± 0.9	-	-	447.9 ± 198.2	37.2 ± 19.7
Giersch, Morrissey et al. (2020)	-	-	412.4 ± 53.9	3.7 ± 0.9	449.3 ± 60.8	16.5 ± 4.9
Giersch, Morrissey et al. (2020)	-	-	480.2 ± 88.1	2.9 ± 0.6	445.9 ± 89.9	14.3 ± 4.4
Overall mean (range)	207 (88 - 910)	2 (1 - 4)	513 (273 - 1204)	4 (2 - 10)	450 (304 - 1252)	22 (14 - 61)

EF: Early Follicular; LF: Late-Follicular; ML: Mid-luteal

Figure 3. Theoretical influences of oestrogen and progesterone on heat dissipation / conservation mechanisms.

Elliott, K., Cable, N., Reilly, T., & Diver, M. (2003). Effect of menstrual cycle phase on the concentration of bioavailable 17-beta oestradiol and testosterone and muscle strength. Clinical Science, 105(6), 663–669. doi:https://doi.org/10.1042/CS20020360

 Web of Science ®Google Scholar

Kuwahara, T., Inoue, Y., Abe, M., Sato, Y., & Kondo, N. (2005). Effects of menstrual cycle and physical training on heat loss responses during dynamic exercise at moderate intensity in a temperate environment. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 288(55), R1347–R1353. doi:https://doi.org/10.1152/ajpregu.00547.2004

 PubMed Web of Science ®Google Scholar

Abt, J., Sell, T., Laudner, K., McCrory, J., Loucks, T., Berga, S., & Lephart, S. (2007). Neuromuscular and biochemical characteristics do not vary across the menstrual cycle. Knee Surgery, Sports Traumatology, Arthroscopy, 15(7), 901–907. doi:https://doi.org/10.1007/s00167-007-0302-3.

 PubMed Web of Science ®Google Scholar

Kubo, K., Miyamoto, M., Tanaka, S., Maki, A., Tsunoda, N., & Kanehisa, H. (2009). Muscle and tendon properties during menstrual cycle. International Journal of Sports Medicine, 30(2), 139–143. doi:https://doi.org/10.1055/s-0028-1104573

 PubMed Web of Science ®Google Scholar

De Souza, M., Toombs, R., Scheid, J., O’Donell, E., West, S., & Williams, A. (2010). High prevalence of subtle and severe menstrual disturbances in exercising women: Confirmation using daily hormone measures. Human Reproduction, 25(2), 491–593. doi:https://doi.org/10.1093/humrep/dep411.

 PubMed Web of Science ®Google Scholar

Tsampoukos, A., Peckham, E., James, R., & Nevill, M. (2010). Effect of menstrual cycle on sprinting performance. European Journal of Applied Physiology, 109 (4), 659–667. doi:https://doi.org/10.1007/s00421-010-1384-z

 PubMed Web of Science ®Google Scholar

Montgomery, M., & Shultz, S. (2010). Isometric knee-extension and knee-flexion torque production during early follicular and postovulatory phases in recreationally active women. Journal of Athletic Training, 45(6), 586–593. doi:https://doi.org/10.4085/1062-6050-45.6.586

 PubMed Web of Science ®Google Scholar

Jarvis, S., Vangundy, T., Galbreath, M., Shibata, S., Okazaki, K., Reelick, M., et al. (2011). Sex differences in the modulation of vasomotor sympathetic outflow during static handgrip exercise in healthy young humans. American Journal of Physiology. Regulatory, Integrative, and Comparative Physiology, 301(1), R193–R200. doi:https://doi.org/10.1152/ajpregu.00562.2010

 PubMed Web of Science ®Google Scholar

Janse de Jonge, X., Thompson, M., Chuter, V., Silk, L., & Thom, J. (2012). Exercise performance over the menstrual cycle in temperate and hot, humid condition. Medicine and Science in Sports and Exercise, 44(11), 2190–2198. doi:https://doi.org/10.1249/MSS.0b013e3182656f13

 PubMed Web of Science ®Google Scholar

Lei, T., Stannard, S., Perry, B., Schlader, Z., Cotter, J., & Mündel, T. (2017). Influence of menstrual phase and arid vs. Humid heat stress on autonomic and behavioural thermoregulation during exercise in trained but unacclimated women. Journal of Physiology, 595(9), 2823–2837. doi:https://doi.org/10.1113/JP273176

 PubMed Web of Science ®Google Scholar

Notley, S., Dervis, S., Poirier, M., & Kenny, G. (2019). Menstrual cycle phase does not modulate whole body heat loss during exercise in hot, dry conditions. Journal of Applied Physiology, 126(2), 286–293. doi:https://doi.org/10.1152/japplphysiol.00735.2018

 PubMed Web of Science ®Google Scholar

Ansdell, P., Brownstein, C., Škarabot, H. K., Simones, D., Thomas, K., Howatson, G., … Goodall, S. (2019). Menstrual cycle-associated modulations in neuromuscular function and fatigability of the knee extensors in eumenorrheic women. Journal of Applied Physiology, 126(6), 1701–1712. doi:https://doi.org/10.1152/japplphysiol.01041.2018

 PubMed Web of Science ®Google Scholar

Rodriguez-Giustiniani, P., & Galloway, S. (2019). Influence of peak menstrual cycle hormonal changes on restoration of fluid balance after induced dehydration. International Journal of Sports Nutrition and Exercise Metabolism, 29(6), 651–657. doi:https://doi.org/10.1123/ijsnem.2019-0105

 PubMed Web of Science ®Google Scholar

Beidleman, B., Rock, P., Muza, S., Fulco, C., Forte, V., & Cymerman, A. (1999). Exercise VE and physical performance at altitude are not affected by menstrual cycle phase. Journal of Applied of Physiology, 86(5), 1519–1526. doi:https://doi.org/10.1152/jappl.1999.86.5.1519.

 PubMed Web of Science ®Google Scholar

Giersch, G., Morrissey, M., Katch, R., Colburn, A., Sims, S., Stachenfeld, N., & Casa, D. (2020). Menstrual cycle and thermoregulation during exercise in the heat: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 23(12), 1134–1140. doi:https://doi.org/10.1016/j.jsams.2020.05.014

 PubMed Web of Science ®Google Scholar