On-Field Methodological Approach to Monitor the Menstrual Cycle and Hormonal Phases in Elite Female Athletes

Abstract

Objectives: Currently, there are no guidelines for implementing the monitoring of menstrual status, including the natural menstrual cycle (NC) or oral contraception (OC), in a sport setting. We aimed to provide a feasible, on-field methodological approach for monitoring NC and OC in female athletes. Methods: We developed a smartphone app with daily questionnaires to monitor both NC and OC phases in 19 elite female soccer players (23.7 [4.4] y) over 7 months. Adherence and compliance were evaluated. The NC and OC phases were based on calendar data to establish an individual menstrual profile for each athlete. Results: The initial questionnaire revealed that the vast majority of female players (80%) were interested in monitoring their menstrual status. The online monitoring yielded high athlete adherence (87.0% [14.2%]) with a slight decrease over the winter break and at the end of the championship, which necessitated adaptations to promote compliance. Monitoring identified the specific menstrual pattern of each athlete and highlighted large interindividual variability. Conclusion: This study assesses, for the first time, the interest of female players in monitoring their menstrual status. It provides a new methodological approach, as well as guidelines for optimizing on-field monitoring. It also anticipates some obstacles sport staff may encounter when trying to implement such follow-up. It is essential to better understand the menstrual profile of athletes and determine its potential impacts on well-being and performance.

Impact of menstrual cycle or combined oral contraception on elite female cyclists' training responses through a clustering analysis of training sessions

“…We recognize the potential bias in determining the MC based solely on the calendar method. Indeed, based on the latest recommendations surrounding MC ( 4 , 41 ), our model and analysis would gain accuracy in using urinary ovulation testing and blood hormonal analysis in order to avoid a mis-categorization between follicular and late-cycle phases and inclusion of anovulatory cycles ( 19 ). But it's not practical for elite athletes to use these tests on a regular basis for a longitudinal approach.…”

“…The menstrual status monitoring relied on a menstrual diary, which was completed daily using the same application for RPE collection to determine the beginning and the end of the menstruation phase or the pills withdrawal phase ( 17 , 19 ). To investigate the influence of estimated MC and OC phases on training, different phases were defined depending on athletes' menstrual status ( 19 ).…”

“…For OC athletes, we divided their cycle into two phases: a withdrawal phase (WP) of 7 days (i.e., placebo, pause) and an active pill phase (APP) of 21 days ( 19 ).…”

Injury Incidence, Severity, and Type Across the Menstrual Cycle in Female Footballers: A Prospective Three Season Cohort Study

“…For best accuracy in determining phases, endogenous reproductive hormonal measurements should be taken as a "gold standard" approach (21). However, in an applied setting, this can be challenging, particularly where athletes are being tracked longitudinally over an extended period, for example., multiple seasons (22). The practicalities of regular hormone measurements, including the athlete burden, staffing burden, associated challenges around sample collection and storage, the required financial resource, in addition to a clear need to justify this to the coaching staff means that at present, with the current methods for hormone measurement, this is likely to be unrealistic on an ongoing continual basis.…”