Coaches’ perspectives on menstruation for female adolescent athletes

Abstract

Adolescent females in Canada begin menstruation around age 12, and the onset of menstruation is associated with decreased participation in sport and physical activity. Coaches play an important role in supporting athletes’ participation in sport, and adolescent athletes who report greater coach support also report greater intention to stay in sport. While previous research on menstruation in sport has focused on older female athletes and athletes in aesthetic sports (e.g., dance), few studies have examined coaches’ perspectives of coaching adolescent female athletes who are navigating menstruation. A qualitative approach was taken; thirteen coaches (female n = 7; male n = 6) participated in semi-structured qualitative interviews, and data were analyzed using reflexive thematic analysis. Key themes included the ways coaches discussed menstruation (medicalising, optimising, and avoiding altogether); coaches’ beliefs about girls in sport (periods hindering performance, and concerns over sexualizing adolescent athletes); and positioning female coaches as the experts when discussing menstruation with athletes. Male coaches demonstrated discomfort in discussing menstruation by using euphemisms and drew on stereotypes of menstruation. For coaches, medicalizing menstruation was a useful entry point into discussions with athletes, although this reflected a pathologizing of menstruation. The overall results reflect the concerns of coaches regarding the topic of menstruation, and the results shed light on broader narratives regarding women in sport that influence the ways in which coaches navigate these issues.

Introduction

Sport represents an important context for personal development among young girls navigating adolescence. While sport participation has the potential to enhance physical health, mental well-being, and social skills, ¹ these benefits are dependent on the social environment within the sport context. Coaches are central to this environment and play a key role in shaping female athletes’ experiences, behaviors, attitudes, and outcomes. ² Supportive coaching is directly related to motivation and continued participation in sport. ³ Therefore, supportive coach-athlete relationships are crucial for female athletes to enjoy the benefits of sport participation.

Despite these benefits, rates of dropout from sport are high among adolescent girls, ¹ coinciding with the average age at menarche in 12 year old youth in Canada. ⁴ However, research on physical activity among adolescent girls often neglects the effect that menarche may have on sport participation. ⁵ Menarche is defined as the onset of menstruation, or the cyclical discharge of the uterine lining. ⁶ Menstruation is part of the menstrual cycle, which involves hormonal changes that can be associated with pain, mood disturbances, sleep quality, and fatigue, ⁷ that may interfere with sport performance and enjoyment. Given that many female athletes withdraw from sport at a time when they may also be experiencing menstruation, and given the importance of coaches in supporting girls’ sport participation, research on coaches’ views of menstruation among adolescent female athletes is warranted. The present study aimed to address this gap in the literature. Consistent with the exploratory nature of this study, terms related to both gender and sex are used to describe coaches and athletes, reflecting participants’ language. While sex refers to biological characteristics, including those relevant to menstruation, gender involves sociocultural roles that influence coaches’ perspectives and experiences within the sport context. ⁸

Menstruation-related challenges for adolescent athletes

Young female athletes face challenges related to menstruation that can negatively impact their sport performance and participation. Physical changes during biological maturation, including menarche and physical changes in fat distribution in the female body, may reduce interest in sport participation among early maturing girls. ⁹ These physical changes may negatively affect how girls perceive their bodies, especially in aesthetic sports such as dance and gymnastics, where thin, lean body ideals are emphasized. ¹⁰ Female athletes may also perceive negative impacts on performance as a result of physical and emotional symptoms that occur throughout the menstrual cycle, including lower back pain, mood swings, and menstrual cramps. ¹¹ Pain experienced as a result of premenstrual symptoms is commonly reported by athletes and contributes to fatigue, leading to reductions in sport performance. ¹² Therefore, menstruation may play an important role in female athletes’ sport enjoyment, participation, and performance.

Variations in the timing and regularity of the menstrual cycle can impact injury risk among female athletes. Specifically, delayed menarche and irregular menstruation are linked to higher incidences of injury, often in the context of Relative Energy Deficiency in Sport (RED-S), which contributes to both immediate and long-term negative health consequences. ¹ Potential consequences of RED-S among female athletes include bone injury, cardiovascular consequences, anxiety, and depression. ¹³ Further, menstrual irregularity is often normalized by athletes, ¹⁴ and is associated with less knowledge of menstrual health, ¹⁵ suggesting that a lack of understanding of the menstrual cycle may contribute to the prevalence of menstrual dysfunction. Despite these risks, menstruating athletes do not receive adequate support due to communication barriers and limited knowledge of menstrual health among coaches and athletes. ¹⁶ This lack of support can lead to negative outcomes like reduced performance, ¹² increased risk of injury, ¹ and negative body image. ¹⁷ For example, many female athletes are largely unaware of the link between irregular menstruation and osteoporosis, in line with the female athlete triad, ¹⁵ which illustrates the potential dangers of communication barriers around menstruation in sport.

Menstruation and sport participation

The challenges associated with menstruation among female athletes play an important role in their sport experiences, and may potentially lead to withdrawal from sport. Self-consciousness has a particularly strong impact on sport participation, with many girls avoiding exercise due to their menstrual cycle.^11,18,19 In fact, a 2021 survey conducted with 2291 girls aged 11–18 shows that 70% of adolescent female athletes avoided exercise during the time of menstruation, and almost half of female athletes aged 14–16 stopped participating in physical activity due to fear of leaking, pain, and embarrassment surrounding menstruation. ²⁰ Clothing requirements for sports, including tight or revealing uniforms and white bottoms, have been cited as another barrier for young girls participating in sport while menstruating, particularly due to discomfort and anxiety about menstrual management and apppearance.^11,21 Athletes also report that psychological changes related to the menstrual cycle, including overthinking, catastrophizing, and rumination, may inhibit effective coping and have negative impacts on performance. ²¹ These barriers, including both psychological symptoms like embarrassment, and physical symptoms including pain, have been suggested to contribute to increased dropout rates among young female athletes. ²²

A lack of support ¹¹ due to stigma and limited knowledge ¹⁶ contribute to negative experiences that may reduce sport enjoyment and increase risk of dropout. For athletes who continue to participate in sport, challenges including menstruation-related symptoms, menstrual dysfunction, increased risk of injury, and performance detriment may undermine motivation and well-being, potentially impacting long-term sport participation.

Research on coach-athlete communication

Coaches are an important source of support for athletes, and they can play a significant role in shaping athletes’ experiences and continued involvement in sport. To counteract potential contributing factors for increased female adolescent dropout from sport, coaches play a role in creating supportive environments ²¹ for athletes to manage symptoms related to the menstrual cycle and navigate the impacts of menarche on sport participation.

Creating a supportive sport environment can be challenging due to stigma around menstruation, which may stem from the idea that menstruation is inherently female and clashes with the traditionally masculine norms of sport. ²³ As a result, menstruation is viewed as private and is rarely discussed openly in sport, ²⁴ leading to potentially dangerous false beliefs, including the normalization of menstrual irregularity or lack of menstruation as a response to training. ²⁵ Very few athletes report discussing menstruation-related issues with coaches ¹⁰ due to feelings of discomfort, especially with male coaches.^11,26 Athletes attribute their discomfort to stigmatizing attitudes about menstruation, which influence how they think, feel, and act. ²⁷ Coaches also report feelings of discomfort, with male coaches reporting an unwillingness to ask athletes about menstrual irregularity and general uneasiness when communicating about menstruation. ²⁸ Additionally, some female coaches may not acknowledge the potential negative impacts of the menstrual cycle on athletes due to a lack of personal experience with symptoms, or socialization to endure them silently. ²⁴

The gender and sex of coaches plays a critical role in shaping female athletes’ relationships and communication with their coaches. It takes a strong coach-athlete relationship characterized by trust and respect for athletes to be willing to share their experiences related to impacts of the menstrual cycle on training and performance. ¹⁶ When female athletes feel unable to discuss menstruation-related concerns with their coaches, it can compromise the strength of the coach-athlete relationship. ¹⁶ Moreover, many female athletes indicate being more open to discussing their menstrual cycle with female support staff and express discomfort around speaking about menstruation with male coaches. ²⁶ However, some athletes report a willingness to discuss menstruation with both male and female coaches, provided they perceive their coach as caring and approachable about sensitive matters. ¹¹ A recent review of coach-athlete relationships identified key facilitators of healthy sport participation for menstruating athletes including the presence of female coaches, positive experiences communicating about the menstrual cycle, and trust. ²⁹

Coach training for women athletes

In Canada, coach education on female athletes’ experiences of the menstrual cycle is limited. ¹¹ While women-focused professional development opportunities exist,^30–32 formal menstrual health education remains largely absent from coach education. As a result, many coaches lack knowledge about menstruation and its influence on training and competition.^16,29,33 Despite this lack of knowledge, coaches report making adjustments to training based on assumptions rather than knowledge of their athlete's menstrual cycle. ¹⁶ Athletes’ lack of knowledge further contributes to issues with communication regarding the menstrual cycle, as many have trouble understanding the connection between psychological symptoms and hormonal fluctuations. ²¹ However, despite communication barriers and widespread knowledge shortcomings regarding female athletes’ experiences of menstruation, some coaches have demonstrated interest in learning about the menstrual cycle in order to optimize performance, manage training loads, and improve communication with athletes. ³⁴ In this way, performance considerations may serve as a route for coaches to discuss menstruation with athletes, providing a practical focus that can be leveraged to promote open dialogue and support. However, there is a significant gap between the desired and actual amount of coach-athlete communication about menstruation in sport, as female athletes report being interested in learning about connections between the menstrual cycle and performance but rarely have these conversations with coaches. ³⁵

The present study

Coaches play a key role in shaping the enjoyment and continued participation of young girls in sports, ³ which in turn supports sport as an important context for personal development during adolescence. This role requires coaches to understand and address menstruation-related challenges faced by athletes, ¹² including stigma, communication barriers, and lack of knowledge.^11,16 Without this support, athletes may be more likely to drop out of sport around the onset of menarche. Despite the importance of this topic, few studies have examined coaches’ perspectives and experiences in coaching female adolescent athletes and navigating topics related to menstruation. Limited research suggests coaches have limited menstrual cycle knowledge ¹⁶ and face communication barriers with athletes, ¹¹ yet this work has largely focused on elite or senior-level athletes.^21,26,28 Further, some studies focused on one specific sport and may not apply to the wider sport context.^18,26 To build on existing research in this area, it is important to explore youth coaches’ experiences of coach-athlete communication about menstruation to understand why these communication barriers exist. Therefore, the purpose of the current research was to explore coaches’ understanding of menstruation in relation to sports participation and how they navigate this topic with athletes in sport.

Methods

The study adopted a generic qualitative approach underpinned by a constructivist paradigmatic position, which holds a relativist ontology and transactional epistemology.^36,37 A relativist ontology assumes there is no single external reality; each individual exists in their own reality. ³⁶ A transactional epistemology assumes that knowledge is created through interactions between researcher and participant. ³⁶ Researchers are not able to remove themselves from their previous experiences. ³⁶ Generic qualitative approaches are useful for researchers as working outside of established methodologies provides an opportunity to ask new types of questions.^36,37 The research team consisted of two PhD students, one postdoctoral researcher, and a full professor. All members of the research team self-identify as female. Two members have experience coaching adolescent female athletes, and three have experience playing sports during the onset of menstruation. These three members of the research team acknowledged and recounted their experiences of minimal discussions surrounding menstruation with their coaches. Additionally, the gap of communication between coaches and athletes was identified by [initials blinded for review]'s dissertation research with female youth athletes. ³⁸ Two members of the research team have previous experience conducting research with adolescent athletes. All members of the research team engaged in discussion of their previous experiences either playing/coaching sport, conducting research, and personal experiences of menstruation.

Participants and recruitment

Thirteen coaches (male n = 6, female n = 7) were recruited using purposeful sampling ³⁹ to participate in a semi-structured interview via Zoom Video Conferencing Software. Participants were primarily recruited using the research team's personal contacts. Coaches were contacted about participation via email and personal communication. The coaches’ ages ranged from 19–51 years (M = 35) and their self-identified ethnicity was Chinese (n = 1), Latina (n = 1), West Asian (n = 1), White (n = 9), and (n = 1) selected prefer not to answer. Coaches represented a variety of sports including soccer, flag football, wrestling, volleyball, swimming, equestrian, rugby, hockey, and boxing. Coaches in the present study were not asked specifically about the competitive level at which they coach; however, based on interviews, most coaches represented ‘rep’ competitive level. Inclusion criteria were individuals who: a) were coaching adolescent female athletes in Ontario (aged 14–16), and b) could complete an interview in English. Individuals were excluded if: a) they were not a coach of adolescent female athletes in Ontario, and b) could not complete an interview in English.

After approval was obtained from the University Research Ethics Board, study information was shared with potential participants via email, social media, and in-person recruitment. Interested coaches were able to contact the research team via email to schedule a time for their interview. If coaches were eligible to participate, an information letter and consent form were sent by a member of the research team for the participant to review and sign prior to meeting for their interview. Informed consent was obtained prior to beginning the interview.

Data collection

The interviewer reviewed the information letter and consent form with the participant at the start of their interview. They also reviewed the purpose of the research project, reminded participants that they had the ability to terminate participation at any time with no penalty, and answered any questions the participant had. Most participants were personal contacts of the research team. Therefore, during these interviews less attention was focused on building trust and rapport with participants, as it already existed. For example, the first interview question sought to build rapport by asking participants to discuss their experiences in sport and how they got involved in coaching their current sport - this portion of the discussion was shorter with participants who had a pre-existing relationship with the interviewer. With participants who were not personal contacts, it was important to build trust, as one-time qualitative interviews involved asking participants to discuss personal thoughts during the first, and only meeting. ⁴⁰ Interview questions focused on coaches’ perspectives of how menstruation impacts adolescent female athlete experience in sport. Example questions from the interviews include: “Do you feel that the onset of menstruation, and experience of menstruation impacts adolescent females’ participation in sport?”, “As a coach of female adolescent athletes, have you ever discussed this topic with athletes?”, “Is there anything that you wish you had done differently as a coach of adolescents experiencing these changes?”, and “What might be your advice to other coaches of adolescent athletes who are approaching menarche, specifically related to sport, and more generally?” (see supplementary material for all interview questions). Interviews ranged between 34 and 69 min (M = 45 min). Participants each received a $20 gift card for participating in an interview. Interviews were transcribed verbatim, all identifiable information was removed, and transcripts were reviewed while listening to the audio recording of the interview to ensure that no details were omitted in the transcribing process. Interviews were conducted by two members of the research team [initials blinded for peer review] and did not occur concurrently. Interviewer 1 completed interviews 1–9, and interviewer 2 completed interviews 10–13. To ensure a consistent approach to interviews, interviewer 2 reviewed the previously conducted interviews to ensure they were following the same procedures and lines of questioning. Additionally, interviewers 1 and 2 met prior to interviewer 2 conducting interviews, and met periodically throughout the data collection process.

Data analysis

The data were analyzed using reflexive thematic analysis, which aligns with the epistemological and ontological positions of the research team, as it acknowledges the active role of the researcher in the entire research process and fits with research questions and purpose aimed at understanding participant subjective experiences. ⁴¹ Throughout the research process, the members of the research team acknowledged their previous experiences and assumptions as important influences in the data collection, analysis, and writing process. Additionally, reflexive thematic analysis is an iterative process, ⁴¹ providing flexibility to revisit concepts and themes as researchers progress through analysis. For example, multiple coaches discussed religious beliefs and cultural differences in discussions of menstruation. This was not something that the research team had discussed prior to starting data collection; following multiple coaches discussing perceived religious differences, the research team met to discuss their personal experiences with religion and menstruation, and how these shaped their understandings of the coach discussions.

After six interviews were completed, the data analysis began with the interviewers [initials blinded for peer review] reviewing the transcripts and noting any initial themes they felt were pertinent or came up in multiple interviews. Following the steps of reflexive thematic analysis, the interviewers familiarized themselves with the data by listening to audio recordings of the interviews, and subsequently met to generate a list of ideas from the interviews they felt to be poignant. ⁴¹ Some initial codes includes: ‘tactics to address’, ‘males uncomfortable’, ‘creating a safe space to share’, and ‘menstruation is unclean’. Then, the entire research team read the transcripts and met to discuss initial themes and determined that an additional number of interviews would be beneficial to exploring more of the study topic. The research team noted differences between male (n = 2) and female (n = 4) coaches’ perspectives, and determined that more male coaches should be interviewed, and asked coaches about perceived social differences in their athletes - whether some athletes were more open in their discussion of menstruation than others. The research team then aimed to purposefully sample more male coaches for the remaining interviews; the final sample included six male coaches and seven female coaches.

Once the final set of interviews were completed, three members of the research team continued with the steps of reflexive thematic analysis. The entire team listened to the remaining interview audio files and read each transcript multiple times to familiarize themselves with the data ⁴¹ and further coded for themes they felt were important. The team met again to review individually identified codes, then generate and refine themes, and returned to review their respective transcripts for similar or opposing perspectives. Theme refinement is important as it ensures the story being told by the themes is coherent in answering the research question. ⁴¹ Themes were clustered based on similarity, where the research team discussed which themes best represented the collected data and coaches’ perspectives. The research team repeated this iterative process multiple times to ensure agreement about the generated themes.

Results and discussion

Discussions about menstruation

During interviews, coaches approached the discussion of menstruation in various ways. One approach was to draw parallels between menstruation and injury, where coaches described the need to modify training around symptoms of menstruation as similar to modifications during injury rehabilitation or when an athlete was unwell. Another approach was to treat menstruation as a component of athleticism that could be monitored, and potentially optimised, for performance outcomes. Finally, some coaches avoided discussing menstruation with athletes altogether. Despite approaching the conversation in various ways, coaches invariably shared a desire to normalise the topic of menstruation in youth sport settings, but were unsure how to achieve this aim.

Medicalisation and menstruation as synonymous with injury

In drawing parallels between menstruation and sport-related injuries, coaches discussed how symptoms of menstruation could be managed to avoid negatively impacting sports training and performance: “I suggest like, ‘hey have you checked with the doctor? Maybe there's some medication you could take?’ Or things like that if it's too heavy of a flow” (Coach 5, female). In line with this, coaches sometimes approached menstruation as a factor of performance that could be monitored and optimised to reduce the negative impacts of performance in sport. However, one coach also noted that drawing parallels between menstruation and injury contributed to the negative perceptions around menstruation in sport: “I don't want it to be related to injury like, you know what I mean? I don't think it should be similar to injury. But the example I was going, I was going to say out loud was when you're injured you modify, right? You modify or you take a break. And like that's also okay, too.” (Coach 1, female). While some coaches approached menstruation as something to be medically managed, Coach 1 was aware that treating menstruation as similar to injuries creates a negative perception of menstruation for young female adolescents.

This approach to discussing menstruation aligns with previous research showing that coaches medicalise menstruation and female bodies. For instance, a recent survey in sport showed that the majority of health personnel surveyed believe menstruation has a negative impact on women's athletic performance. ³³ Similarly, Meijen and Martin ²¹ interviewed 12 female athletes and found that athletes self-reported a fear of being viewed by coaches as “period prone,” which may negatively affect their coaches’ view of them. A common challenge for athletes is to be seen as high-risk of injury, or injury-prone, which has negative consequences as coaches often view athletes as unavailable and therefore unsuitable for selection and progression in sport. In Meijen and Martin's ²¹ research, the athletes clearly identified how training challenges due to menstruation are seen as similar to repeated injuries and could risk future progress in sports teams, and coaches in the current research also approached menstruation as a negative factor to be managed.

Furthermore, coaches’ recommendations or strategies to manage menstrual symptoms lacked nuance and generally suggested training “adjustments” (Coach 13, male) or stop participation completely: “we'll either modify it or we'll just say like, would you like to leave it there before it gets worse?” (Coach 8, female); coaches rarely expanded on how they made decisions regarding training modifications or the impact on the athlete. Athletes have self-reported challenges with understanding how their own experiences of menstruation impact their self-perceptions, physical health, and participation in sport.^7,11,15 In the present research, only one coach recommended athletes track their menstrual cycle to understand their experiences more thoroughly:

I started kind of paying attention to tracking my cycle and understanding how that affected my performance, like pretty young, I'd say and I like took a lot of time for it (…) I always talk to the kids around that age about like, ‘hey, pay attention to this and like there might be some links between this and training.’ (Coach 6, female)

While coaches may lack knowledge about sports performance and menstruation, perhaps coaches could support athletes by encouraging them to learn more about the nuances of their own experience.

Optimising menstruation

Coaches normalised menstruation by discussing the topic as a factor in athletic performance that should be monitored and managed to reduce the negative effects of menstruation on performance. As one coach explained: “everything started with the information, with the data. So you need to know if [you’re] starting the day one, and you need to know if it's gonna be like a symptom, the symptoms you have are severe symptoms or moderate or light (…) Based on that, you can start to plan” (Coach 7, male). Coaches also took an approach that placed the ‘optimisation’ of menstruation as the athletes’ problem to manage. In one interview, Coach 13 commented that athletes should manage the situation: “whether you like it or not, you have to train on that day, right? Whether you like it or not, there's a game on that day, right? And so now how can you manage that situation a little bit better?” (Coach 13, male).

Athletes have reported negative psychological and physical decrements in athletic performance associated with stages of the menstrual cycle, for example, lower confidence and decreased aerobic capacity in premenstrual and menstrual stages. ¹⁸ In response to these challenges, athletes have also discussed coping strategies such as modifying their training around stages of menstruation ²¹ ; for athletes, finding ways to cope with symptoms helped them to manage their performance. While athletes can find coping strategies to manage their negative menstrual symptoms, the above quotes demonstrate how coaches in youth sport settings largely leave it up to athletes to find ways to limit the negative effects of menstruation. By not providing education or guidance to athletes, coaches could potentially create a culture in which athletes may feel unsupported.

Avoidance

Coaches were generally open to the idea of discussing menstruation: “honestly, I'm open to it if, if a player has to explain something to me” (Coach 10, male), and “if they can feel comfortable in, in asking questions (…) then I think that's the way forward” (Coach 13, male). Through the analytic process, the research team interpreted that coaches’ approaches to the topic of menstruation centered on the theme of avoidance, ranging from openly discussing their own experiences with menstruation, addressing the topic indirectly, to purposefully avoiding the topic. Three female coaches described sharing their own experiences to show athletes that they were comfortable discussing menstruation. Coach 2 explained that she tried to “be like, as open as I can with the girls. And so I’ll like, I’ll say things like ‘oh, I’m cramping’”, and Coach 1 (female) summarized how she chose to mention menstruation to encourage conversations: “I just bring up the topic once with any young girls or any athletes, it just like, breaks the ice and then they can be like, me too.” While these coaches chose not to avoid discussing menstruation, they approached the topic briefly, and avoided asking direct questions to athletes about their experiences.

Conversely, one coach purposefully avoided communicating with athletes about menstruation altogether:

You don't want it to become a case where they say ‘coach [name] does not understand what I'm going through’ or ‘he's a male because he's a male he doesn't get it’. To avoid that type of conversation, it's just better. (Coach 3, male)

Outside of the above examples, the other coaches described brief interactions in which they learnt athletes were experiencing some symptoms but chose not to engage in discussions. For example, Coach 10 (male) explained “others will outright say ‘it's that time coach’ and I go ‘OK’.” Similarly, Coach 12 (male) described one encounter with an athlete who was upset at practice:

I just said to her, listen, anytime you need (…) go into this room and just take 10–15 min for yourself and nobody needs to know that you're in there, nobody, and it's nobody's business. (…) She came out and she just quietly said, you know, thank you, and got right back into the workout.

Similarly, Coach 11 (male) chose not to discuss menstruation when they noticed athletes may be experiencing symptoms, and instead redirected the training session to focus on enjoyment over performance: “when I know the girl's not into it, I try to get back to the roots of, of not focusing on the hockey, but just focusing on the fun.” In these examples, coaches still avoided having an open discussion with their athletes, but showed support by allowing athletes a place to be alone, or changing the training session to accommodate.

Consistent with previous research, coaches and athletes rarely have open dialogue with regards to menstruation. ²³ Particularly with male coaches, there was a perception that it was easier to avoid the topic rather than say something that was incorrect or inappropriate, ⁴² and female coaches also agreed menstruation was a “touchy subject” (Coach 6, female), or that male coaches “don't want to overstep” (Coach 5, female). The above quotes demonstrate that coaches want to be supportive, but lack understanding of what athletes want, and how to communicate. Drawing on previous literature, athletes want coaches to be proactive and supportive, provide them with agency and privacy, and maintain open communication. ²³ The coaches in this research demonstrated early examples of these behaviours: female coaches proactively mentioned menstruation, and other coaches gave athletes private places to compose themselves, or amended their training sessions to accommodate. Despite these positive steps, coaches could build more trust by learning with athletes about the impact of menstruation, and opening up communication channels throughout the season, rather than once at the beginning, in the manner that Gopalan et al. ²⁹ (p. 1798) summarize: ‘a concerted and coordinated effort is required from all stakeholders’.

Coaches also made linguistic choices during interviews that attempted to avoid mentioning the topic directly, either choosing colloquialisms or general language to convey that they knew an athlete was menstruating and may not be able to participate in sport. For example, one coach said: “She's going through some lady things (…) going through some rough days for the next couple days” (Coach 12, male). Other examples of metaphors or colloquialisms included “[feeling] under the weather” (Coach 10, male), or “she's just not into it, or just out of it” (Coach 11, male). Across interviews, seven coaches opted to use these colloquialisms rather than addressing menstruation directly with athletes or parents. One coach suggested that this approach was better than potentially embarrassing the individual in a team setting: “we never want to embarrass the kids. So we usually just say, like, ‘ohh she's not feeling well’” Coach 8 (female).

Researchers have previously found that coaches of adolescent athletes avoid the topic of menstruation due to lack of knowledge and well-placed intentions to not draw attention to female athletes’ personal experiences in the public sports setting.^11,16 Female athletes also report stigma around menstruation, fear of uncomfortable situations, and lack of knowledge as reasons they do not discuss their menstrual cycle with sports coaches. ⁴³ However, given the mounting evidence that menstruation impacts not only performance, but also general trends in sports participation, choosing to not discuss menstruation may lead to unintended consequences for female athletes such as delaying to seek medical attention, and a lack of informational and emotional support performance.^28,43 Coaches in the current research were aware of these issues and what has been referred to as mutual avoidance ⁴⁴ on the part of coaches and athletes. However, given coaches’ leadership position, coaches may be best positioned to start the conversation with athletes, perhaps by asking athletes if there is any support they would prefer. ⁴⁴

Beliefs about girls in sport

Periods can hinder performance

Our analysis identified that coaches’ discussions about menstruation seemed to be influenced by underlying beliefs about girls in sport. On one hand, coaches saw adjusting training structures as an easy way to accommodate athletes due to their experiences with menstruation: “you reduce [the] training loads and give something different, like some technique or drills, something, some low intensity that's gonna work as well” (Coach 7, male).

In other instances, male coaches perceived menstruation as a hindrance to female athletes’ performance and were less willing to make accommodations: “I'm not telling them they have to, but I'm kind of as a coach saying you also have to learn how to play with this if you plan on playing” (Coach 11, male). Coaches also discussed instances where other coaches said the female athletes should “suck it up” because they were training with male athletes who were not impacted by menstruation. Coach 12 (male) described an interaction with his colleague:

So when we had a situation where, the one athlete was lagging behind in training, he [Coach] was hard on her. He was yelling at her, yelling at her, yelling at her. And eventually, when I said ‘coach, (…) I got a feeling maybe that's [menstruation] what it could be’. And his response was basically like ‘well, she's with the boys, tell her to just be like the boys. Suck it up’.

These beliefs about girls in sport were complex; coaches wanted to support female athletes’ participation, but some comments suggested that female athletes should continue performing in spite of their period. McMahon and Barker-Ruchti ⁴⁵ presented similar themes in their phenomenological study of Australian female swimmers: “athletes were expected to acquire a boyish corporeality deemed acceptable for male elite swimmers and considered necessary for perceived performance,” (p. 171) and these standards were enforced by some coaches’ inherent beliefs that menstruation was somehow un-athletic, or at least damaging for athletic potential. Another example of this was from Coach 6 (male) who described how “early developers [i.e., females who menstruated earlier than their teammates] seem to feel more self-conscious earlier. Especially like, with many athletic bodies near them who are just like, more coordinated.” Coach 6 raises a point that puberty can lead to physiological changes that can alter mechanics and coordination^10,12; however, comments like Coach 6's point to a belief that female bodies that menstruate are somehow less athletic and athletes who do not menstruate represented the “athletic bodies”.

There were also instances in which coaches’ descriptions could be seen as suggesting athletes who menstruate were less dedicated to their sport: “the conversation was to let the parents know that having your period, it cannot be seen as an excuse for bad performance or lack of a performance” (Coach 3, male). Despite growing evidence that symptoms associated with menstruation can impact performance output, some coaches spoke of menstruation in a dismissive way.^21,22

One female coach summarised the theme well by explaining that because coaching is a male-dominated environment, it has historically dismissed the female experience, including menstruation: “all men know it's a thing that exists, but I think in the sport environment they very much see young girls as like as athletes, right, and you know, in athletic situations, we don't have to think about periods” (Coach 2, female). Therefore, to be an athlete is to not have to think about menstruation.^26,45 Unpacking and understanding some of these unconscious beliefs about female athletes may help youth sport coaches to develop stronger coach-athlete relationships, ¹⁶ and approach conversations about menstruation by first assuring female athletes that menstruation does not mean they are unathletic, or cannot perform to a high standard.

Concerns about sexualization of female athletes

In line with previous research, ²⁸ coaches were unsure if they should discuss menstruation with female adolescent athletes and often avoided discussions because it would be uncomfortable. In some cases, coaches shared that they would prefer to have conversations with youth athletes with a parent present:

“You and I could be having a conversation alone on the floor… I don't want people to think there's anything going on there like, that's not, that shouldn't be said. So I make sure Mom and Dad know that anytime I'm with their daughter, I would like somebody in the room with me to see the training.” (Coach 12, male)

Male coaches generally indicated that they were not comfortable interacting with female youth athletes alone, and when asked specifically about how they might feel when discussing menstruation, male coaches ultimately felt the topic was inappropriate, or perhaps even endangering the safety of the athlete. As one male coach summarised: “But you know, I cannot like, ask them or something like that. So it's straight to the jail [laughs]” (Coach 7, male). Male coaches seemed to fear that to discuss menstruation was predatory or against safe-sport policies. Female coaches also echoed this sentiment: “How, as a male coach… do you tap that athlete on the shoulder and say ‘I wasn't looking at your butt, but (…) but I saw that your shorts are leaking’, right?” (Coach 2, female).

Female athletes have reported feeling comfortable discussing menstruation when there is a trusting relationship with male coaches, but have also generally reported feeling more comfortable to discuss menstruation with female coaches and support staff. ²⁶ The experiences of coaches in the current study support previous findings, and also suggest that coaches’ concerns about discussing topics that are deemed ‘sexual’ may contribute to coaches’ concerns about the topic. Coaches shared a sense of ambiguity about the appropriateness of the topic, and likened discussing menstruation as something akin to an illicit act. Given that female adolescent athletes already experience heightened body-image awareness and scrutiny around the time of menstruation, ⁴⁶ coaches may also contribute to female adolescent athletes’ perceptions that menstruation is something to be hidden, avoided, or something that will negatively impact their participation in sport. Taken together, coaches seemed to avoid the topic of menstruation due to lack of education and fears that discussing the topic with athletes in some way creates an inappropriate environment, viewing menstruation as a highly personal, or perhaps sexualised topic that should be avoided.

Essentialization of female coaches

To avoid some of the challenges with discussing menstruation with athletes, coaches suggested that a female coach should have these conversations or be present during conversations: “if you're a male coach working with the female team, you should have a female - female on your staff” (Coach 3, male). In addition, almost all of the female coaches interviewed commented that they could relate to their athletes because they had their own experiences with menstruation: “I’m a woman who gets it because I have it every month” (Coach 2, female). Previous research findings^21,23,26 have confirmed that athletes perceive female coaches and support staff as more supportive and understanding when discussing menstruation. Similarly, coaches in the current research felt that a female staff member is best-positioned to address issues of menstruation.

Athletes in previous research studies have also reported male coaches as less knowledgeable regarding menstruation,^11,26 and coaches interviewed here also positioned themselves as less knowledgeable, partly because they lack first-hand experience: “I've never lived through it” (Coach 10, male). Coaches also felt they were not the ‘ideal’ person for these conversations. As one coach explained: “I don't think it was something I should be involved in, so a lot of that, the girls handled that - our female coaches handled [it]” (Coach 11, male). These quotes further supported the theme of avoidance, because coaches opted to outsource to female staff rather than discuss periods directly with athletes. Given that female athletes have reported male coaches to be less supportive and knowledgeable with regards to menstruation,^16,47 coaches should be cognisant that avoiding these conversations could be damaging their relationships with their athletes, which is unfortunate given that almost all the coaches in the present research showed a willingness to learn how they could support their athletes more effectively.

In line with Barnes et al.'s commentary on sexism and misogyny for women coaches in sport, ⁴⁷ some of the views shared by male coaches did suggest that women coaches were helpful for their ability to take on the role of ‘feminine expert’. The coaches could be considered to be essentializing female coaches for their gender, rather than their coaching skills. One coach suggested that the female coach should be educated and qualified for coaching positions: “you should have a female - female on your staff, not just a manager, but like a qualified female coach. Um because there are many different conversations that you could benefit [from by] having a female on your staff” (Coach 3, male). While several male coaches thought that female coaches were essential in assistant or staff roles for discussing certain topics with female athletes, we noted that none of the male coaches interviewed in this research suggested that female coaches could be best-positioned as the head coach, able to support female adolescent athletes and provide expertise in sport specific coaching in tandem.

Conclusion and limitations

In conclusion, the current research adds to the growing literature exploring the experiences of female adolescent athletes and coaches with regards to the impact of menstruation in sport. In line with previous research, coaches in the current study communicated feelings of discomfort with addressing the topic, ²⁸ leading to communication approaches that treated menstruation as similar to an injury, a physiological factor to be optimised, or a topic to be avoided. However, interviewing coaches first-hand did reveal that coaches have a sincere interest in learning more about the impact of menstruation in sport, particularly if the information could help them to better support female athletes. However, none of the coaches discussed proactively seeking information.^11,21

There are several considerations and limitations with the current research that should be considered when interpreting the research findings. One limitation is that we did not collect demographic data regarding coaches’ competitive level; only three coaches discussed coaching competitive athletes that were part of a performance pathway geared towards elite sport. In most cases, coaches oversaw athletes that were in competitive ‘rep’ teams that participated in tournaments and leagues, but not part of a high-performance route. Findings that coaches had limited knowledge of the impact of menstruation in sport, and few experiences of discussing menstruation with athletes, could be a symptom of coaching at less competitive levels of sport. As competitive level may provide coaches with more professional development and greater experience, future research could examine whether coach communication about menstruation may vary across competitive levels. Coaches in elite or highly competitive sports settings would likely have additional staff or resources (e.g., more funding for education or sports scientists) that could also supporting female athletes. For example, elite female rugby players have reported seeking support from Sports Medicine Doctors. ⁴⁸ Equally, discussing ways to optimise menstrual cycles for peak performance is a more salient goal for individuals coaching elite athletes, ⁴⁹ and the coaches in the current study may be less likely to discuss the impact of menstruation on performance when performance is not the primary goal. In conclusion, the conclusions drawn may not be representative of coaches who are responsible for female adolescent athletes in high performance settings, where resources may be increased and the main goal of participation is to optimise performance. However, we do suspect that many coaches in North America, those who volunteer to coach semi-competitive, local sports teams, will relate to the experiences of coaches interviewed as part of this research.

Furthermore, the research only sampled the perspectives of coaches. Other research ¹¹ has sampled coaches, parents, and athletes to obtain a wider view of how multiple people in the sports setting perceive conversations about menstruation and menarche and sports participation. Additionally, the coaches in the current study expressed that they had very little direct experience of discussing the topic. Indeed, researchers have consistently found that coaches and athletes do not communicate frequently about menstruation.^29,35 As such, coaches’ perspectives were largely based on their assumptions or hypothetical scenarios, similar to other studies in which coaches shared making adjustments to training based on assumptions around the experience of menstruation. ¹⁶

However, the coaches in this study provided novel insights into how they think about female adolescent athletes’ experiences. Coaches’ approaches to communication about menstruation were rooted in beliefs about the female experience of sport, the focus on performance as the aim of sports participation, and the role of female coaches in the sports system as an ‘expert’ in menstruation. Male participants talked in ways that positioned female coaches as the most adept to deal with the topic of menstruation, due to their own lack of knowledge. Although, coaches did share enthusiasm for the potential opportunity to receive education to help them coach more effectively with regards to menstruation. While female coaches are a facilitator to positive communication around menstruation, ²⁹ these trends speak to wider beliefs about the role of women in sport and a persistent sense that menstruation may continue to be a taboo topic that many coaches do not discuss in sports settings. Coaches also demonstrated a fear of being accused of overstepping personal boundaries and sexualizing young female athletes if they broached the topic, which highlights the very real dichotomy of this topic: coaches want to learn and support athletes but have real concerns about how they would be perceived by athletes and parents if they discussed the topic of menstruation. Perhaps one of the biggest takeaways was that coaches want, and require, education and support as much as athletes to navigate menstruation and sport.

While the current research was exploratory, there are some applied recommendations can be provided from coaches’ insights. For instance, if coaches are unsure whether to discuss menstruation with athletes (i.e., lean toward avoiding the topic), they could begin by asking athletes, female coaches, or female staff, whether they would like to discuss the impact of menstruation on sports performance, or whether there is anything the coach can do to support athletes better. Of course, coaches may find this communication uncomfortable, but this approach would give athletes autonomy to guide how much communication they would appreciate. Coaches also suggested they would appreciate educational courses on the topic, and as suggested by Keil et al., ¹¹ coaches and athletes could take part in this education together, to facilitate communication. Additionally, some coaches did mention small logistical choices that showed a level of support for athletes, such as including sanitary products in the team equipment bag, or providing uniforms that are darker in colour and looser for athletes. These small changes could be ‘easy wins’ for coaches and could be a safe way to begin a conversation with teams and athletes. From here, researchers should continue to investigate the perspectives of coaches, parents, and athletes, and perhaps facilitate conversations regarding sports participation and menstruation to determine how conversations can benefit participation rates and develop trusting relationships with coaches and athletes.

Supplemental Material

sj-docx-1-spo-10.1177_17479541261435571 - Supplemental material for Coaches’ perspectives on menstruation for female adolescent athletes

Supplemental material, sj-docx-1-spo-10.1177_17479541261435571 for Coaches’ perspectives on menstruation for female adolescent athletes by Rachel C Dunn, Kirsten Hutt, Rylan Curtis and Katherine A Tamminen in International Journal of Sports Science & Coaching