A Quantitative and Qualitative Investigation of Menstrual Cycle Dysfunction and Related Perceptions in British Women Athletes

Introduction: Menstrual cycle dysfunctions (MCDs) do not have one uniform definition or diagnostic criteria and can be deconstructed into several clinical conditions by their presenting signs and symptoms. The most common involve: alterations to cycle length or complete absence of a menstrual cycle (oligomenorrhea and amenorrhea respectively); presence of pain (dysmenorrhea); and anovulatory cycles. A range of modifiable factors have been identified as causative factors in MCDs . Behavioural factors relating to volume of exercise and nutritional intake have been specifically linked to the higher prevalence of MCD in female athletes . Few studies, however, have explored the prevalence, awareness and understanding of MCDs in sporting populations, and any proposed management strategies are poorly reported.

Purpose: To identify the prevalence of MCD in women athletes and to explore the causative factors to which they attribute MCD. This will facilitate the subsequent identification of areas in which education and understanding are lacking, thus enabling recommendations to be made for future research, teaching and clinical practice.

Methodology: This study used an observational cross-sectional design. Following pre-testing and piloting of the questionnaire, participants completed the online survey identifying participation in sport, physical activity levels, menstrual status, and awareness of MCD and its causative factors. Inclusion criteria limited participants to women between the ages of 18 and 50.

Results: 667 women were recruited over a two-week period in October 2020. The proportion of women actively involved in sport at recreational or competitive level was 27.3% (182/667) of whom 135 participants (75%) had experience of MCD. These participants ranked the following as causative factors for MCD: stress (n=81), diet (n=34), increased exercise (n=22), weight fluctuations (n=10), and 15 alluded to low energy availability. Also identified were the effects of the menstrual cycle on performance; these are categorised in Table 1 and depicted in Figure 1. Of the women with experience of working with a coach (n=157), few (n=10, 6.4%) had discussions about their menstrual cycle. All participants actively involved in sport (n=182, 100%) thought that there was insufficient teaching on, and awareness of, MCD.

Conclusion: This is the first study to explore awareness and understanding of MCD in female athletes; it confirms categorically both the high prevalence, and poor understanding of the causative factors. The subjective impact of the menstrual cycle on performance is identified by this study. The need for education is identified, as MCDs are the red flag pointing towards the need for adjustments to training schedules and/or nutrition. Means of providing education, applications in clinical practice, and areas for future research, have all been identified in this study.