Cognitive test performance is improved during ovulation, but performance is greater improved by physical activity, according to a recent study published in Sports Medicine – Open.1
When assessing the impact of the menstrual cycle on cognitive performance, the fastest reaction times and fewest errors were observed on the day of ovulation. However, much greater differences were linked to physical activity vs nonactivity, with nonactive patients being a mean of 70 milliseconds slower.1
Key takeaways:
- Women demonstrated faster reaction times and fewer cognitive errors during ovulation compared with other menstrual phases.
- Physical activity had a stronger positive impact on cognitive performance than menstrual cycle phase alone.
- Active participants outperformed inactive ones, with nonactive women averaging 70 milliseconds slower reaction times.
- Elite athletes showed the greatest improvement in reaction times during ovulation compared with mid-luteal phases.
- Related research found an estetrol pill significantly reduced menstrual symptoms, including pain, fatigue, and irritability.
“At the elite level, this could make the difference between sustaining a serious injury in a collision or not,” said Flaminia Ronca, PhD, researcher at University College London.1
Defining activity levels
The trial was conducted to evaluate the impact of the menstrual cycle on cognitive processes.2 Participants included women aged 18 to 40 years with a self-reported menstrual cycle between 21 and 35 days, no regular spotting outside of menstruation, tracking their period for at least 3 months before the study, and not taking hormonal contraceptives.
Patients were considered active if they engaged in physical activity at least twice a week or were competing below club level. Those not taking part in regular physical activity were considered inactive. Competing was defined as being involved in a club-level sport competition, and those competing at national or international levels were considered elite.2
During an initial laboratory visit, participants obtained urinary kits and received a link to the online cognitive battery, which took 10 to 15 minutes to complete. The battery included a simple reaction time task, a sustained attention task, an inhibition task, and a spatial timing anticipation task.2
Assessing reaction time
Participants completed the online battery on the first day of bleeding, 2 days after bleeding cessation, the day of ovulation, and 7 days after ovulation. The urinary ovulation kits were used to estimate participant phases during the study period.2
During the simple reaction time test, patients pressed the spacebar as quickly as possible when an illustration of a winking or smiling face appeared on the screen. During the sustained attention test, patients would press the spacebar when seeing the winking face but withhold at the smiling face.2
The inhibition test required patients to press the spacebar at the smiling face but withhold at the winking face. Finally, the anticipation test required patients to press the spacebar when 2 footballs moving across the computer screen collided.2
Faster reaction times during ovulation
There were 54 participants aged a mean of 28 ± 6 years included in the final analysis. The mean body mass index was 23.6 ± 4.4, and the average cycle length was 29 ± 2 days in these patients. These characteristics did not significantly differ between groups. Recreational sport participation was reported by 20 participants.2
During ovulation, faster reactions were reported on the attention and inhibition battery. However, slower reaction times were reported during the mid-luteal phase, and more errors occurred during the late follicular phase. Additionally, slower reaction times and more errors were reported in inactive vs active patients.2
A main effect of phase F(3,150) = 4.53 indicated faster reaction times during ovulation. For active participants, a main effect of F(3,50) = 3.80 was reported. During group by phase interaction, only elite participants had faster reaction times during ovulation vs other phases and slower reaction times during the mid-luteal phase. Reaction times included:
- 482 ± 81 ms for the sustained attention task during ovulation
- 390 ± 69 ms for the inhibition task during ovulation
- 531 ± 138 ms for the sustained attention task during the mid-luteal phase
- 430 ± 127 for the inhibition task during the mid-luteal phase
Overall, the results indicated improved cognitive performance during ovulation. However, athletic participation had a greater effect on cognitive outcomes vs the menstrual phase.2
“Working exercise into our day doesn’t need to be difficult. Some of our previous studies have shown that 15 minutes of moderate activity is enough to boost our mood and cognitive performance, that is equivalent to taking a brisk walk around the block or cycling to the shops,” said Ronca.1
Hormonal treatment for menstrual symptoms
Menstrual symptoms also impact other aspects of quality of life, but a phase 3 trial published in April 2025 highlighted the efficacy of an estetrol pill toward easing these symptoms.3 Patients were either starters, defined as not using hormonal contraception prior to the study, or switchers, defined as transitioning from another hormonal contraceptive.
Symptom intensity across pain, water retention, and negative affect domains were significantly reduced among starters, while relief remained stable among switchers. Additionally, many symptoms such as cramps, headaches, back pain, fatigue, swelling, tender breasts, anxiety, and irritability showed at least a 40% reduction in severity.3
“So even in those switchers, there’s a definite ability of the product to have a significant impact for people,” said Mitchell Creinin, MD, professor at the University of California Davis Health.3
References
- Menstrual cycle affects women’s reaction time but not as much as being active. University College London. October 9, 2025. Accessed October 13, 2025. https://www.eurekalert.org/news-releases/1101068.
- Ronca F, Watson E, Metcalf I, Tari B. Menstrual cycle and athletic status interact to influence symptoms, mood, and cognition in females. Sports Medicine – Open. 2025;11(104). doi:10.1186/s40798-025-00924-8
- Krewson C. Mitchell Creinin, MD, reports estetrol pill eases menstrual symptoms. April 15, 2025. Accessed October 13, 2025. https://www.contemporaryobgyn.net/view/mitchell-creinin-md-reports-estetrol-pill-eases-menstrual-symptoms.
