WORK PRODUCTIVITY AND COGNITIVE LOAD ACROSS MENSTRUAL CYCLE PHASES: A NARRATIVE LITERATURE REVIEW
Abstract
Hormonal fluctuations across the menstrual cycle are increasingly recognized as meaningful contributors to variations in cognition, emotional regulation, and daily functioning. However, empirical evidence remains fragmented across disciplines, with studies differing widely in methodological rigor, outcome measures, and approaches to menstrual phase classification. This lack of integration limits the field’s ability to draw coherent conclusions about how cycle-related changes influence cognitive load and work productivity—domains of growing significance for women’s health and occupational wellbeing. This narrative review addresses this gap by synthesizing findings from nineteen empirical studies spanning neuroscience, psychology, occupational health, and digital menstrual tracking.
A structured search of PubMed, Scopus, and Web of Science was used to identify eligible studies. Data were then extracted using a standardized analytical protocol. The findings reveal domain-specific patterns of cognitive variation, with the most consistent differences observed in reaction time, attentional stability, and temporal anticipation. Cognitive-emotional processes—including rumination, stress reactivity, and negative attentional bias—showed particularly pronounced fluctuations during the luteal and premenstrual phases, especially among individuals with PMS or PMDD, and were associated with reduced efficiency, motivation, and routine management. Digital tracking tools provided additional insight into menstrual variability but demonstrated methodological limitations that affect their reliability for studying cognitive and functional outcomes.
Overall, the evidence indicates that menstrual-cycle-related changes in cognition and emotional processing interact with symptom burden to shape cognitive load and everyday productivity. Strengthening methodological rigor, incorporating validated measures, and improving menstrual health literacy may enhance both research precision and practical strategies for supporting individuals across menstrual cycle phases.
References
Alemu, B. W., Waller, M., & Tooth, L. R. (2025). The association between menstrual disorders and workforce participation: A prospective longitudinal study. BJOG: An International Journal of Obstetrics & Gynaecology, 132, 961–971. https://doi.org/10.1111/1471-0528.18109
Avila-Varela, D. S., Hidalgo-Lopez, E., Dagnino, P. C., Acero-Pousa, I., del Agua, E., Deco, G., Pletzer, B., & Escrichs, A. (2024). Whole-brain dynamics across the menstrual cycle: The role of hormonal fluctuations and age in healthy women. npj Women’s Health, 2, Article 8. https://doi.org/10.1038/s44294-024-00012-4
Bucher, E., Sharkey, C., Henderson, A., Basaran, B., Meyer, S., & Chen, C. X. (2025). An evaluation of menstrual health apps’ functionality, inclusiveness, and health education information. BMC Women’s Health, 25, 261. https://doi.org/10.1186/s12905-025-03812-1
Cunningham, A. C., Prentice, C., Peven, K., Wickham, A., Bamford, R., Radovic, T., Klepchukova, A., Fomina, M., Cunningham, K., Hill, S., Hantsoo, L., Payne, J., Zhaunova, L., & Ponzo, S. (2024). Efficacy of the Flo App in improving health literacy, menstrual and general health, and well-being in women: Pilot randomized controlled trial. JMIR mHealth and uHealth, 12, e54124. https://doi.org/10.2196/54124
Hardy, C., & Hunter, M. S. (2021). Premenstrual symptoms and work: Exploring female staff experiences and recommendations for workplaces. International Journal of Environmental Research and Public Health, 18, 3647. https://doi.org/10.3390/ijerph18073647
Henderson, A., Gardani, M., Dyker, G., & Matthews, L. (2025). Cognition and behaviour across the menstrual cycle in individuals with premenstrual dysphoric disorder: A systematic review. Journal of Affective Disorders, 371, 134–146. https://doi.org/10.1016/j.jad.2024.11.033
Iida, M., Namba, M., & Nomura, K. (2025). Association of severity of premenstrual disorders with absenteeism and presenteeism among Japanese working women: A cross-sectional study. Industrial Health, 63, 123–132. https://doi.org/10.2486/indhealth.2025-0016
Koh, S., Okawara, M., Hirashima, K., Kuwazuru, T., Yamashita, S., Ohkubo, N., Tateishi, S., & Fujino, Y. (2025). Association of menstrual-related symptoms and presenteeism: A cross-sectional study of working women in Japan. Journal of Occupational and Environmental Medicine, 67(5), 311–316. https://doi.org/10.1097/JOM.0000000000003340
Le, J., Thomas, N., & Gurvich, C. (2020). Cognition, the menstrual cycle, and premenstrual disorders: A review. Brain Sciences, 10, 198. https://doi.org/10.3390/brainsci10040198
Loukzadeh, Z., Eslamy, N., Dehghan, M., & Mehrparvar, A. H. (2024). The impact of premenstrual disorders on work disruptions among working women: A cross-sectional study. International Journal of Reproductive BioMedicine, 22(2), 149–156. https://doi.org/10.18502/ijrm.v22i2.15712
Park, Y., Murphy, A., & da Cruz, D. C. (2023). Occupational participation and engagement of women experiencing premenstrual syndrome: A qualitative study. British Journal of Occupational Therapy, 86(9), 639–647. https://doi.org/10.1177/03080226231174792
Ponzo, S., Wickham, A., Bamford, R., Radovic, T., & Zhaunova, L. (2023). Menstrual cycle–associated symptoms and workplace productivity in US employees: A cross-sectional survey of Flo app users. Digital Health, 9, 1–12. https://doi.org/10.1177/20552076221145852
Rabbani, H., Irfan, S., & Khanum, S. (2025). Pre- and post-menstruation cognitive functioning in women with premenstrual dysphoric disorder, premenstrual syndrome and controls: A quasi-experimental study. BMC Women’s Health, 25, 559. https://doi.org/10.1186/s12905-025-04103-5
Raves, D. M., Herrera, W. D., Darnell, M. E., Rice, T., Friedman, C., Moratti, S. C., Sims, S. T., Sihanath, W. B., Ehrhardt, S. N., & Phillips, A. (2025). A survey assessing the impact of symptoms related to the menstrual cycle and perceptions of workplace productivity: Considerations for employer-sponsored menstrual health programs. BMC Women’s Health, 25, 418. https://doi.org/10.1186/s12905-025-03833-w
Ronca, F., Blodgett, J. M., Bruinvels, G., Lowery, M., Raviraj, M., Sandhar, G., Symeonides, N., Jones, C., Loosemore, M., & Burgess, P. W. (2025). Attentional, anticipatory and spatial cognition fluctuate throughout the menstrual cycle: Potential implications for female sport. Neuropsychologia, 206, 108909. https://doi.org/10.1016/j.neuropsychologia.2024.108909
Sawicka, A. K., Michalak, K. M., Naparlo, B., Bermudo-Gallaguet, A., Mataró, M., Winklewski, P. J., & Marcinkowska, A. B. (2025). Menstrual cycle phase influences cognitive performance in women and modulates sex differences: A combined longitudinal and cross-sectional study. Biology, 14, 1060. https://doi.org/10.3390/biology14081060
Schantz, J. S., Fernandez, C. S. P., & Jukic, A. M. Z. (2021). Menstrual cycle tracking applications and the potential for epidemiological research: A comprehensive review of the literature. Current Epidemiology Reports, 8(1), 9–19. https://doi.org/10.1007/s40471-020-00260-3
Schoep, M. E., Adang, E. M. M., Maas, J. W. M., De Bie, B., Aarts, J. W. M., & Nieboer, D. (2019). Productivity loss due to menstruation-related symptoms: A nationwide cross-sectional survey among 32,748 women. BMJ Open, 9(6), e026186. https://doi.org/10.1136/bmjopen-2018-026186
Symul, L., Wac, K., Hillard, P., & Salathé, M. (2019). Assessment of menstrual health status and evolution through mobile apps for fertility awareness. npj Digital Medicine, 2, 64. https://doi.org/10.1038/s41746-019-0139-4
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