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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
Open accessAbstract
Objectives: The menstrual cycle can affect sports participation and exercise performance. There are very few data on specific menstrual cycle symptoms (symptoms during various phases of the cycle, not only during menstruation) experienced by exercising women. We aimed to characterise the most common symptoms, as well as the number and frequency of symptoms, and evaluate whether menstrual cycle symptoms are associated with sporting outcomes. Methods: 6812 adult women of reproductive age (mean age: 38.3 (8.7) years) who were not using combined hormonal contraception were recruited via the Strava exercise app user database and completed a 39-part survey. Respondents were from seven geographical areas, and the questions were translated and localised to each region (Brazil, n=892; France, n=1355; Germany, n=839; Spain, n=834; UK and Ireland, n=1350; and USA, n=1542). 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. We propose a novel Menstrual Symptom index (MSi) 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). Results: 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%). After controlling for body mass index, training volume and age, the MSi was associated with a greater likelihood of missing or changing training (OR=1.09 (CI 1.08 to 1.10); p≤0.05), missing a sporting event/competition (OR=1.07 (CI 1.06 to 1.08); p≤0.05), absenteeism from work/academia (OR=1.08 (CI 1.07 to 1.09); p≤0.05) and use of pain medication (OR=1.09 (CI 1.08 to 1.09); p≤0.05). Conclusion: Menstrual cycle symptoms are very common in exercising women, and women report that these symptoms compromise their exercise participation and work capacity. The MSi needs to be formally validated (psychometrics); at present, it provides an easy way to quantify the frequency of menstrual cycle symptoms.
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“These cyclic hormone changes can affect a number of physical and psychological attributes and, ultimately, may influence sports performance, although the effects are highly individual [88,90,91].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [90]
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“This recommendation is particularly prudent during the active pill weeks of COC users and during the luteal phase of the menstrual cycle of eumenorrheic women, where there is a greater effect of sex hormone suppression of gluconeogenesis output during exercise [90,166].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [90]
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Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., et al. (2023) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2204066 · Cited by 129
“gical attributes and, ultimately, may influence sports performance, although the effects are highly individual [88,90,91].”
BackgroundBruinvels, G., Hackney, A. C., & Pedlar, C. R. (2022) · Sports Medicine · doi:10.1007/s40279-022-01691-2 · Cited by 82
Self-citationMcNamara, A., Harris, R., & MINAHAN, C. L. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001300 · Cited by 81
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“…ventilatory response at exercise, SaO 2 oxygen arterial saturation fluctuations impact numerous physiological functions that may influence training [160, 161] and performance [162, 163], such as recovery [164], wellness [165], and in particular, considering the altitude environment, respiratory…”
Background
Metadata
- Authors
- Bruinvels, G., Goldsmith, E., Blagrove, R., Simpkin, A., Lewis, N., Morton, K., Suppiah, A., Rogers, J. P., Ackerman, K. E., Newell, J., & Pedlar, C.
- Affiliations
- St Mary's University Twickenham London (GB)
- Loughborough University (GB)
- National University of Ireland (IE)
- University of Manchester (GB)
- Boston Children's Hospital (US)
- Corresponding author
- Bruinvels, Georgie
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2020-11-16
- Volume
- 55
- Issue
- 8
- Pages
- 438-443
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W3098022168
- Cited by
- 173
- References
- 38
- Citations by year
- 2026: 37 · 2025: 40 · 2024: 45 · 2023: 26 · 2022: 16 · 2021: 9
- FWCI
- 9.54
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- cc-by-nc
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- St Mary's University Repository (ULCC) (acceptedVersion)
- Figshare (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- menstrual symptoms, female athletes, absenteeism, fatigue, mood changes, hormonal contraception, analgesic use, exercise performance, menstrual status, training volume, body mass index, training recovery
- MeSH terms
- Absenteeism, Adult, Affect, Analgesics, Anxiety, Competitive Behavior, Fatigue, Feeding Behavior, Female, Health Surveys, Humans, Menstrual Cycle, Sports, Exercise, Abdominal Pain, Prevalence, Mobile Applications
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