Characteristics Of Menstrual Cycle And Hormonal Contraceptive Use In Collegiate Female Athletes In The United States

Abstract

BACKGROUND: Menstruation is an important metric to assess and monitor optimal health in female athletes. Phases of the menstrual cycle are also correlated with variations in performance outcomes. Historically, collegiate-level athletes have relied on hormonal contraceptives (HC) to promote menstrual cycle regularity and reduce dysfunction. However, global trends indicate a decrease in HC use in female athletes, but this has not been quantified in collegiate NCAA athletes. Therefore, the purpose of this study is to quantify HC vs. non-use, and to characterize menstrual cycle patterns of non-HC users, in a diverse population of NCAA female athletes. METHODS: Female NCAA athletes (N = 410) from four universities, across 13 sports assessed, completed a questionnaire through the WHOOP application platform. Responses were categorized by groups using oral contraceptives (OC) (n = 175), other forms of HC (n = 60), and non-users of HC (n = 175). The group using other forms of HC were subcategorized into IUD, implant, ring, or other, groups. The number of typical bleeding days per cycle, and cycles in the past year, were examined in non-HC users only. Prevalence and type of HC use and non-use is reported as percentage of total sample and HC population, respectively. Days of menstruation is reported as percentage of the non-HC user population, by day ranges. RESULTS: HC use was 57% (n = 235, age = 21 ± 2 yrs.) of total population, of which 74% (n = 175) used OC, 7% (n = 31) used IUDs, 3% (n = 16) used a hormonal implant, and 2% (n = 11) reported other HC use. Non-HC users were 42% (n = 175, age = 21 ± 2 yrs.) of which 60 % (n = 105) reported normal bleed patterns of 3 to 6 days, while 1% (n = 2) reported 1 to 2 days, and 6% (n = 10) reported 7 to 8 days. Of the non-HC users, 3% (n = 6) reported 5 or less periods in the last year, while 74% (n = 130) reported 9 or more in the last year. CONCLUSIONS: This is the first study to investigate HC vs. non-HC use, as well as menstrual cycle patterns in female NCAA athletes from a wide range of sports. Knowledge of HC use and menstrual cycle patterns in female athletes is important for developing appropriate monitoring and management practices. Future outcomes of this dataset will investigate menstrual cycle irregularities across the season, variations by sport, and changes due to stress, training modalities, and lifestyle behaviors.