Menstruation and training – A quantitative study of (non-)communication about the menstrual cycle in German sports clubs

Abstract

The menstrual cycle is one of the most fundamental differences between men and women and is capable of influencing the performance, well-being and health of female athletes. Despite increasing research, the influence of the menstrual cycle on athletic performance is still largely a mystery and highly individual. This in turn increases the importance of effective communication between coaches and female athletes. The purpose of this study is to analyse the existing communication behaviour of coaches as perceived by female athletes, as well as their willingness to communicate about the menstrual cycle. Therefore, we developed an online questionnaire addressed to female sports club athletes (n = 1195). Questions about the coach's thematisation of the menstrual cycle and the female athlete's willingness to communicate served as dependent variables. Ordinary least squares regressions were conducted for both dependent constructs. We found that communication behaviour depends on coaches’ age, type of sport and training frequency. Communication willingness depends on the gender of the coach, athletes’ age, type of sport, training frequency and perception of cycle-related performance fluctuations. Overall, the results of our study also show a large gap between desire and reality-even in 2022 coaches rarely talk about the menstrual cycle, although a large proportion of female athletes would be willing to do so. Both coaches and athletes should be empowered to communicate more openly about menstrual cycle. Improving communication skills on both sides may also improve the coach-athlete relationship.

Keywords

Age biological rhythm coach-athlete relationship female athlete gender health

Introduction

The persistent underrepresentation of women in sports science¹ is reflected in the fact that, notwithstanding substantial anatomical, physiological and endocrine differences between male and female athletes, most training methods are derived from research on men.² One of the most fundamental differences between males and females is the menstrual cycle, which influences cardiovascular, respiratory, metabolic and neuromuscular parameters³ and can affect athletic performance.⁴ Moreover, excessive athletic activity can cause menstrual irregularities with detrimental health effects.⁵

Despite the relevance of the menstrual cycle for the performance and the health of female athletes, several studies suggest that communication about the menstrual cycle between female athletes and – still predominantly – male coaches remains difficult or is even absent.^6–15 Most of this previous research is qualitative in nature,^7–10,13 and so more objective, quantitative approaches may be beneficial here. Furthermore, many contributions focus only on one or a few distinct sports and can, therefore, not account for contextual differences between sports, which might affect menstrual cycle–related communication.^9–11,15 Moreover, most scholars have studied elite athletes.^7–11,15 However, a lack of communication strategies about the menstrual cycle is particularly problematic in grassroots sports, where education and medical support are already lacking. Overall, female athletes at all levels of performance and in different sports would benefit from effective communication about the menstrual cycle. Finally, none of the studies has been conducted in a German context, which is important in that dealing with and communicating about the menstrual cycle is also culturally determined.¹⁶

Therefore, we aim to contribute to the debate about menstrual cycle–related communication by presenting the results of a quantitative survey conducted among German female athletes. We address the question of how female grassroots and competitive athletes perceive communication with their coaches about the menstrual cycle and which factors determine whether communication takes place. The design of our study allows us not only to systematically test hypotheses presented in previous research but also to examine sports-specific conditions that might impede or facilitate communication about the menstrual cycle. Among others, we can systematically account for differences between individual and team sports and between grassroots sports and competitive sports. Our quantitative study can, therefore, provide clues for developing context-sensitive approaches for improving menstrual cycle–related communication.

The paper proceeds as follows: first, we discuss in brief the findings of the relationships between the menstrual cycle, athletic performance and health. Then, we review existing research on menstrual cycle–related communication. In the empirical section, we analyse the perceived communication behaviour of German coaches and the willingness of their female athletes to communicate about the menstrual cycle. The results allow recommendations to be derived for the education of coaches and athletes and for identifying research gaps.

Theoretical background

The menstrual cycle regulates female reproduction and is considered one of the most important biological rhythms for women.¹⁷ Until menopause, women menstruate on average 457 times,² and although academic interest in the impact of the menstrual cycle on athletic performance has increased, specific applied base knowledge is rare.

Findings on the relationship between the menstrual cycle and athletic performance

Due to the cyclic fluctuations of estradiol and progesterone, the menstrual cycle has complex effects on the cardiovascular system, ventilation, substrate metabolism, thermoregulation, muscle activation, body composition and injury risk.^4,18 In addition, female athletes frequently experience perimenstrual performance reductions before and during menstruation, mainly due to premenstrual and menstrual symptoms.^4,7,19 Both premenstrual and menstrual pain can reduce athletic performance^6,15,20 and motivate athletes to cancel training or even competitions.¹⁹ However, although menstrual cycle–related symptoms can significantly impair the ability to train and/or perform,⁸ female athletes avoid disclosure of menstrual cycle–related symptoms,^6,10 which may be attributed to a sense of social discomfort, among other factors.¹¹

Moreover, excessive athletic activity can affect the menstrual cycle and thus athletes’ health.⁵ The risk of menstrual disorders is significantly increased among female athletes in comparison to the general population.^21–24 Menstrual disorders can have far-reaching detrimental health effects²⁵; the associated hypogonadism and underlying energy deficit can, for example, negatively affect bone health, thus promoting the occurrence of stress fractures and even osteoporosis.^5,24,26 In young female athletes, cycle abnormalities are of particular concern because puberty is considered a critical time for building maximal bone mass.²² However, while many female athletes notice menstrual irregularities, knowledge and communication about the consequences seem to be rare.¹² Höök and colleagues¹¹ found that elite female endurance athletes even believe that menstrual irregularities (i.e., oligomenorrhea or amenorrhoea) are normal and that coaches believe that there is a trade-off between a regular menstrual cycle and athletic performance. Therefore, Emery and Lebrun²² emphasise the need to educate female athletes, coaches and medical staff about the importance of a normal menstrual cycle. Despite this recommendation, only two out of 27 international sports federations have implemented or are currently implementing projects on knowledge and communication about the menstrual cycle.²⁷ Not surprisingly, many female athletes and coaches are inadequately informed about the importance of monitoring menstrual function.²⁸

Communication about the menstrual cycle in training

Overall, research suggests that athletes and coaches rarely communicate about the menstrual cycle. The lack of communication might also account for the fact that females do not adjust their training to their menstrual cycle.^6,15 The non-thematisation of the menstrual cycle is all the more surprising as gender sensitivity and individualised training are, in particular, recommended for top female athletes to improve athletic performance.^29,30 Yet, female athletes and their coaches alike seem to perceive barriers to communication about the menstrual cycle. There is uncertainty on both sides about who should take the initiative and initiate conversations about the female cycle. Social norms and concerns about athletes’ privacy make coaches hesitant to address the menstrual cycle.^8,11 Furthermore, both coaches and athletes frequently cite insufficient knowledge as a reason to explain a lack of communication.^7–11,15,30 Some studies found that male coaches know less about the menstrual cycle and menstrual irregularities than their female counterparts.^12,15,20 Other studies found that female coaches were also in need of education because their perception of a ‘normal’ menstrual cycle is based on their personal experiences.^8,11

In this context, it is relevant that previous research indicates that menstrual cycle–related communication between female athletes and their coaches is influenced by social, cultural and organisational factors. Communication is generally influenced, for example, by the gender and age of athletes and coaches, but also by the specifics of their sport, that is, e.g., the individual or team character.³¹ The key aim of the current study is to analyse athletes’ perceptions of menstrual cycle–related communication and potential communication barriers in training to inform strategies to overcome such barriers and normalise menstrual cycle–related communication. Moreover, we aim to identify factors potentially relevant to developing context-sensitive strategies.

We will now present the guiding hypotheses of our study derived from the presented research. These hypotheses are derived from previous research, which has been mostly qualitative. Yet, our quantitative design allows us to expand existing research insofar as we can systematically account for potentially relevant context features.

Some scholars suggest that the gender of coaches has a significant influence on the menstrual cycle–related communication behaviour of athletes and coaches. Male coaches perceive menstrual irregularities as less harmful, consider an exchange about the menstrual cycle as less important, and are less comfortable talking to female athletes about their menstrual cycle.¹² According to Sherman and LeResche,¹⁴ female coaches are more likely to talk about amenorrhoea and more likely to refer female athletes to medical staff for menstrual irregularities. Female athletes perceive their male coaches as feeling uncomfortable talking about the menstrual cycle and prefer, therefore, to communicate with female coaches.^6,7,9,11,15 This is problematic because the vast majority of top coaches are still male.³² These insights inspire our first set of hypotheses: H1a:

Female coaches communicate more about the menstrual cycle than male coaches do.

H1b:

The willingness of athletes to communicate is higher when they are coached by a female coach.

The previous scholarship also suggests that athlete age influences the willingness of female athletes to communicate about the menstrual cycle. Athletes become more comfortable talking about the menstrual cycle as they get older due to increased maturity and confidence.^7,11,13 Johnson²⁰ assumes that the age of coaches may also influence their level of knowledge and thus their communication behaviour. Therefore, we hypothesise: H2a:

The perceived communication behaviour of coaches decreases with age.

H2b:

The willingness of athletes to communicate is negatively influenced by the increasing age of their coaches.

H3:

The willingness of athletes to communicate increases with age.

Some studies assume that the likelihood of communication increases when there is a close coach–athlete relationship.^7,11 Brown and Knight⁸ also found that awareness of the relevance of the menstrual cycle increases when coaches have worked with female athletes for a long time. For some coaches, a good coach–athlete relationship is a mandatory prerequisite to discussing the menstrual cycle, which is why, according to Höök et al.,¹¹ more favourable conditions for addressing the menstrual cycle exist in individual sports. Moreover, the implementation of menstrual cycle–oriented training seems to be more complex in team sports.²⁹ In addition, menstrual cycle–related effects may be more significant for individual female athletes because they are solely responsible for their performance.²⁰ Thus, we test the following hypotheses: H4a:

Coaches of individual athletes communicate more about the menstrual cycle than coaches of team athletes do.

H4b:

The willingness of individual athletes to communicate is higher than that of team athletes.

Some researchers assume that elite athletes may exhibit a greater willingness to talk about the menstrual cycle because a stronger focus on performance optimisation creates a need for communication or serves to lower barriers to communication.^7,11 Accordingly: H5a:

Coaches of athletes with high-performance levels communicate more about the menstrual cycle than coaches of athletes with low-performance levels do.

H5b:

The willingness of athletes with high-performance levels to communicate is higher than that of athletes with low-performance levels.

Finally, some athletes indicated that they would be more willing to talk about their menstrual cycle if it affected their performance.⁷ Therefore, we hypothesise: H6:

The willingness of athletes to communicate is higher when they perceive cycle-related performance fluctuations.

Research design and methods

Survey and measures

To measure the current menstrual cycle–related communication in sports and to identify factors that promote or limit menstrual cycle–related communication, we created an online survey using Unipark software (EFS Case 2021). To generate high coverage and reach athletes of as many performance levels as possible, the online questionnaire was distributed via various messenger services and social media platforms. For this purpose, top female athletes from different sports and sports institutions, among others, were contacted to draw attention to the survey. Participation was voluntary and participants had to give informed consent to complete the questionnaire. The participants were informed that the data would be conducted completely anonymously, used exclusively for scientific purposes and processed according to Art. 6 (1) of the EU-General Data Protection Regulation. Moreover, the respondents had the right to revoke the data protection consent at any time.

As the study is aimed exclusively at (a) female participants and (b) who were actively training in a sports club at the time of the survey, respondents not fulfilling these criteria were filtered and excluded from the survey. To ensure that all participants understood the terms ‘menstrual cycle’ and ‘menstrual-related symptoms’ in the same way, both constructs were introduced at the beginning of the interview with the help of a short explanatory text.

The survey contained 32 questions and was divided into three sections. The first section addressed the demographics of athletes and their coaches, the type of sport, the composition of the training group, competition level and frequency of training. In addition, participants were asked to indicate whether they use hormonal contraceptives and/or perceive menstrual cycle–related variations in performance. The second section focuses on the extent to which coaches address the menstrual cycle, while the third section inquires about the willingness of female club athletes to communicate with their coaches about the menstrual cycle (for a full version see Appendix).

To measure coaches’ perceived communication behaviour and female athletes’ willingness to communicate, two scales were constructed based on previous research findings and recommendations for cycle-based training. Both scales are very economical, with 11 and six items (Figures 1 and 2). The communication behaviour scale distinguishes three different domains that are influenced by the menstrual cycle and should, therefore, be addressed in sports: performance (five items), well-being (four items) and health (two items). The communication willingness scale consists of six items related to the athletes’ willingness to communicate. Based on current research, the items consider relevant factors such as general physiology and one's menstrual cycle, menstrual discomfort, menstrual disorders and the use of hormonal contraceptives. Participants were asked to indicate the extent to which each statement applied to them and/or their coach using a four-point Likert scale. Figures 1 and 2 provide an overview of the items of the communication behaviour and communication willingness scales and illustrate the extent to which the female club athletes agree with the respective statements. Although both scales were tested for the first time in this study, both consistency statistics used yield very good values: Exploratory factor analyses revealed only one meaningful factor for each of the two scales (communication behaviour with an Eigenvalue = 5.33 and communication willingness with an Eigenvalue = 2.22). Also, Cronbach's alphas (communication behaviour = 0.89 and communication willingness = 0.81) indicate high internal consistencies for both scales so we decided to simply calculate the mean of both scales as dependent variables for our calculations.

Figure 1.

Items of the communication behaviour scale.

Figure 2.

Items of the communication willingness scale.

Study sample

The survey period lasted from December 15, 2021, to February 1, 2022. Although a total of 1225 participants completed the questionnaire, 30 respondents had to be excluded due to missing and/or incorrect information. Hence, the final dataset consists of 1195 valid records. Respondents were on average 21.64 years old (SD = 4.73). Of the respondents, 35% participated in team sports, 58% in individual sports and 7% describe their sport as both a team sport and an individual sport. For simplicity, these latter data records were excluded from the analyses. Training groups were recorded, with 46% of the study participants in an all-female training group, while 54% participated in a gender-heterogeneous training group. As indicators of the performance level, we surveyed both the training frequency and whether the female athletes stated that they practice their sport as a competitive sport. Training frequency was recoded into three groups, athletes who practice their sport up to twice a week (36%), three to four times per week (37%) and five times per week or more (28%); 60% of the study participants stated that they practiced their sport as a competitive sport, and 40% denied this. Most of the club sportswomen were trained by coaches who were between 30 and 50 years old (47%). Regarding the coaching staff, 17% were younger than 30 years and 36% were older than 50 years. Descriptive statistics of the variables are displayed in Table 1.

Table 1.

Descriptive analyses.

Name	Definition	Type	Obs	Min	Max	Mean	SD
Dependent variables
communicationbehaviour	Medium value of the 11 items of the communication behaviour scale	Continuous	1195	1	4	1.403	0.571
communication willingness	Medium value of the 6 items of the communication willingness scale	Continuous	1195	1	4	2.705	0.698
Independent variables
COACH_GENDER	Coach's gender: 1 = female, 2 = male, 3 = diverse, 4 = unknown	Categorical	1195	1	4	1.798	0.443
	female		256
	male		930
	diverse		3
	unknown		6
COACH_AGE	Coach's age: 1≤ 30 years, 2 = 30-50 years, 3 ≥ 50 years of age of coach	Categorical	1195	1	3	2.188	0.707
	< 30 years		207
	30–50 years		556
	> 50 years		432
ATH_AGE	Age of female athletes	Continuous	1195	12	55	21.637	4.728
SPORT_TYPE	Type of sport: 1 = individual sport, 2 = team sport, 3 = both	Categorical	1195	1	3	1.484	0.617
	individual sport		695
	team sport		422
	both		78
GROUP_TYPE	Type of training group: 1 = females only, 2 = gender heterogeneous	Binary	1195	1	2	1.541	0.498
	females only		548
	gender heterogeneous		647
FREQUENCY	Frequency of training: 1 ≤ 2 times training per week, 2 = 3–4 timestraining per week, 3 = ≥ 5 times training per week	Categorical	1195	1	3	1.929	0.794
	≤ 2 times training per week		422
	3–4 times training per week		436
	≥ 5 times training per week		337
PERF_LEVEL	Performance level: 1 = competitive level, otherwise = 0	Binary	1195	0	1	0.594	0.491
	competitive level		710
	other		485
INFLUENCE	Athlete's perceived influence of the menstrual cycle on performance:1 = yes, otherwise = 0	Binary	1195	0	1	0.813	0.610
	yes		709
	otherwise		486

Analytic strategy

To test our hypotheses, we ran Ordinary Least Squares regressions (OLS) for our two dependent constructs. Model 1 examines perceived communication behaviour. We included the coaches’ gender (COACH_GENDER) and age (COACH_AGE). Since the numbers of diverse and unknown coaches’ genders were so small, we decide to exclude these cases to not have biases. In addition, the type of sport (SPORT_TYPE) and the frequency of training per week (FREQUENCY) were included. We had to exclude the type of group variable (GROUP_TYPE) since it was highly correlated with SPORT_TYPE. Furthermore, we excluded the binary variable level of performance (PERF_LEVEL), which correlated highly with FREQUENCY. Since heteroscedasticity was detected for model 1, with less homogeneity of variance for higher communication behaviour, this model was calculated with robust standard errors. All these variables were also in included model 2, which analyses communication willingness. Moreover, we added the athlete's age (ATH_AGE) and whether the participants perceive an influence of the menstrual cycle on performance (INFLUENCE).

Results

Our study first indicates a significant gap between coaches’ perceived communication behaviour and female athletes’ willingness to communicate. In our data set, only 8% of all participants remember ever having been asked by their coaches whether they have a regular cycle. At the same time, 54% of the athletes surveyed would openly talk to their trainer about their own menstrual cycle. However, the willingness of female athletes to communicate about their own menstrual cycle is higher (54%) than their opinion that such communication is useful (45%). In addition, female participants were less willing to address their own menstrual cycle than the menstrual cycle in general (84%), suggesting that the personal menstrual cycle is still a social taboo. In total, 59% of respondents reported menstrual cycle–related performance fluctuations and 90% of the study participants stated that they were interested in possible connections between the menstrual cycle and athletic performance.

Regarding multi-variate analyses of menstrual cycle–related communication, both models performed rather poorly according to R² (Table 2). However, the effect sizes for both models as measured by ω² being above 0.14 are high according to Cohen.³³ Besides the regression coefficients and significance levels, we also report the effect sizes (partial ω²) for each variable. Following Cohen,³³ we consider partial ω² values >.01 as small, >.06 as medium and >.14 as large effect sizes. The difference between the intercepts of both models indicates that the athletes’ willingness to communicate about the menstrual cycle (communication willingness, Model 1) is higher than the coaches’ perceived communication behaviour (communication behaviour, Model 2). We report the results guided by our hypotheses.

Table 2.

OLS regressions for communication behaviour and communication willingness.

Independent variables	Model 1^a communication behaviour		Model 2 communication willingness
Independent variables	Coefficients (SE)	Partial ω^2b	Coefficients (SE)	Partial ω^2b
COACH_GENDER (reference is female)		0.002		0.015
Male	−0.073^† (0.040)		−0.214*** (0.053)
COACH_AGE (reference is < 30 years old)		0.005		0.005
30–50 years	−0.015 (0.045)		−0.052 (0.059)
>50 years	−0.104* (0.049)		−0.150 (0.062)
ATH_AGE	-		0.020*** (0.005)	0.018
SPORT_TYPE (reference is individual sport)		0.028		0.032
Team sport	−0.226*** (0.035)		−0.293*** (0.050)
FREQUENCY (reference is ≤ 2 × per week)		0.063		0.053
3–4 × per week	0.106*** (0.030)		0.253*** (0.051)
≥5 per week	0.398*** (0.051)		0.462*** (0.062)
INFLUENCE (reference is no)				0.009
Yes	-		0.138*** (0.044)
Intercept	1.447*** (0.056)		2.319*** (0.123)
R ²	0.157		0.176
Adj. R²			0.169
ω²	0.153		0.168

Note: Displayed are coefficients for OLS regressions.

OLS regression with robust standard errors.

Effect sizes (Cohen, 1988): small = 0.01; medium = 0.06; large = 0.14.

***

p < 0.001, **p < 0.01, *p < 0.05, ^†p < 0.1.

The hypothesis that female coaches communicate more about the menstrual cycle than male coaches receives only weak support, as the coefficient is not significant with p > 0.05 (H1a rejected). Yet, the hypothesis that the willingness of athletes to communicate is higher when they are coached by a female coach is supported since the coefficient for COACH_GENDER = Male in Model 2 is negative and highly significant (H1b supported).

The support for our hypothesis concerning the impact of the coaches’ age on menstrual cycle–related communication is weak at best. The results indicate that athletes perceive the communication behaviour of coaches >50 years worse than the one of younger coaches with p < 0.05 (H2a supported). However, the idea that the coaches’ age influences the willingness of their female athletes to communicate is not supported, having no significant coefficients (H2b rejected). In contrast, the results strongly support the hypothesis that older athletes are significantly more willing to communicate with p < 0.001 (H3 supported). The models calculated also provide strong support for the idea that communication behaviour, as well as communication willingness, are significantly higher (p < 0.001) in individual sports than in team sports (H4a and H4b supported). Moreover, the frequency of training, which serves as a proxy for professional and performance level, significantly (p < 0.001) influences communication behaviour and communication willingness (H5a and H5b supported). Finally, Model 2 strongly supports our claim that perceived menstrual cycle–related performance fluctuations significantly increased the willingness of athletes to communicate about the menstrual cycle (p < 0.001, H6 supported).

Figure 3 displays the predicted values for the impact of the distinct independent variables on communication behaviour. Figure 4 shows the predicted values for the impact on communication willingness. Both figures, together with the reported effect sizes, strongly suggest that the organisational setting (SPORT_TYPE) and training frequency (FREQUENCY) are the most important factors for menstrual cycle–related communication.

Figure 3.

Predictive margins and cis of communication behaviour at different levels of the independent variables.

Figure 4.

Predictive margins and cis of communication willingness at different levels of the independent variables.

Limitations

Before we reach our conclusions, we need to discuss some factors limiting our study. A major limitation of our study is that we did not analyse the coach–athlete relationship in more detail. For this, we explicitly recommend mixed methods approaches. Moreover, to maximise participation, we kept the questionnaire brief and included only rough proxies for organisational settings. This is why we also examined only the communication perceived by the athletes and initially left out the coaches’ view. Thus, we cannot provide any further information on what prevents the coaches from communicating about the menstrual cycle. Furthermore, the low share of younger participants is problematic (<16 years = 4%; <18 years = 17%) given that the menstrual cycle starts between 12 and 14 years³⁴ and that sports club membership among women decreases sharply from the age of 18.³⁵ The newly constructed communication behaviour and communication willingness scales were not pilot-tested or otherwise validated before completing this study. Although the construction of both scales was theory-based, and they showed very good consistencies, further validation is needed. These limitations should be addressed in subsequent research.

Discussion

Our study found that even today, female athletes and their coaches rarely talk about the menstrual cycle, although female athletes would be willing to do so. Given the importance of the menstrual cycle to female athletes’ performance, health and well-being, this discrepancy between perceived communication behaviour and willingness to communicate is problematic. However, our findings are in line with previous research.^6,7,10,15 Thus, in general, our study supports previous calls for including menstrual cycle–related knowledge in coaches’ education.^6–9,12 Yet, such educational strategies will not suffice if coaches continue to feel uncomfortable talking about the menstrual cycle. Although previous research has shown that female athletes would prefer that menstrual cycle–related communication be initiated by coaches,¹⁰ our study supports the idea that coaches still see barriers to open communication.¹¹ Hence, overcoming such barriers should be a key pillar of coaches’ education.⁹ Our study can further inspire the debate about improved education and communication strategies because it is based on a large sample and considers a wide range of potentially relevant factors.

Coaches’ gender

First, our study contradicts recommendations that menstrual cycle–related education strategies should be primarily developed for male coaches.¹² Rather, the communication behaviour of coaches should be generally improved.⁸ Yet, given that female athletes are more willing to communicate with female coaches, our study supports calls for more female coaches as well as for the removal of social barriers that prevent communication between female athletes and male coaches. In Germany, only 13% of coaches in high-performance sports are female, and this number is stagnating. Programmes tailored to female coaches need to be stepped up, as does the education of coaches of any gender in women's health, which has been absent from coach education curricula in recent decades.

Type of sport

Following previous research, we found that the conditions for menstrual cycle–related communication are more favourable in individual sports,^11,13,20 which also indicates a great importance of the coach-athlete relationship. It seems characteristic for team sports that athletes downplay pain to avoid disappointing teammates and coaches.¹³ Thus, there is a need for more targeted education strategies in team sports. There are, however, examples of successful sports teams that show that menstrual cycle–oriented training is equally feasible and performance-enhancing in team sports. Chelsea FC Women, for example, was the first soccer club to adapt training to the menstrual cycle in 2020 and has since won the last two championships.¹⁹ Findlay et al.¹⁰ show an initial, workable model for successful communication in team sports. This model, which recommends, among other things, using a person as a mediator between the team and the coach, should be elaborated upon in the licensed coach education.

Training frequency

Our study is the first to demonstrate the relevance of training frequency for menstrual cycle–related communication. We treat training frequency here as an indication of athletes’ professional level and performance orientation. Hence, the more intensive sport is practiced, thus, the more professional the training setting is and the easier menstrual cycle–related communication seems to become or at least the need to communicate about the menstrual cycle is considered higher. Accordingly, we side with demands for more targeted education and communication strategies in grassroots sports, which is already characterised by lower medical support. In addition, high training frequencies may intensify the coach–athlete relationship,^7,11 again suggesting that future strategies to improve menstrual cycle–related communication should consider the coach–athlete relationship.

Age of coach

In contrast to previous considerations,²⁰ the age of coaches seems to play a minor role. Only at first glance, the irrelevance of age might be perceived as good news, as it also indicates that no change in the way the female cycle is handled is evident and that there is a need for more education on menstrual cycle–related matters among coaches of all generations.

Age of athlete

Confirming previous research,^7,11 we found that older athletes are more willing to communicate about the menstrual cycle. Considering that the health risks associated with menstrual irregularities are particularly high in younger athletes,²² this result should inspire efforts to educate, in particular, younger athletes about the need for menstrual cycle–related communication. Here, we can echo Höök et al.,¹¹ who suggest, among other things, interventions or workshops in training groups that focus on education about women's specific physiology and the broader impact of the female hormonal cycle on health, well-being and performance. As Höök et al.¹¹ confirm, a lack of knowledge is one of the biggest barriers to open communication in the training context. Furthermore, for reliable monitoring of menstrual cycle–related symptoms, the use of already available apps should be recommended. These include apps such as Flo, Clue or FitrWoman, of which the latter was developed with scientific support and provides personalised training and nutrition recommendations depending on your own cycle. In addition, many smartwatches are nowadays able to track the menstrual cycle.

Perceived menstrual cycle–related performance fluctuations

Finally, following previous research, we found that female athletes who perceive menstrual cycle–related performance fluctuations are more willing to communicate about the menstrual cycle.^6,7 That the desire to communicate increases when influences of the menstrual cycle are perceived is reasonable. However, this does not mean that communication does not have to take place with female athletes who do not perceive any influence. Education about and awareness of potential fluctuations and influences of the menstrual cycle on performance, health and well-being may first lead female athletes to perceive or understand own menstrual cycle–related changes. Furthermore, knowing and understanding one's own body and its biological processes is important for every athlete, especially in competitive sports, in order to reflect on training, for example.

Conclusion and outlook

Taken together, the perceived likelihood of communication about the menstrual cycle in club sports depends on several factors: That are systematic differences between team and individual sports, as well as between different levels of professionalism or age groups or whether the athletes perceive the influence of the menstrual cycle on their performance. Accordingly, we recommend further, differentiated research to be able to provide needs-based recommendations for action.

Although coaches’ perceived communication behaviour is lower than female athletes’ willingness to communicate, the low scores on both scales overall suggest that not only coaches but also female athletes should be empowered and encouraged to talk openly about the impact of the menstrual cycle on their health, performance and well-being. Improving communication skills on both sides may also improve the coach–athlete relationship, which may be crucial for communication related to the menstrual cycle, as indicated by the high importance of sport type and training frequency shown in our study. Here, we would like to refer again to the four-part model of Findlay et al.,¹⁰ which was only created in team sports and high-performance context but also provides important information for individual and grassroots sports in promoting menstrual cycle-related communication. 1) Education about the menstrual cycle should take place both in the training group context, for example, by inviting experts, gynaecologists or even athletes who have already successfully had menstrual cycle–oriented training, but above all, it should also find its way into coach education. Overall, the knowledge on the part of female athletes and coaches about the menstrual cycle must be increased to break down communication barriers. 2) Regular monitoring as a basis of effective communication can nowadays be done very easily via the already mentioned apps and in consultation with gynaecologists. 3) Menstrual cycle profiling will probably only be possible in high-performance sports with the appropriate medical care. 4) A contact person for questions about the menstrual cycle can be found in any training group, regardless of performance level. For example, this function can be performed by a female athlete who is already confident in communication and thus can help breakdown communicative barriers between the group and the coach.

Given the study results presented, the comparatively high willingness of female athletes to talk about the menstrual cycle should be used to initiate the appropriate communication and thus promote the health, well-being and performance of female athletes.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Mara Konjer

References

Janse de Jonge

XAK

Thompson

Han

. Methodological recommendations for menstrual cycle research in sports and exercise. Med Sci Sports Exerc 2019; 51: 2610–2617.

Pitcher

Elliot-Sale

. Considerations for coaches training female athletes. Prof Strength Cond 2019; 55: 19–30.

McNulty

Elliot-Sale

Dolan

, et al. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Med 2020; 50: 1813–1827.

Carmichael

Thomson

Moran

, et al. The impact of menstrual cycle phase on athletes’ performance: a narrative review. Int J Environ Res Public Health 2021; 18: 1667.

Harber

. The young female athlete: using the menstrual cycle as a navigational beacon for healthy development. Can J Women Coach 2011; 11: 1–11.

Armour

Parry

Steel

, et al. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int J Sports Sci Coach 2020; 15: 316–323.

Brown

Knight

Forrest

. Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance. Scand J Med Sci Sports 2020; 31: 52–69.

Brown

Knight

. Understanding female coaches’ and practitioners’ experience and support provision in relation to the menstrual cycle. Int J Sports Sci Coach 2022; 17: 235–243.

Clarke

Govus

Donaldson

. What male coaches want to know about the menstrual cycle in women’s team sports: performance, health, and communication. Int J Sports Sci Coach 2021; 16: 544–553.

10.

Findlay

Macrae

EHR

Whyte

, et al. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. Br J Sports Med 2020; 54: 1108–1113.

11.

Höök

Bergström

Sæther

, et al. “Do elite sport first, get your period back later.” Are barriers to communication hindering female athletes? Int J Environ Res Public Health 2021; 18: 12075.

12.

Kroshus

Sherman

Thompson

, et al. Gender differences in high school coaches’ knowledge, attitudes, and communication about the female athlete triad. Eat Disord 2014; 22: 193–208.

13.

Moreno-Black

Valliantos

. Young women’s experiences of menstruation and athletics. Womens Stud Q 2005; 33: 50–67.

14.

Sherman

LeResche

. Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol 2006; 291: 245–256.

15.

Solli

Sandbakk

Noordhof

, et al. Changes in self-reported physical fitness, performance, and side effects across the phases of the menstrual cycle among competitive endurance athletes. Int J Sports Physiol Perform 2020; 15: 1324–1333.

16.

Bobel

Winkler

Fahs

, et al. The Palgrave handbook of critical menstruation studies. Singapore: Palgrave Macmillan, 2020, p.1037.

17.

Constantini

Dubnov

Lebrun

. The menstrual cycle and sport performance. Clin Sports Med 2005; 24: 51–82.

18.

Romero-Parra

Barba-Moreno

Rael

, et al. Influence of the menstrual cycle on blood markers of muscle damage and inflammation following eccentric exercise. Int J Environ Res Public Health 2020; 17: 1618.

19.

Read

Mehta

Rosenbloom

, et al. Elite female football players’ perception of the impact of their menstrual cycle stages on their football performance. A semi-structured interview-based study. Sci Med Footb. Epub ahead of print 29 December 2021. DOI: 10.1080/24733938.2021.2020330.

20.

Johnson

. Knowledge and attitudes regarding the menstrual cycle, oral contraceptives, and sport performance: The conceptualization and development of a questionnaire for athletic coaches. PhD Thesis, Florida State University, US, 2008.

21.

De Souza

Toombs

Scheid

, et al. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod 2010; 25: 491–503.

22.

Emery

Lebrun

. Injury prevention in the female athlete. In: Margo

Mountjoy

(eds) Handbook of sports medicine and science: the female athlete. Hoboken: John Wiley & Sons, 2014, pp.9–19.

23.

Kishali

Imamoglu

Katkat

, et al. Effects of menstrual cycle on sports performance. Int J Neurosci 2006; 116: 1549–1563.

24.

Misra

. Menstrual health in the female athlete. In: Margo

Mountjoy

(eds) Handbook of sports medicine and science: the female athlete. Hoboken: John Wiley & Sons, 2014, pp.67–75.

25.

Baumgartner

. Management der “female athlete triad”/RED-S. J Gynakol Endokrinol CH 2021; 24: 32–38.

26.

Elliot-Sale

Tenforde

Parziale

, et al. Endocrine effects of relative energy deficiency in sport. Int J Sport Nutr Exerc Metab 2018; 28: 335–349.

27.

Mountjoy

Burke

Stellingwerff

, et al. Relative energy deficiency in sport: the tip of an iceberg. Int J Sport Nutr Exerc Metab 2018; 28: 313–315.

28.

Brook

Tenforde

Broad

, et al. Low energy availability, menstrual dysfunction, and impaired bone health: a survey of elite para athletes. Scand J Med Sci Sports 2019; 29: 678–685.

29.

Lisenchuk

Tyshchenko

Zhigadlo

, et al. Analysis of psychological state of qualified female handball players depending on the phase of the ovarian-menstrual cycle. J Phys Educ Sport 2019; 19: 808–812.

30.

Meignié

Duclos

Carling

, et al. The effects of menstrual cycle phase on elite athlete performance: a critical and systematic review. Front Physiol 2021; 12: 654585.

31.

König

. Kommunikation als Herausforderung. Eine theoretisch-empirische Studie zur Trainer-Athlet-Kommunikation im Spitzensport. Eur J Sport Soc 2015; 12: 421–426.

32.

International Olympic Committee. Gender equality & inclusion report 2021. Report, 2022. Lausanne (CH): IOC.

33.

Cohen

. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.

34.

Scholz

. Endspurt Klinik: Gynäkologie, Geburtshilfe. Skript 9. Stuttgart: Georg Thieme Verlag, 2018.

35.

Deutscher Olympischer Sportbund. e.V. Bestandserhebung 2021. Report, 1 October 2021. Frankfurt (DE): DOSB.