Heart Rate Variability Measurements Across the Menstrual Cycle and Oral Contraceptive Phases in Two Olympian Female Swimmers: A Case Report.

The heart rate variability (HRV), influenced by female sex hormone fluctuations, is an indicator of athletes' adaptation. This case study explores HRV responses over 18 months across a natural menstrual cycle (MC) and during oral contraceptive (OC) use in two Olympic female swimmers. HRV measurements-including mean heart rate (HR); root mean square of successive differences (RMSSD); and frequency-domain indices-were collected at rest in supine (SU) and standing (ST) positions across two competitive seasons. Nocturnal HR and RMSSD were assessed using the Ōura ring. MC and OC phases were identified through specific tracking, and training load was controlled. In both athletes, resting HR was lower during bleeding phases, increasing from menstruation to the luteal phase (MC) and from withdrawal to active pill phases (OC). In the ST position, RMSSD was higher but decreased throughout the phases. Nocturnal measurements confirmed these trends. Overall, findings suggest a phase-related parasympathetic overactivity shift. This study provides novel insights into HRV responses across hormonal cycles in elite female athletes, which present unique characteristics. Such monitoring tools may support a data-informed approach to guide and periodize training more effectively.