Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports

Abstract

Female athletes train and compete under the potential influence of hormonal fluctuations during the menstrual cycle or during use of various hormonal contraceptives. Dysmenorrhea and premenstrual symptoms are common in the general population, as well as side effects of hormonal contraceptives. More detailed knowledge concerning prevalence and perceived impact of these symptoms on training and performance in different sports is required. The aim of the study was to 1) characterize perceptions of training and performance during the menstrual cycle phases and by hormonal contraceptive use in a large population of female athletes; 2) explore whether symptoms experienced are related to perceived performance; and 3) examine potential differences in these factors between athletes at different levels of performance. The study was based on self-reported data from 1,086 athletes from 57 sports at different performance levels via a web-based questionnaire. Thirty-seven percent (n = 407) of the athletes did not use hormonal contraceptives. In this group, menstrual cycle related symptoms were common across all athlete levels, particularly dysmenorrhea (74%, n = 300) and premenstrual symptoms (78%, n = 318), which also influenced perceived performance of aerobic fitness, muscle strength, mental sharpness, balance, and sleep quality. Sixty-three percent (n = 679) of the athletes used various hormonal contraceptives and 40% (n = 272) perceived a variety of side-effects. Physical performance was experienced equally independent of time-point of the pill-chart except for the period of inactive pills, which was associated with more negative impact. Nonetheless, only 18% (n = 191) of the athletes considered menstrual cycle or hormonal contraceptive issues when planning their training or competitions. These results indicate that greater focus is needed to identify and effectively treat different menstrual cycle and hormonal contraceptive related symptoms on an individual level.

Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training

“…The influence of the menstrual cycle could be a factor to consider in program design, along with a host of other factors: nutrition, fatigue, sleep quality, stress, injury, motivation, and program enjoyment. We acknowledge that menstrual symptoms can influence exercise performance in some women ( 40 ), and thus it would be helpful to document this for reviewing long-term progress and adjusting a program. When reviewing the evidence as a whole—and the methodological shortcomings therein—we propose it is highly premature to conclude that short-term fluctuations in ovarian hormones appreciably influence acute exercise performance or longer-term adaptations to resistance training.…”

“I hardly have a problem […] I have my period quite rarely too”: Female football players’ and their coaches’ perceptions of barriers to communication on menstrual cycle

“…Previous research has shown that symptoms related to the MC affect the performance level and wellbeing of many female athletes in various ways (6,(13)(14)(15)(16). For example, MC disturbance is one of the most well-known signs of Relative Energy Deficiency in Sport (RED-S), which can impair athlete performance negatively (e.g., increased risk of injury, decreased level of strength and endurance, and reduced training response) (17).…”

“…Furthermore, previous studies have mainly focused on senior athletes [e.g., (15,18,19)] and athletes in individual sports [e.g., (6,11,20)]. Since the JST is a critical stage in the talent development process (2,3) and that the MC may affect the performance level and wellbeing (6,(13)(14)(15)(16), it is crucial to explore the experiences of MC communication among junior athletes and their coaches in team sports as well. Knowledge about junior athletes is important since we might expect that they would consider talking about MC more difficult compared to senior athletes.…”

“…To manage their MC, many athletes use hormonal contraceptives (HC) ( 11 , 14 , 18 , 24 ). For example, Ekenros et al ( 13 ) reported that 63% from a group of 1,086 athletes used various HC, from which 40% perceived a variety of side effects. Although HCs may affect athlete performance in multiple ways (e.g., weight gain, tiredness, depression, and a decrease of maximal aerobic capacity) ( 18 , 25 , 26 ), the HC knowledge among elite athletes is reported to be low ( 23 ).…”

“…Although HCs may affect athlete performance in multiple ways (e.g., weight gain, tiredness, depression, and a decrease of maximal aerobic capacity) ( 18 , 25 , 26 ), the HC knowledge among elite athletes is reported to be low ( 23 ). Not surprisingly, only a minority of female athletes considered MC or HC issues when planning their training and competitions ( 13 ).…”