How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players

Abstract

ObjectivesTo explore athletes’ past and current experiences and perceptions of the menstrual cycle in relation to its impact on sporting performance.Methods15 international female rugby players participated in individual semi-structured interviews (age: 24.5±6.2 years). All interviews were recorded and transcribed verbatim, resulting in 37 376 words of text for descriptive and thematic analysis. Inter-rater reliability checks resulted in a concordance of agreement of 83%.ResultsAlmost all athletes (93%) reported menstrual cycle-related symptoms. Thirty-three per cent perceived heavy menstrual bleeding and 67% considered these symptoms impaired their performances. Two-thirds of athletes self-medicated to alleviate symptoms. Thematic analysis generated 262 meaning units, 38 themes, 10 categories and 4 general dimensions. The four general dimensions were: (1) symptoms: physiological and psychological menstrual cycle-related symptoms such as dysmenorrhoea, flooding, reduced energy levels, worry, distraction, fluctuating emotions and reduced motivation; (2) impact: perceived impact of menstruation on different aspects of daily lives and performance including negative and neutral responses; (3) resolution: the methods/approaches in dealing with menstruation-related concerns including accepting, or adapting and managing symptoms with self-medication or expert treatment; (4) support: available support and comfortability in discussing menstrual cycle-related issues.ConclusionsThis study provides the first in-depth insight into athlete’s experiences of the menstrual cycle and perceived impact on training and competition. It highlights individual responses to menstrual ‘issues’ and emphasises the need for clinicians and support staff to undertake menstrual cycle profiling, monitoring and continue to develop awareness, openness, knowledge and understanding of the menstrual cycle.

Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance

“…The ability of elite athletes to train due to adverse symptoms was a prevalent feature; physical symptoms, including stomach cramps, lower back pain, or bloating were the predominant causes for training to be altered or missed. This is consistent with the results described by Kishali et al, 13 in which it was determined pain affects performance, further supported by Findlay et al 14 and Kin, Yegu & Illi 31 reporting 70.87% of athletes indicated painful menstruation within their study. Psychological and affective symptoms also were reported in our study, with feelings of lethargy, decreased motivation and distraction being the most recurrent symptoms.…”

“…One consistently reported element was the distraction of leaking or blood showing through clothes especially at competition, which was consistent across all sports, irrespective of competition clothing which ranged from singlets, leotards, shorts, and a white gi. This aligns with previous findings in which the trauma of staining clothing or leaking through underwear was deemed the most embarrassing event that could happen while menstruating 4,14 . This is an element which should be addressed within sport, providing athletes advice on menstrual products available and consideration of clothes females are required to wear for competition.…”

“…Previous research has made us aware of data relating to the perceived impact of the menstrual cycle on sport performance; Bruinvels et al 7 identified 51.1% of elite British female runners and rowers felt their menstrual cycle had in some way impacted upon their training and performance, Martin et al 29 reported that 77% of elite athletes (n = 430), not using hormonal contraception, had negative side effects during their menstrual cycle and Findlay et al 14 highlighted experiences of the menstrual cycle within elite rugby. However, there was a need to understand individual perceptions and which aspects of the menstrual cycle impacted on training and competition in individual and across multiple sports, as previous research has been predominantly large‐scale survey‐based approaches with minimal qualitative elements which allow individual responses to be addressed.…”

“…Despite the menstrual cycle potentially influencing a number of physiological and psychological constructs as previously highlighted, we are yet to establish an open environment in which the menstrual cycle is discussed equally with any other physiological determinants within sport performance 7 . This lack of consideration may be attributed to a variety of factors, either the limited research within this area or resulting from athletes’ individual experiences of their menstrual cycle and their discomfort having conversations on this topic with members of their support network as highlighted by Findlay et al 14 noting female rugby players felt unease having menstrual cycle conversations with male support staff. Women still try to conceal they are menstruating or experiencing premenstrual symptoms, this negative attitude toward menstruation has been reinforced by‐products and media.…”

“…If there was an open environment to talk about menstrual blood, there would be no reason to call it anything other than menstruation or menses 17 . Within elite team sport, one study identified that some athletes have expressed a reluctance to confide in their coaches relating to the menstrual cycle due to reported awkwardness, embarrassment, gender differences, and feeling like there would be nothing that the coach could do to help them 14 . Communication is a fundamental part of coaching, yet when focussing on the menstrual cycle, previous research has highlighted male coaches, compared to female coaches, reported it was less important to ask athletes about menstrual irregularity, being less comfortable communicating with female athletes about the topic 18 .…”