Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present

Abstract

Coaches consider various competencies (e.g. conditioning, nutrition, skills and tactics), when planning sessions, though rarely the impact of menstruation on the efficacy of training and competition performance for athletes. Given the impact menstrual symptoms can have on athletes, the management strategies that athletes may use to minimise any potential impact, and the mechanisms that provide barriers to greater coach athlete interaction require investigation and consideration. Therefore, this study aimed to investigate the strategies used by athletes to manage menstrual symptoms and the role coaches played in this process. An anonymous, 36-item questionnaire was developed and hosted on Qualtrics. Descriptive statistics and Chi-square statistics were used to analyse the data. One hundred and twenty-four valid responses from Australian athletes 16–45, with a mean age of 29 years, were received. Period pain (82%) and pre-menstrual symptoms (83%) were commonly reported and contributed to fatigue and to perceived reductions in performance during or just prior to the period (50.0% in training, 58.7% on ‘game day’). Contraceptive use was reported by 42% of athletes. Those reporting heavy menstrual bleeding (29.7%) were more likely to report increased fatigue (relative risk 1.6, 95% CI 1.07 to 2.32). Over three-quarters of athletes reported neither they nor their coaches altered training due to the menstrual cycle. Most athletes (76%) did not discuss menstruation with their coaches. Given the perceived negative impact on performance and potential risks with contraceptive usage during adolescence, coaches, trainers and athletes need to have a more open dialogue around the menstrual cycle.

The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review

“…It is apparent that many athletes believe their performance fluctuates with MC phase; indeed, all included studies reported that MC phase impacted athletes’ perceived performance [ 72 , 73 , 74 , 75 , 76 ]. A large proportion, 50–71% and 49–65%, of participants reported feeling their performance in training and competition, respectively, is impaired in certain MC phases [ 72 , 74 , 76 ]. Perceived strength, speed and power ratings were also altered during certain MC phases [ 75 ].…”

“…Athletes most commonly perceived performance to be best in all phases of the MC except the early follicular and late luteal phases [ 76 ] and performance was perceived to be impaired in the early follicular and late luteal phases compared to the rest of the MC [ 72 , 75 , 76 ]. The perceived performance detriment in the early follicular and late luteal phases coincides with the occurrence of menstrual symptoms; a common reason attributed to this perceived performance decline was experiencing fatigue [ 72 ] or lethargy [ 74 ]—which are common menstrual symptoms experienced around menstruation in the general reproductive aged population [ 77 ]—menstrual pain and other menstrual symptoms [ 74 ]. Elite rugby players also cited feeling distracted by their menstrual pain or feeling concerned about flooding during the early follicular phase [ 74 ].…”

“…Elite rugby players also cited feeling distracted by their menstrual pain or feeling concerned about flooding during the early follicular phase [ 74 ]. Distraction and worry about flooding was also reported by athletes from other sports and competitive levels [ 72 ].…”

“…The studies included in this review did not specify if participants experienced pre-menstrual syndrome. Nonetheless it is interesting that fatigue and distraction were identified as risk factors for reduced performance [ 85 ], as these were some of the most common physical and psychological symptoms reported to have a negative impact on performance in the study on athletes [ 72 ].…”

“…The existence of low and high responders should also be investigated; Julian et al [ 116 ] suggested that some athletes may be more or less susceptible to changes in performance as a result of MC phase. Given that some athletes report their performance to be affected by MC phase and others do not [ 72 , 76 ], and it is known that some females are more susceptible to experiencing severe menstrual symptoms than others [ 117 ], it is feasible there are individual differences in the extent to which MC phase affects performance. It would be useful to determine if low and high responders to these MC phase effects exist, and if they do, how these responders can be identified.…”