Scientific Programme
Applied Sports Sciences
IS-AP02 - Female health and menstrual cycle research; do we need to change our approach? A call for action
Date: 02.07.2025, Time: 13:15 - 14:30, Session Room: Arco
Description
Research on the effect of the menstrual cycle (MC) on performance has rapidly grown in the past five years. While this progress is encouraging, i) current research tends to neglect hormonal contraceptive cycles (HC) and menstrual dysfunction; ii) the primary focus is on specific parts of MC phases rather than including transitions between MC or HC phases; iii) testing is generally performed in a resting rather than fatigued state when the success of a game or race is generally determined. These points raise the question: How could current research methodologies be augmented to study the effect of the MC/HC on female health and sports performance in a way that may be more meaningful for those working within sport? As part of the invited symposium, we will discuss the effect of the MC on performance parameters in relation to durability, as well as the potential of using hormone profile patterns to monitor health status and optimise training prescriptions in female athletes. In addition, we will present several case studies from elite athletes and how they deal with female health challenges within their training programs and competitions.
Chair(s)
Robert Lamberts
University Medical Centre Groningen, University of Groningen, Department for Human Movement Sciences
Netherlands
Speaker A
Ritva Mikkonen
University of Jyväskylä, Sports Technology Unit, Faculty of Sport and Health Sciences
Finland
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Research and reality: Female health monitoring in diverse environments
Intentional monitoring of female health alongside performance has gained popularity in the lab as an opportunity to: i) examine the potential influence of menstrual (or hormonal contraceptive) phase on acute responses to exercise and performance; ii) establish menstrual status as part of, or prior to inclusion in research. In field settings monitoring female health alongside performance also provides information that may help to: i) identify recurring patterns of negative and positive symptoms that may influence performance or subjective feelings of performance; ii) detect early warning signs of low energy availability and/or low carbohydrate availability as well as overtraining/accumulated physical/social/psychological stress; and iii) to promote health literacy and empower female athletes. Monitoring female health alongside performance is an essential tool for bridging the gap between research and practice to better understand the relationships between female athlete health and performance. When carefully planned and implemented, monitoring may, on both case and population levels, serve academics and researchers as well as those working within sport i.e. athletes, coaches, and multidisciplinary teams including physicians, physical therapists, and pyschologists1. As a component of female health and performance monitoring, several approaches to menstrual cycle tracking are available. Where methodological recommendations for research regarding the menstrual cycle have been published2,3,4,5, a "gold standard" protocol for tracking menstrual cycles in field settings has yet to be developed/identified. Furthermore, tracking hormonal contraceptive cycles and menstrual disturbances/dysfunction has received significantly less attention where methodological considerations may require further development. Nevertheless, tracking cycle characteristics and symptoms of athletes with menstrual disturbances/dysfunction or using hormonal contraceptives may also provide meaningful and valuable information for athletes, coaches and multidisciplinary teams. The purpose of this presentation is to discuss the suggested approaches and rationale for tracking menstrual and hormonal contraceptive cycles (incl. menstrual disturbances/dysfunction) in female athletes “in the field” including how this data can potentially contextualise other health and performance data in a way that is meaningful for athletes. The feasibility and potential limitations of different analysis methods from traditional paper and pencil records to more sophisticated digital applications and biochemical measures for use in the field will be addressed. References 1Burden et al. Int J Sports Physiol Perform 2024; Ahead of Print. 2Elliott-Sale et al. Sports Med 2021; 51(5):843-861. 3Smith et al. Int J Sport Nutr Exerc Metab 2022; 32(2):114-127. 4Schaumberg et al. J Sci Med Sport 2017; 20(11):965-969. 5Janse de Jonge et al. Med Sci Sports Exerc. 51(12):2610-2617.
Speaker B
Robert Lamberts
University Medical Centre Groningen, University of Groningen, Division of Movement Science and Exercise Therapy (MSET)
Netherlands
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The effect of the menstrual cycle on performance; methodological challenges and the importance of durability
Research on the effect of the menstrual cycle on performance has gained much interest over the last five years. Although this is encouraging, most studies do not find differences in performance outcomes (1), while self-reported effects of the menstrual cycle on training habits and performance by athletes clearly do (2,3). This discrepancy may be explained by the variation in individual responses to the menstrual cycle and the effect it has on performance. This variation can lead to not finding significant differences at group level, while at an individual level, clinically meaningful changes might be observed in certain athletes. Another possible contributing factor might be that most performance tests in these studies are conducted in a rested (fresh) state rather than a fatigued state. Recently, Erp et al. (4) showed that performance characteristics in highly versus less successful male professional cyclists were similar in a fresh state but differed significantly in a fatigued state. In line with this, van Erp and Lamberts (5) showed similar outcomes in female professional cyclists in the top-5 versus not top-5 finishers. These findings highlight the importance of durability when monitoring and predicting performance. In addition, it also raises the question of whether the menstrual cycle impacts performance more clearly and with less variation between individuals in a fatigued state. This presentation will discuss the challenges and limitations of conducting group analysis within menstrual cycle research and how to overcome these, while also discussing the importance of durability testing female cyclists. As part of this, we will present some new and novel data from a study in which female-trained cyclists (23 ± 5 years; 4.4 ± 0.6 W⸱kg⁻¹) performed a standardised submaximal warm-up test and a 20-min time trial test before (fresh) and after (fatigued) a 60km submaximal ride during which they burned an average of 22 kJ⸱kg⁻¹. Besides providing new and novel insights into improving menstrual cycle research, practical insight will also be provided on how to monitor the menstrual cycle and the impact on performance in the field on an individual level. References 1 Mc Nulty et al. Sport Med. 2020;50:1813-1827 2 Brown et al. Int J Sports Physiol Perform. 2024;19:1012-1020 3 Solli et al. Int J Sports Physiol Perform. 2020;21:1324-1333 4 van Erp et al. Med Sci Sports Exerc. 2021;53:1903-1910 5 van Erp and Lamberts. Int J Sports Physiol Perform. 2022;17:1070-1076
Speaker C
Georgie Bruinverls
University College London, Division of Surgery and Interventional Science.
United Kingdom
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Translation to the real world; the cold, hard reality of needing to perform on any day
As female athletes keep pushing the barriers of human performance, focus is increasingly being placed on data collection and analysis to facilitate more informed decision making. A key part of this involves the monitoring of female health markers alongside wellness and performance measures. Integrating these data streams aids with contextualisation and helps to identify times where an athlete may show altered physiological, physical or psychological readiness. The acceleration in female athlete research over the past decade has clearly demonstrated the significant inter- and intra- individual variation in response to changes in endogenous and exogenous hormones through a menstrual cycle and/or in response to use of hormonal contraception (1,2). For some, this may manifest in adverse symptoms at particular times, that have the potential to negatively impact exercise participation and performance, alternatively many feel times where they get a boost or feel a positive response (3). The increase in data collection has facilitated a means for better identifying and understanding these responses. With the ongoing emergence of scientific rationale for the aetiology of menstrual cycle-related symptoms alongside an increased understanding of the natural physiological response to hormonal changes, it makes prudent sense to look at means for both reducing symptoms and optimising support around overt changes in markers of readiness (3,4). This is of particular relevance in elite sport, where margins are fine, ensuring an athlete is able to perform at their best on any day is fundamental. This presentation will provide several case reports from team and individual elite athletes, outlining how strategies have been implemented to optimise readiness and wellness based on the longitudinal monitoring of multiple data streams. 1. McNulty KL et al. Sports Med. 2020;50(10):1813-1827. 2. Oester C et al. J Sci Med Sport. 2024;27(6):373-384. 3. Antero J et al. Front Physiol. 2023;14:1110526. 4. Gaskins AJ et al. Am J Epidemiol. 2012;175(5):423-31.