Menstrual Cycle Symptoms Research Articles

Perceived Negative Menstrual Cycle Symptoms, but not Changes in Estrogen or Progesterone, are Associated with Impaired Cycling Race Performance.

Purpose: To examine the relationship between menstrual cycle (MC) phase-dependent fluctuations of estrogen and progesterone and virtual cycling race performance, with a secondary aim of correlating perceived MC-related symptoms with performance.Methods: In a novel observational study design, thirty-seven female cyclists/triathletes not using any hormonal contraception completed one virtual cycling race [19.5 km time trial (TT)] per week across a one-month period (totaling four races). Participants completed MC characterization and tracking, including urinary ovulation kits, across two complete MCs. Venous blood samples were collected within 21 h of racing to determine serum 17-β-estradiol and progesterone concentrations, as well as an assessment of self-reported, perceived race-day MC and gastrointestinal (GI) symptoms, which were all then correlated to race performance.Results: There was no relationship between race completion time and individual estradiol (r = -0.001, p = 0.992) or progesterone (r = -0.023, p = 0.833) concentrations. There was no difference between race time between MC phases (follicular/luteal, p = 0.238), whether MC bleeding or not bleeding (p = 0.619) and ovulating or not ovulating (p = 0.423). The total number of perceived MC symptoms recorded on race day was positively correlated to increased race time [r = 0.268 (95% CI 0.056 to 0.457), p = 0.014], as was the number of GI symptoms of at least "moderate" severity before the race (r = 0.233 [95% CI 0.021 to 0.425], p = 0.031), but not post-race (r = 0.022, p = 0.841).Conclusions: When implementing a novel, virtual cycling race, fluctuations in ovarian hormone concentrations across the MC do not appear to affect real-world cycling performance among trained cyclists, while perceived negative MC and GI symptoms may relate to impaired performance. Therefore, the management of negative MC and GI symptoms appears important for athletic performance enhancement or to mitigate performance decline.

Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes

ObjectivesTo co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being.Methods40 Team USA...

Menstrual cycle patterns and their relationship with measures of well-being and perceived performance metrics in competitive and recreational resistance-trained athletes.

There is mixed evidence on how the menstrual cycle (MC) affects sports performance, with many studies showing variations in performance during different phases of the MC, while other evidence shows that the MC's effects on performance may be trivial. Therefore, this exploratory longitudinal monitoring study was designed to investigate MC characteristics and symptoms in a resistance-trained (RT) population to look for associations between measures of well-being and perceived performance metrics across the MC. RT females reported their workout habits, perceived performance metrics, and measures of well-being while tracking their MC with detailed methods via daily check-ins in an app. Most MC characteristics and symptoms in the present RT population aligned with previous research on the general population. However, the frequency of irregular cycles was higher than in previous research on the general population. The amount of individual variation and within-subject cycle-to-cycle variation in MC characteristics and MC symptoms was also high. All measures of well-being were significantly associated with specific days of the MC, demonstrating a change in well-being based on the timing of the MC. Several perceived performance metrics were significantly associated with changes across the MC, while others were not. Overall, with the current evidence as it stands, a highly individualized approach should be taken for any training or performance considerations surrounding the MC due to the high levels of individual variation.

Chronicling menstrual cycle patterns across the reproductive lifespan with real-world data

The intricate hormonal and physiological changes of the menstrual cycle can influence health on a daily basis. Although prior studies have helped improve our understanding of the menstrual cycle, they often lack diversity in the populations included, sample size, and the span of reproductive and life stages. This paper aims to describe the dynamic differences in menstrual cycle characteristics and associated symptoms by age in a large global cohort of period-tracking application users. This work aims to contribute to our knowledge and understanding of female physiology at varying stages of reproductive aging. This cohort study included self-reported menstrual cycle and symptom information in a sample of Flo application users aged 18–55. Cycle and period length and their variability, and frequency of menstrual cycle symptom logs are described by the age of the user. Based on data logged by over 19 million global users of the Flo app, the length of the menstrual cycle and period show clear age-associated patterns. With higher age, cycles tend to get shorter (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 1.85 days, Cohen’s D = 0.59) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.42 days, Cohen’s D = 0.09), until close to the chronological age (40–44) suggesting menopausal transition, when both cycles and periods become longer (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.86 days, t = 48.85, Cohen’s D = 0.26; Period length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.08, t = 15.6, Cohen’s D = 0.07) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 2.80 days, t = 111.43, d = 0.51; Period length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.23 days, t = 67.81, Cohen’s D = 0.31). The proportion of individuals with irregular cycles was highest in participants aged 51–55 (44.7%), and lowest in the 36–40 age group (28.3%). The spectrum of common menstrual cycle-related symptoms also varies with age. The frequency of logging of cramps and acne is lower in older participants, while logs of headache, backache, stress, and insomnia are higher in older users. Other symptoms show different patterns, such as breast tenderness and fatigue peaking between the ages of 20–40, or mood swings being most frequently logged in the youngest and oldest users. The menstrual cycle and related symptoms are not static throughout the lifespan. Understanding these age-related differences in cycle characteristics and symptoms is essential in understanding how best to care for and improve the daily experience for menstruators across the reproductive life span.

Impact of COVID-19 infections and vaccination on menstrual cycle symptoms in the south of Jordan: a cross-sectional study

BackgroundSeveral recent studies have highlighted the need for more evaluation of the impact of COVID-19 infections and vaccines on the reproductive system and menstruation. This study aimed to assess the impact of COVID-19 infection and vaccines on menstrual symptoms.MethodsA cross-sectional survey utilizing face-to-face interviews from January 1 to 31 March 2022 was conducted in the city of Al-Karak in southern Jordan. The questionnaire included sociodemographic characteristics, medical and reproductive history, the contraceptive method used if any, menstrual cycle (MC) status, previous medical and drug history, and the impact of infection and vaccination on the MC.ResultsThe study questionnaire was completed by 400 participants with a mean age of 32.1±12.6 years. Regarding the history of COVID-19 infections, 33.8% of the participants reported a history of confirmed COVID-19 infections, 77.8% of them did not report any menstrual changes following the infection, while the remaining 22.2% reported changes in menstruation. The most commonly reported post-COVID-19 manifestations were irregular (27.6%) and light menstrual cycle (MC) (24.15) or dysmenorrhea (24.1%). Heavy menstruation was reported by 17.2% of participants post-COVID-19 infection. Two-thirds of the study participants (66.6%) reported no changes in the MC following the administration of the COVID-19 vaccine. The most reported symptoms for those who experienced changes in the MC following the vaccination were irregular cycle (13.1%), heavy menstruation (7%), and light menstruation (7%). Other reported symptoms were dysmenorrhea (4.6%), intermenstrual bleeding (1.2%), and amenorrhea (0.5%).ConclusionThis study revealed minor changes in the MC following COVID-19 infections and administration of the COVID-19 vaccine. These findings are consistent with published reports. It is recommended that future clinical trials for new vaccines for women of childbearing age include outcomes related to sex hormones and MC. Women should be encouraged to take the vaccines and report symptoms to healthcare professionals for further assessment.

The prevalence of menstrual cycle symptoms and their association with mental health and sleep in German exercising women and athletes

ObjectivesMenstrual cycle symptoms are very common in female athletes. However, more evidence about the association between menstrual cycle characteristics and symptoms with sleep and mental health in athletes needs to be gathered. This study aimed to examine this association in German exercising women and athletes. Design322 women (mean age: 23.13 ± 4.36) participated in a cross-sectional study. The survey included the Menstrual Symptom index (MSi), the Depression Anxiety Stress Scales (DASS-21), the Pittsburgh Sleep Quality Index (PSQI), and the Athletes Sleep Behavior Questionnaire (ASBQ). Additionally, demographic, sport-specific data and further menstrual cycle characteristics were examined. Multiple regression models were used for the statistical analyses. ResultsThe MSi score demonstrated a highly significant (p < 0.001) positive association with Depression, Anxiety, Stress, PSQI, and ASBQ. The most prevalent menstrual cycle symptoms were cravings/increased appetite, mood changes/anxiety, and tiredness/fatigue. A difference between individual and team sport athletes could not be found. Moreover, there was no association between the constructs and menses length, irregularity, or heaviness of bleeding. ConclusionsMenstrual cycle symptoms occur very frequently in female athletes. In this study, they were related to mental health, sleep quality, and sleep behavior, regardless of the cycle phase. This evidence demonstrates the relevance of considering the menstrual cycle and menstrual symptoms in future studies with female athletes and in sport practice.

Menstrual cycle characteristics, hormonal contraceptive use and perceptions of related effects in resistance-trained athletes

There has been an increased interest in the effects the menstrual cycle (MC) may have on sports performance. As a part of the MC, many females experience a wide range of symptoms related to hormonal fluctuations and menstrual bleeding, including physical pain and mood disturbances. Currently, there is a lack of data on the MCs of females who participate in resistance training. The dearth of information on the regular MC in female athletes may lead to poorly informed training recommendations which may be detrimental for female athletic advancement. The purpose of this survey was to determine the average MC characteristics, hormonal contraceptive (HC) use and perceived effects of the MC on training in resistance-trained athletes, and to determine if there are differences in these variables when comparing recreationally trained women to competitive-level athletes. A survey addressing questions about the MC, HC use and perceived effects of the MC was accessed by 906 participants who self-identified as resistance-trained athletes. Resistance-trained athletes, competitive or not, experience MCs similar to data on other exercising females and the general population. MC symptoms are widespread and, for some, can be quite severe and limiting. Competitive athletes were not more likely to experience MC irregularities than non-competitive females. Nearly half of the participants reported using HCs. Most participants perceived that their MC had a negative effect on their performance and that their MC caused reductions in training load or workout program adherence, although most competitive-level athletes did not withdraw from competitions due to MC symptoms.

Menstrual-Cycle Symptoms and Sleep Characteristics in Elite Soccer Players.

To determine whether menstrual-cycle symptoms are associated with sleep in elite female athletes. Sleep was assessed for a minimum of 25 nights (range = 25-31) using activity monitoring and sleep diaries. Menstrual-cycle symptoms were collected over the same duration in 12 elite female professional soccer players. Generalized estimating equations were used to examine the relationship between the day of the menstrual cycle (from day 1) and total menstrual-cycle symptoms on sleep characteristics. There was a significant relationship between sleep duration and the day of the menstrual cycle (P = .042) and total symptoms reported that day (P < .001), with sleep duration increasing by 21minutes for every symptom reported. There was a negative day × symptom interaction on sleep duration (P = .004), indicating that with increased symptoms, the day of the menstrual cycle had a smaller relationship with sleep duration. Sleep efficiency (P = .950), wake after sleep onset (P = .217), and subjective sleep quality (P = .080) were not related to the day of the menstrual cycle. The total symptoms reported had no relationship with sleep efficiency (P = .220), subjective sleep quality (P = .502), or sleep latency (P = .740) but did significantly relate to wake after sleep onset (P < .001), with a significant day × symptom interaction (P < .001). Sleep duration increased from day 1 of the menstrual cycle and was associated with the number of menstrual-cycle symptoms reported. All other sleep metrics remained unchanged; however, total symptoms reported were related to wake after sleep onset. Monitoring and managing menstrual-cycle symptoms should be encouraged due to a potential relationship with sleep characteristics.

Menstrual cycle tracking in professional volleyball athletes.

The menstrual cycle may affect well-being and physical performance of elite female athletes by interfering with the function of multiple physiological systems. The aim of this study was to characterize the symptoms of the menstrual cycle and their frequency in elite female volleyball players. Twenty professional female volleyball players were instructed to track their menstrual symptoms over the course of the first German national league season using the FitrWoman® tracking app. The app recorded the cycle length, duration, and intensity of the period as well as the occurrence and frequency of frequent cycle symptoms. The reported symptoms were then categorized into four categories (frequently, sometimes, rare, never) in order to create an individual Menstrual Symptom index (MSi) for each athlete. The most frequently occurring symptoms among all players without hormonal contraception (non-HC; n = 15) were "stomach cramps" (n = 15), "sleep disturbances" (n = 11), and "tiredness" (n = 11). The average number of symptoms counted per cycle was 11.8 (±17.7) and the average calculated MSi within the team was 12.9 (±10.7) points for non-HC users. The HC players (n = 4) also regularly experienced symptoms such as "sleep disturbances" or "tendered breasts". The most common symptoms "stomach cramps" and "disturbed sleep" occurred more frequently during menstruation, while symptoms such as "bloating", "cravings" or "tendered breasts" did also peak before menstruation. Menstrual cycle symptoms can be highly individual within a professional sports team. The calculation of the MSi seems to be a simple and accessible method to describe and overview the intensity and prevalence of symptoms in top female athletes in sports games.

Recreational Female Athletes’ Understanding of and Perceived Impact of the Menstrual Cycle on Physical Performance, Mood, and Sleeping Behaviour

This study aimed to examine female recreational (FRC) athletes’ knowledge of the menstrual cycle and their perception of how each phase affects their performance, mood, and sleep. One hundred and sixty-four (n = 164) FRC athletes completed an online survey. The questionnaire employed was based on previously validated questionnaires and consisted of three different sections: (a) knowledge about the menstrual cycle, (b) menstrual cycle symptoms, and (c) menstrual cycle and performance. The results indicated that 70.1% of the surveyed FRC athletes were not knowledgeable regarding the phases of the menstrual cycle, with 55.5% being ignorant of the specific hormones released during the cycle. Furthermore, 37.8% perceived that their performance was sometimes affected during the early follicular phase, with the main symptoms being physical fatigue (17.9%) and a more irritable mood (25.9%). In addition, 19.5% of the FRC athletes reported sleeping disturbances, and 20.4% described changes in sleep quality during menstruation. Lastly, 11.9% of the FRC athletes reported suffering from a combination of mood swings, sleeping problems, bloating or stomach issues, breast tenderness, headaches, and fatigue prior to menstruation. The results of this study provide valuable insights into how FRC athletes experience the menstrual cycle, which can help RC athletes and trainers better understand their needs and support them in achieving optimal performance.

Physical activity and combined hormonal contraception: association with female students' perception of menstrual symptoms.

Aim: The aim of this study was to examine the association between physical activity (PA) and combined hormonal contraceptive (CHC) on female students' self perceptio of their menstrual cycle symptoms. Methods: Healthy French female students (n = 834) completed an online questionnaire to assess their PA level (Group 1: non-active; Group 2: moderate physical activity; Group 3: high physical activity; Group 4: very high physical activity), menstrual status or contraception use, self-reported diet and medication, impact on engagement in some social activities, and self-assessment of perceived mental and physical symptoms during the week prior to menses (PM) for students with a normal menstrual cycle (NMC), and the week of menses (ME) for normal menstrual cycle students and those using combined hormonal contraception. Results: Whatever the conditions (PM and ME, NMC and CHC), fewer self-perceived symptoms and self-reported alteration in fat intake were reported by the students in Group 4, and more analgesic and anti-inflammatory medication use was reported by Group 1. Fewer self-perceived symptoms were also found in CHC vs NMC female students for all physical activity levels, but in a more marked way when associated with very high physical activity. In addition, less university and sports practice absenteeism was observed with high and very high physical activity. Conclusion: In conclusion, the perception of menstrual cycle symptoms was lower with very high physical activity, as with combined hormonal contraception. Moreover, female students training more than 5h/week also reported less university absenteeism and impairment in physical activities. Further studies are necessary to establish the causal link of physical activity and combined hormonal contraception on menstrual symptoms.

Trends in menstrual cycle symptoms, physical activity avoidance, and hormonal contraceptive use in a general population of adult women

IntroductionResearch examining symptoms and side effects of the menstrual cycle on physical activity performance and participation has almost exclusively focussed on elite and athletic populations. The current study aimed to i) identify any differences in symptomatic experiences of the menstrual cycle between hormonal contraceptive users and non-users, ii) gain insight into hormonal contraceptive use, iii) describe perceived symptomatic influences on physical activity engagement, and iv) identify perceived levels of knowledge and understanding around the menstrual cycle. Methods: An online questionnaire was completed by 881 adult females aged between 18 and 55 years. Questionnaire items related to hormonal contraceptive use, habitual physical activity levels, experiences and symptoms of the menstrual cycle, and sources of information resulting in knowledge and understanding of the menstrual cycle. Results: More than half of all participants (52%) identified themselves as being recreationally active, and the most commonly reported menstrual symptoms were abdominal cramps, lethargy, abdominal bloating, lower back pain, and heavy bleeding. Of all respondents, 48.1% were using some form of hormonal contraception, 66% of which were using a version of a combined oral contraceptive pill. Discussion: Consistent with previous studies, 90% of respondents regularly experienced adverse menstrual symptoms, including abdominal cramps, lethargy, abdominal bloating, lower back pain, and heavy bleeding. Menstrual symptoms were frequently identified as influential factors in the avoidance of, and reduced performance in, physical activity. Almost half of all participants were using some form of hormonal contraception, a noticeably larger proportion than has been previously documented in studies examining non-athletic populations.

"I hardly have a problem […] I have my period quite rarely too": Female football players' and their coaches' perceptions of barriers to communication on menstrual cycle.

Symptoms related to the menstrual cycle (MC) affect the performance level and health of female athletes in various ways. Previous research has reported MC symptoms such as pain, mood disturbance, reduced coordination and competition distraction as well as diminished performance levels and an increased injury risk among female elite athletes. Despite this, the coach-athlete communication related to the female hormonal cycle is limited. The aim of the present study was to explore the perceptions of MC communication in a group of junior elite football players and their male coaches in a case study of one youth football team in a specific club in Norway. The study used a qualitative approach with semi-structured interviews. In total, 8 female junior elite players (aged 16-20) from a Norwegian football team and 2 of their male coaches participated in the study. The data analysis revealed two main communication barriers: 1. interpersonal barriers (e.g., false assumptions about the coach/athletes and social discomfort) and 2. knowledge barriers (e.g., unaware/perceptions of insufficient knowledge levels). As the players seemed to be unaware of their insufficient MC knowledge (e.g., failed to see a connection between the MC and their health and performance level), the coaches perceived their knowledge as insufficient and coped mainly by outsourcing MC communication to female staff and apps. Hence, the MC communication was hindered by both the athletes and the coaches (e.g., mutual avoidance). In line with previous research, this study supports that there is a need for developing effective strategies to overcome the interpersonal barriers and knowledge gaps.

Menstrual cycle symptoms are associated with nutrient intake: Results from network analysis from an online survey.

Less is understood about female's nutrient intake's impact on the severity of the menstrual cycle (MC) symptoms, which consequently interferes with their life quality. The goal of this study is to look at the relationship between female nutrient consumption and the severity of MC symptoms to better understand how food affects women's quality of life during their MCs. To investigate this impact among healthy adult women, a self-administered, cross-sectional online questionnaire was obtained from 204 regularly menstruating women aged between 18 and 40. The questionnaire included questions on sociodemographic characteristics, a semi-food frequency questionnaire (FFQ), Arabic Premenstrual Syndrome Scale (A-PMS-S) for MC symptoms. Results showed intake of polyunsaturated fatty acids (PUFAs) was associated with lower no to mild versus moderate to severe physical symptoms (odds ratio (OR): 0.71, 95% confidence interval (CI): 0.59-0.85; p < 0.001), psychological symptoms (OR: 0.87, 95% CI: 0.77-0.99; p < 0.05), and functioning symptoms (OR: 0.92, 95% CI: 0.83-1.02; p > 0.1). Thiamine prevented psychological symptoms (OR: 0.02, 95% CI: 0.02-0.02; p < 0.001), physiological symptoms (OR: 0.59, 95% CI: 0.58-0.60; p < 0.001), and functioning symptoms (OR: 0.47, 95% CI: 0.47-0.48; p < 0.001). Saturated fat, iron, and niacin intakes increased the risk of experiencing MC psychological symptoms. Our findings suggest that MC symptoms were correlated with some nutrient intake from food sources, which is considered an external controllable factor more than demographic characteristics. Therefore, women should be aware of the type of food consumed during their monthly MC phase.

Do Recreationally-Trained Women of Different Ages Perceive Symptoms of the Menstrual Cycle and Adjust Their Training According to Phases?

We aimed to investigate the effects of the menstrual cycle (MC) in recreationally trained women athletes, including their perception of training, if age affected their perception of MC symptoms, and if they adjusted their training according to phases of the MC which they would perceive as the best/worst phase to train in. Three hundred- and ten-women amateur athletes with regular MC replied to an online quiz about their perception and the effects of MC on training and how they adjusted training according to their MC. Women were classified into three age groups: 18-25 years-old (n = 108), 26-35 years-old (n = 135), and 36-45 years-old (n = 67). Despite a higher ratio of younger perceived symptoms and the influence of MC phases in training, the group varied their training according to MC phases the least (37%) compared to 26-35 (50%) and 36-45-year-olds (40.2%). Most of athletes perceived the late follicular phase (LF) as the best phase to train in (18-25 = 79.6%; 26-35 = 80.7%; 36-45 = 91%) and the worst phases were early follicular (EF) (54.6%; 58% and 46.2%), and late luteal (LL) (38%; 48% and 47.7%). Regardless of age, most women perceived MC symptoms, and women in the 26-35 group adjusted their training more according to MC phases.

How Lifestyle Changes during the COVID-19 Global Pandemic Affected the Pattern and Symptoms of the Menstrual Cycle.

This research investigated the implications that the COVID-19 pandemic had on the menstrual cycle and any contributing factors to these changes. A questionnaire was completed by 559 eumenorrheic participants, capturing detail on menstrual cycle symptoms and characteristics prior to and during the COVID-19 pandemic lockdown period. Over half of all participants reported to have experienced lack of motivation (61.5%), focus (54.7%) and concentration (57.8%). 52.8% of participants reported an increase in cycle length. Specifically, there was an increase in the median cycle length reported of 5 days (minimum 2 days, maximum 32 days), with a median decrease of 3 days (minimum 2 days and maximum 17 days). A lack of focus was significantly associated with a change in menstrual cycle length (p = 0.038) reported to have increased by 61% of participants. Changes to eating patterns of white meat (increase p = 0.035, decrease p = 0.003) and processed meat (increase p = 0.002 and decrease p = 0.001) were significantly associated with a change in menstrual cycle length. It is important that females and practitioners become aware of implications of environmental stressors and the possible long-term effects on fertility. Future research should continue to investigate any long-lasting changes in symptoms, as well as providing education and support for females undergoing any life stressors that may implicate their menstrual cycle and/or symptoms.

Reliability Of The Visual Analog Scale For Menstrual Cycle Symptoms And Impact On Perceived Performance

PURPOSE: Fluctuations in estrogen during the menstrual cycle are thought to reduce athletic performance and aerobic capacity, hence, the purpose of this study was to determine the reliability of a menstrual cycle survey that proposes to assess the presence of symptoms and the perceived impact on training within collegiate athletes. METHODS: Seven NCAA-Division I women swimmers (19 ± 1 years, 30.1 ± 4.1 BMI), who trained normally participated in this study during the collegiate swim season. Athletes completed an electronic Visual Analog Scale (VAS) assessing menstrual status, as well as the presence and impact of symptoms twice within 30 minutes. Responses were recorded by marking a point on a 100-point line anchored by “not at all” and “often” in response to the presence of menstrual symptoms or “not at all” and “severely impacted” in response to the impact of menstrual symptoms on their training. Test re-test data were analyzed using two-tailed dependent samples t-tests and Intraclass Correlation coefficients (ICC3,1). RESULTS: A significant Intraclass Correlation was observed without a difference between surveys for the presence of mood swings (ICC:0.913, p = 0.143), loneliness (ICC:0.835, p = 0.395), headaches (ICC:0.835, p = 0.057) backaches (ICC:0.958, p = 0.125) and bloating (ICC:0.878, p = 0.198). A significant Intraclass Correlation was also observed without a difference between surveys in the perceived effect on training for cramps (ICC:0.823 p = 0.383), breast pain (ICC:0.818, p = 0.214), and bloating (ICC:0.817, p = 0.857). A significant difference between surveys was observed for athletes’ feelings of anxiousness (ICC:0.896, p = 0.022) and restlessness (ICC:0.707, p = 0.010); as well as the perceived effect anxiety (ICC:0.934, p = 0.041) and backaches (ICC:0.966, p = 0.009) had on training. CONCLUSION: Initial results from this survey suggest an electronic VAS may be a reliable measurement tool for some symptoms, including the frequency of mood swings, loneliness, backaches, bloating and possibly headaches, as well as the perceived effect cramps, breast pain and bloating have on training. Future research should focus on validating the results of this study against performance measures of participants as well as testing the reliability of participants with prior experience completing an electronic VAS.

The effect of BNT162b2 SARS-CoV-2 mRNA vaccine on menstrual cycle symptoms in healthy women.

ObjectiveTo investigate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) mRNA BNT162b2 vaccine on women's menstrual cycle.MethodsIn this questionnaire‐based cross‐sectional study, we assessed menstrual pattern and changes in women who completed the SARS‐CoV‐2 mRNA BNT162b2 vaccine 3 months before and after receiving the vaccine. Included were women aged 18–50 years without known gynecologic comorbidities who regularly monitor their menstruation through electronic calendars. All participants competed a detailed questionnaire on their menstrual symptoms including information on any irregular bleeding. To minimize bias, each woman served as a self‐control before and after vaccination. Primary outcome was rate of irregular bleeding following vaccination and secondary outcome was presence of any menstrual change, including irregular bleeding, mood changes, or dysmenorrhea following the vaccine.ResultsA total of 219 women met the inclusion critieria. Of them, 51 (23.3%) experienced irregular bleeding following the vaccine. Almost 40% (n = 83) of study participants reported any menstrual change following vaccination. Parity was positively asssociated with irregular bleeding with 26 (50%) of those suffering from irregular bleeding being multiparous compared with only 53 (31.5%) of women with no irregular bleeding (nulliparous 46% vs 60%, multiparous 50% vs 31%, rest 4% vs 8%, P = 0.049). The presence of medical comorbidities was also significantly higher among patients who experienced irregular bleeding (20.0% vs 6.0%, P = 0.003).ConclusionOur study shows relatively high rates of irregular bleeding and menstrual changes after receiving the SARS‐CoV‐2 mRNA BNT162b2 vaccine. Further research is needed to confirm our findings and to better characterize the magnitude of change and any possible long‐term implications.

Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance

The authors present opinions based on their applied experiences of working with female athletes in combination with the existing evidence-based literature. Most of the existing menstrual cycle research focuses on a few steady-state time points within the pre-defined menstrual cycle phases, yet this disregards the day-to-day hormonal changes that women have to accommodate to perform optimally and consistently. The traditional research models are inadequate for studying symptoms and symptom management, and ultimately for supporting athletes to perform well throughout the entirety of their cycle. As such, the monitoring of the day-to-day variation, particularly during the transitions between menstrual cycle phases appears to be an important “overlooked” consideration. This is particularly pertinent considering the known intra-individual and inter-individual variation in menstrual cycle characteristics. Anecdotal and research evidence supports the idea that athletes can use non-pharmacological solutions to mitigate negative menstrual cycle symptoms and do not need to “grit their teeth and roll with it”. However, further research (including case studies) is needed in this important research area. Such knowledge should be and needs to be widespread amongst practitioners and athletes as they should not have to figure this out alone. As such, researchers and practitioners need to put more work into understanding symptom aetiology, symptom clusters and their relationship with hormonal changes, menstrual cycle phases and transitions, with potential for a profound impact on individual athlete health and well-being. In so doing, those working with female athletes need to continue building on the recent progress made in educating athletes and practitioners; for example, normalising the discussion of and about the menstrual cycle and all of its implications.

Menstrual cycle-associated symptoms and workplace productivity in US employees: A cross-sectional survey of users of the Flo mobile phone app.

Mood and physical symptoms related to the menstrual cycle affect women's productivity at work, often leading to absenteeism. However, employer-led initiatives to tackle these issues are lacking. Digital health interventions focused on women's health (such as the Flo app) could help fill this gap. 1867 users of the Flo app participated in a survey exploring the impact of their menstrual cycle on their workplace productivity and the role of Flo in mitigating some of the identified issues. The majority reported a moderate to severe impact of their cycle on workplace productivity, with 45.2% reporting absenteeism (5.8 days on average in the previous 12 months). 48.4% reported not receiving any support from their manager and 94.6% said they were not provided with any specific benefit for issues related to their menstrual cycle, with 75.6% declaring wanting them. Users stated that the Flo app helped them with the management of menstrual cycle symptoms (68.7%), preparedness and bodily awareness (88.7%), openness with others (52.5%), and feeling supported (77.6%). Users who reported the most positive impact of the Flo app were 18-25% less likely to report an impact of their menstrual cycle on their productivity and 12-18% less likely to take days off work for issues related to their cycle. Apps such as Flo could equip individuals with tools to better cope with issues related to their menstrual cycle and facilitate discussions around menstrual health in the workplace.