Surprisingly here is very little data relating to the impact of the menstrual cycle on exercise performance. This week’s FastFact profiles a study, published in the BJSM, that has investigated both the types of symptoms experiences by exercising woman and the impact they have on their sporting participation.1
This survey based study involved a total of 6812 adult women of reproductive age (mean age: 38.3 (8.7) years) who were not using combined hormonal contraception. They were recruited via the Strava exercise app from seven geographical areas. The survey captured exercise behaviours, current menstrual status, presence and frequency of menstrual cycle symptoms, medication use for symptoms, perceived effects of the menstrual cycle on exercise and work behaviours and history of hormonal contraception use. Based on this survey the most prevalent menstrual cycle symptoms were mood changes/anxiety (90.6%), tiredness/fatigue (86.2%), stomach cramps (84.2%) and breast pain/tenderness (83.1%). Based on the study’s results it appears that these symptoms have an impact on an athlete’s ability to play or train. A number of symptoms (when adjusting for age, BMI and training volume) were significantly associated with missing/changing training, missing a sporting event/competition, missing work/lectures and pain medication use.
Support staff need to be aware of the impact that menstrual cycle symptoms can have on exercising women. This study’s authors highlight that these symptoms are very common and suggest that clinicians should more actively screening for these symptoms and look for strategies to help manage them more effectively. This may include better planning or training sessions, planning recovery as well as exploring other non-pharmacological and medical treatment options. More research is also needed to better understand the aetiology of many of the common symptoms and to develop evidence based interventions to either prevent or treat them.
As part of the study the authors developed an assessment tool to help quantify symptom burden. This was named the Menstrual Symptom index (MSi) and is based on the presence and frequency of 18 commonly reported symptoms (range 0–54, where 54 would correspond to all 18 symptoms each occurring very frequently). It is hoped that this may be the first step in the development of a screening tool that could be used to help quantify menstrual cycle symptoms and be used to measure the efficacy of treatment.
It should be noted that there are a number of methodological limitations associated with this study, including a limited response rate, the self-reporting and the reliance on the Strava app. It should be noted that the participants in this study were not football players and as a result may not represent this group of exercising women. On the other hand, the large sample size and the geographical spread of participants are clear strengths.
1. Bruinvels G, Goldsmith E, Blagrove R, et al Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app British Journal of Sports Medicine Published Online First: 16 November 2020. doi: 10.1136/bjsports-2020-102792