{"id":13337,"date":"2025-06-11T16:11:09","date_gmt":"2025-06-11T16:11:09","guid":{"rendered":"https:\/\/www.fitpro.com\/blog\/?p=13337"},"modified":"2025-06-11T16:11:09","modified_gmt":"2025-06-11T16:11:09","slug":"menstrual-cycle-symptomology","status":"publish","type":"post","link":"https:\/\/www.fitpro.com\/blog\/menstrual-cycle-symptomology\/","title":{"rendered":"Menstrual cycle symptomology – practical guidance for coaches and trainers"},"content":{"rendered":"

Debby Sargent <\/strong>looks at female sex hormones, training and performance, offering practical guidance for coaches and trainers on menstrual cycle symptomology<\/strong>.<\/h2>\n

The precise relationship between female sex hormone variations and objective measures of sports performance remains unclear despite an increasing number of studies, regardless of whether these changes are accounted for by the menstrual cycle or are mitigated by oral contraceptives. Studies have demonstrated that female sex hormones have little to no effect on metabolic, physiological, thermoregulatory and psychological responses1,2<\/sup>.<\/p>\n

This can be partially explained by the lack of academic rigour in some of these studies3,4<\/sup> and the paucity of research in other areas5,6,7<\/sup>, mostly due to the financial and logistical difficulties involved in conducting these kinds of studies. Research under these conditions makes it difficult to draw conclusions, and it is easy to make judgements that are premature or incorrect, which can be misleading for practitioners.<\/p>\n

Consequently, there is little guidance available for active females and their coaches or strength and conditioning trainers to make training decisions that further optimise and manage training load, although it is well known and documented that menstruation-related symptoms can negatively impact certain individuals’ quality of life and capacity to attend and adhere to training schedules8,9<\/sup>; these three factors are necessary to create an overload stimulus for physiological adaptation.<\/p>\n

Menstrual symptomology<\/strong><\/h4>\n

Dysmenorrhea, another name for period pain, is a type of pain and discomfort that occurs during menstruation. It often begins on the first day of the cycle and can continue for the whole period, though it is typically worst on the first or second day10<\/sup>. The symptoms of dysmenorrhea\u00a0typically include headaches, nausea, diarrhoea, abdominal pain and back pain10<\/sup>. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), a severe form of PMS that typically appears in the late luteal phase (the time between ovulation and your next period) and stops when (or just after) menstruation begins, are not the same as dysmenorrhea10,11<\/sup>.<\/p>\n

\"Debby<\/p>\n

Both PMS and PMDD are associated with a variety of physiological (tiredness, bloating or cramping, breast tenderness, headaches) and psychological (mood swings, feeling depressed, upset, anxious or irritable) symptoms that, when coupled with the symptoms of dysmenorrhea, have a detrimental effect on the quality and quantity of training and the general wellbeing of females12,13,8<\/sup>.<\/p>\n

It should come as no surprise that affected individuals seek methods to lessen bothersome menstruation symptoms, and utilising hormonal contraceptives (HC) is one such method. It is not always the case that athletes who use HCs report fewer physical symptoms; in some populations, it’s been shown that both HC and non-HC users report the most common symptoms (fatigue, bloating, stomach pain and lower back pain) equally13,14<\/sup>. Furthermore, anxiety, anger and irritability are among the most common negative emotional consequences of HC usage (19%); for some individuals14,15<\/sup> this can result in them discontinuing pill usage.<\/p>\n

In summary, despite the highly individualistic nature of menstrual symptomology, research supports that individuals with a high number and severity of symptoms could be compelled to compromise their performance in competitions and training (by attending less and adhering less\u00a0to programmes)1,8,9,12<\/sup>, potentially compromising their physical adaptations and overload.<\/p>\n

When Bruinvels et al (2021)8 <\/sup>used the Menstrual Symptom Index (MSi) to create a composite score based on the severity of 18 different symptoms (a Likert scale with 0 representing “never” to 3 representing “often”), the total scores ranged from 0 to 54. They found that the odds of missing or altering training increased by 1.09 for every unit increase in MSi. A 50% chance of missing a competition and a 90% chance of missing training were also discovered in participants whose MSi scores were higher than the 95th percentile.<\/p>\n

Physically active women’s quality of life has been demonstrated to be significantly impacted by menstruation-related problems<\/em><\/strong><\/p><\/blockquote>\n

Training adherence<\/strong><\/h4>\n

Training adherence refers to an individual\u2019s ability to follow the recommended exercise regimen, which is crucial in order to reach the training dosage needed to produce the intended training goals and adaptations. Researchers have consistently shown that individuals believe their performance is comparatively worse during the early follicular (menses) and late luteal phases. Interview-based16,17,9,12<\/sup> and questionnaire-based8,9,18<\/sup> data both corroborate this. According to Findlay et al (2020)9<\/sup>, training performance is frequently more adversely impacted than competitive performance.<\/p>\n

Menstrual pain can be diverted from and improved by competition9,12<\/sup> in some cases. However, for some individuals these effects may be exacerbated by pressure to perform well and anxiety experienced through lack of control over their menstrual cycle16,17<\/sup>. In comparison to the mid-luteal phase, ratings of perceived exertion are higher in the early and mid-follicular phases19,20<\/sup>, which means that motivating people to complete training sessions can be more challenging.<\/p>\n

Training attendance<\/strong><\/h4>\n

Physically active women’s quality of life has been demonstrated to be significantly impacted by menstruation-related problems (such as PMS), which regularly cause missed job, school and social activities8<\/sup>. Menstruation has also been found to be a deterrent to playing sports for both elite and recreational football players12,18<\/sup>. Menstruation was cited by 24% and 3%, respectively, of 127 amateur football players as the reason they missed 1-3 and 4-6 days of practice per month18<\/sup>.<\/p>\n

Elite football players have been shown to miss 4.1%14<\/sup> to 13.3%12<\/sup> of training and competition. Increased symptoms of PMS\/PMDD have an impact on training attendance; athletes who have more severe symptoms may decide to modify their schedules, skipping difficult sessions or not training at all21,22<\/sup>. Athletes who are not elite frequently rearrange their training; however, the degree of disruption varies22<\/sup>.<\/p>\n

It is imperative that coaches, S&C Trainers and female participants normalise conversations about the menstrual cycle<\/strong><\/em><\/p><\/blockquote>\n

Improving a female\u2019s training entails taking the menstrual cycle into account and modifying training as necessary. Periodised programmes can concentrate on lower-intensity activities during PMS\/PMDD symptoms and use symptom-free periods for harder workouts. Additionally, coaches need to be aware of psychological impacts. Dissatisfaction, low motivation and poor performance can result from neglecting individuals’ needs, which may further reduce exercise adherence and attendance.<\/p>\n

Menstrual monitoring<\/strong><\/h4>\n

Menstrual monitoring serves as a means of facilitating a more open discussion between the coach and participant regarding the subject and is required to identify individuals whose menstrual psychophysiology severely impacts them, hence requiring a modification in training. Because of the unpredictability of some menstrual cycles, long-term monitoring of menstrual symptomology is essential to being able to spot patterns and trends \u2013 some practical suggestions of what to monitor are listed in Table 1 below.<\/p>\n

Table 1: Strategies for monitoring menstrual cycle symptomology<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Monitoring strategy<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n
Training attendance<\/td>\nMonitor patterns of attendance and note number of missed sessions due to symptomology. Include what sessions\/types of training seem to be affected the most.<\/td>\n<\/tr>\n
Negative symptoms<\/td>\nNote the number, severity and duration of symptoms.<\/td>\n<\/tr>\n
Positive symptoms<\/td>\nAll individuals will experience and be able to pinpoint times within their cycle where they feel good and are ready to train \u2013 it is important to note and recognise this, as it will help identify when increasing or intensifying training load may be possible.<\/td>\n<\/tr>\n
Wellness monitoring<\/td>\nThe physical effects of MC symptoms can be picked up in a typical wellness monitoring system (e.g., fatigue, soreness, readiness to train).<\/td>\n<\/tr>\n
Menstrual flow (duration and severity)<\/td>\nMay help identify individuals who may be at risk of dysmenorrhea and PMDD. In athletic populations, a prolonged menstrual cycle was found to be strongly linked to dysmenorrhea23<\/sup>.<\/p>\n

Determines athletes who could require assistance in order to control the possibility of menstruation leakage or flooding9,21<\/sup>.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Practical guidance on how to accommodate menstrual symptomology<\/strong><\/h4>\n

Once a monitoring system has become established, it will provide insights for coaches\/S&C Trainers and participants as how best to work around negative symptomology. Concentrating on de-loading during PMS\/PMDD symptoms and maximising the use of symptom-free periods for harder workouts is a logical step. However, taking more practical measures to manage an individual\u2019s cycle may significantly lessen the uncomfortable menstrual experiences they have had, freeing them up to focus more on their training and performance goals. Actionable areas could include:<\/p>\n

    \n
  1. Wear appropriate clothing to lessen the chance of leaks; pay attention to the colour and fit of your workout attire.<\/li>\n
  2. Ensure that facilities are of a sufficient calibre and that changing areas are conveniently located near the training area to ensure menstrual product management.<\/li>\n
  3. If a competitive female\u00a0is travelling for an extended period of time, consider the challenges she may have with her symptoms and try to accommodate her with tactics like making numerous breaks or staying overnight.<\/li>\n
  4. Provide possibilities for managing symptoms, like breaks and the use of therapeutic tools to reduce pain, like the capacity to fill hot water bottles and enter calm spaces.<\/li>\n<\/ol>\n

    It is imperative that coaches, S&C Trainers and female participants normalise conversations about the menstrual cycle9,24<\/sup>. Open communication is hampered by barriers such as relationships between female exercisers and trainers and a lack of awareness24,25,26<\/sup>. Because they believe they are unable to help their female participants, coaches and S&C Trainers frequently avoid having these conversations.<\/p>\n

    Additionally, female participants steer clear of these kinds of conversations because they perceive menstruation as a private matter, fear discrimination or think their coaches or trainers lack the necessary skills to support them9,15,21<\/sup>. It is essential to educate coaches and participants, address privacy concerns and foster confidence when talking about the menstrual cycle, in order to improve interactions.<\/p>\n

    Listen to Debby Sargent in this FitPro podcast discuss training women athletes around the menstrual cycle<\/a><\/p>\n

    \"\"

    Debby Sargent<\/p><\/div>\n

    DEBBY SARGENT works as assistant professor in strength & conditioning at the Department of Biology, School of Energy, Geoscience, Infrastructure and Society at Heriot-Watt University. She has over 20 years\u2019 experience working with high-performance athletes and has been a UKSCA tutor and assessor since 2008.<\/p>\n

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    References<\/strong><\/p>\n

      \n
    1. D\u2019Souza AC, Wageh M, Williams JS, Colenso-Semple LM, McCarthy DG, McKay AK, Elliott-Sale KJ, Burke LM, Parise G, MacDonald MJ, Tarnopolsky MA (2023), Menstrual cycle hormones and oral contraceptives: A multimethod systems physiology-based review of their impact on key aspects of female physiology, Journal of Applied Physiology<\/em>, 135(6): 1284-99.<\/li>\n
    2. Constantini NW, Dubnov G, Lebrun CM (2005), The menstrual cycle and sport performance, Clinics in Sports Medicine, 24(2): e51-82.<\/li>\n
    3. Elliott-Sale KJ, Minahan CL, de Jonge XA, Ackerman KE, Sipil\u00e4 S, Constantini NW, Lebrun CM, Hackney AC (2021), Methodological considerations for studies in sport and exercise science with women as participants: A working guide for standards of practice for research on women, Sports Medicine<\/em>, 51(5): 843-61.<\/li>\n
    4. Schmalenberger K, Tauseef HA, Barone JC, Owens SA, Lieberman L, Jarczok MN, Girdler SS, Kiesner J, Ditzen B, Eisenlohr-Moul TA, How to study the menstrual cycle<\/em>.<\/li>\n
    5. Elliott-Sale KJ, McNulty KL, Ansdell P, Goodall S, Hicks KM, Thomas K, Swinton PA, Dolan E (2020), The effects of oral contraceptives on exercise performance in women: A systematic review and meta-analysis, Sports Medicine<\/em>, 50(10): 1,785-812.<\/li>\n
    6. Carmichael MA, Thomson RL, Moran LJ, Wycherley TP (2021), The impact of menstrual cycle phase on athletes\u2019 performance: a narrative review. International Journal of Environmental Research and Public Health, 18(4): 1,667.<\/li>\n
    7. Colenso-Semple LM, D’Souza AC, Elliott-Sale KJ, Phillips SM (2023), Current evidence shows no influence of women’s menstrual cycle phase on acute strength performance or adaptations to resistance exercise training, Frontiers in Sports and Active Living<\/em>, 5: 1054542.<\/li>\n
    8. Bruinvels G, Goldsmith E, Blagrove R, Simpkin A, Lewis N, Morton K, Suppiah A, Rogers JP, Ackerman KE, Newell J, Pedlar C (2021), 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<\/a>, British Journal of Sports Medicine<\/em>, 55(8): 438-43.<\/li>\n
    9. Findlay RJ, Macrae EH, Whyte IY, Easton C, Forrest LJ (2020), How the menstrual cycle and menstruation affect sporting performance: Experiences and perceptions of elite female rugby players, British Journal of Sports Medicine<\/em>, 54(18): 1,108-13.<\/li>\n
    10. Guimar\u00e3es I, P\u00f3voa AM (2020), Primary dysmenorrhea: assessment and treatment, Revista Brasileira de Ginecologia e Obstetr\u00edcia, <\/em>42: 501-7.<\/li>\n
    11. Carlini SV, Lanza di Scalea T, McNally ST, Lester J, Deligiannidis KM (2022), Management of premenstrual dysphoric disorder: A scoping review, International Journal of Women’s Health<\/em>, 1,783-1,801.<\/li>\n
    12. Read P, Mehta R, Rosenbloom C, Jobson E, Okholm Kryger K (2022), Elite female football players\u2019 perception of the impact of their menstrual cycle stages on their football performance. A semi-structured interview-based study, Science and Medicine in Football<\/em>, 6(5): 616-25.<\/li>\n
    13. Nolan D, Elliott-Sale KJ, Egan B (2023), Prevalence of hormonal contraceptive use and reported side effects of the menstrual cycle and hormonal contraceptive use in powerlifting and rugby, The Physician and Sports Medicine<\/em>, 51(3): 217-22.<\/li>\n
    14. Martin D, Sale C, Cooper SB, Elliott-Sale KJ (2018), Period prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes, International Journal of Sports Physiology and Performance, 13(7): 926-32.<\/li>\n
    15. Clarke A, Govus A, Donaldson A (2021), What male coaches want to know about the menstrual cycle in women\u2019s team sports: Performance, health, and communication, International Journal of Sports Science & Coaching<\/em>, 16(3): 544-53.<\/li>\n
    16. Brown N, Knight CJ, Forrest LJ (2021), Elite female athletes\u2019 experiences and perceptions of the menstrual cycle on training and sport performance, Scandinavian Journal of Medicine & Science in Sports<\/em>, 31(1): 52-69.<\/li>\n
    17. McHaffie SJ, Langan-Evans C, Morehen JC, Strauss JA, Areta JL, Rosimus C, Evans M, Elliott-Sale KJ, Cronin CJ, Morton JP (2022), Normalising the conversation: A qualitative analysis of player and stakeholder perceptions of menstrual health support within elite female soccer, Science and Medicine in Football<\/em>, 6(5): 633-42.<\/li>\n
    18. Pinel CJ, Mehta R, Okholm Kryger K (2022), The impact and experienced barriers menstruation present to football participation in amateur female footballers, Journal of Sports Sciences<\/em>, 40(17): 1,950-63.<\/li>\n
    19. Mattu AT, Iannetta D, MacInnis MJ, Doyle\u2010Baker PK, Murias JM (2020), Menstrual and oral contraceptive cycle phases do not affect submaximal and maximal exercise responses, Scandinavian Journal of Medicine & Science in Sports<\/em>, 30(3): 472-84.<\/li>\n
    20. Paludo AC, Paravlic A, Dvo\u0159\u00e1kov\u00e1 K, Gimunov\u00e1 M (2022), The effect of menstrual cycle on perceptual responses in athletes: A systematic review with meta-analysis, Frontiers in Psychology<\/em>, 13: 926854.<\/li>\n
    21. Koli\u0107 P, Thomas L, Morse CI, Hicks KM (2023), Presentation of self, impression management and the period: A qualitative investigation of physically active women\u2019s experiences in sport and exercise, Journal of Applied Sport Psychology<\/em>, 35(3): 478-97.<\/li>\n
    22. Prado RC, Willett HN, Takito MY, Hackney AC (2022), Impact of premenstrual syndrome symptoms on sport routines in nonelite athlete participants of summer Olympic sports, International Journal of Sports Physiology and Performance<\/em>, 18(2): 142-7.<\/li>\n
    23. Momma R, Nakata Y, Sawai A, Takeda M, Natsui H, Mukai N, Watanabe K (2021), Comparisons of the prevalence, severity, and risk factors of dysmenorrhea between Japanese female athletes and non-athletes in universities, International Journal of Environmental Research and Public Health<\/em>, 19(1): 52.<\/li>\n
    24. McGawley K, Sargent D, Noordhof D, Badenhorst CE, Julian R, Govus AD (2023), Improving menstrual health literacy in sport, Journal of Science and Medicine in Sport<\/em>, 26(7): 351-7.<\/li>\n
    25. Hook M, Bergstrom M, Saether SA, McGawley K (2021), \u201cDo Elite Sport First, Get Your Period Back Later.” Are Barriers to Communication Hindering Female Athletes?, International Journal of Environmental Research and Public Health<\/em>, 18(22).<\/li>\n
    26. Laske H, Konjer M, Meier HE (2024), Menstruation and training \u2013 a quantitative study of (non-) communication about the menstrual cycle in German sports clubs, International Journal of Sports Science & Coaching<\/em>, 19(1): 129-40.<\/li>\n<\/ol>\n

       <\/p>\n

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