INTRODUCTION: In elite athletes, training individualization is widely recommended to optimize competitive performance. Previous studies have evidenced the impact of hormonal fluctuations on different performance parameters among female athletes, but the parameters themselves, the magnitude and the direction of the effects are inconclusive. While consideration of menstrual cycle phases as a parameter in training individualization strategies is necessary, systematic evidence identifying such impacts in elite athletes should be evaluated. Additional longitudinal and prospective studies to systematically monitor on-field performance parameters are urgently required to enable recommendations and training individualization in female elite athletes. METHODS: The EMPOWER project proposed a longitudinal and prospective study coupled with robust statistical methods to establish and validate causal links, quantify impacts, and make reliable recommendations that can guide evidence-based future training individualizations. The follow-up started with 12 rowers and para-rowers, 16 cyclists, 1 fencer, 6 artistic gymnasts, 23 football players, 5 biathletes, 5 skiers and 4 cross-country skiers. During the follow-up, athletes were asked to fill in a short questionnaire every morning notably with information related to sleep, mood, training performance and feelings. On a regular basis, in each phase of the cycle, athletes had to take a saliva sample to accurately quantify five hormones (testosterone, estrogen and progesterone) as well as a sport-specific performance test for rowers and skiers. Every day their trainings were monitored using different connected devices (watches, power meters...) or questionnaires to quantify the training load of athletes. RESULTS: Before starting the protocol, we assess the necessity of such a monitoring on athlete and their need to an individualized training. First results revealed that each athlete reacts differently to issues related to their gender, and high-level athlete reacts differently from less-trained athletes. In particular, the symptoms related to menstrual cycles are different from those who practice less sport. Athletes are very sensitive to these issues, and this may explain the high level of compliance with the questionnaire (more than 85% of assiduity depending on the sport). Among the population of athletes monitored, we observed divergent hormonal profile. Each female athlete is different from another and does not respond similarly to training throughout the menstrual cycle. There is a variety of athlete responses to physical tests. CONCLUSION: As highlighted in the divergent literature, responses to menstrual issues regarding performance is widely heterogeneous from one athlete to another. These findings emphasize the need for researchers and support staff to undertake menstrual cycle profiling and monitoring and continue to develop awareness, openness, knowledge and understanding of menstrual cycle.
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