Menstrual cycle or hormonal contraceptive related symptoms in elite female athletes from retrospective self-questionnaires and daily monitoring: impact on well-being and objective performance metrics

Nolwenn BADIER^1*Marine Dupuit¹Tom Chassard¹Kilian Barlier¹Alice Lafitte¹Guillaume Saulière¹Lidia Delrieu¹Jean-François Toussaint^1,2Juliana Antero¹

• ¹EA7329 Institut de Recherche BioMédical et d'Epidémiologie du Sport (IRMES), Paris, France
• ²Hopital Hotel-Dieu de Paris, Paris, France

Introduction: Negative menstrual cycle–related symptoms have been shown to perceptually impact well-being, as well as training and competition performance, yet they are rarely daily monitored over extended periods. The aim is to compare menstrual cycle (MC) and hormonal contraception (HC) related symptoms reported through retrospective and daily questionnaires in elite female athletes and to assess their association with well-being and performance metrics. Methods: Data were collected from 108 elite female athletes across seven sports over 554 full cycles. Participants completed a retrospective questionnaire on regular symptoms and provided daily prospective entries for 6 months (n = 16,491) about their symptoms, sleep, fitness and mood. Symptom reporting methods were compared, differences in symptom frequency across cycle phases were analyzed, and associations between symptom count and well-being were explored. Performance metrics were collected for sports providing objective data and analyzed comparing training with versus without reported symptoms. Results: Athletes reported more symptoms retrospectively than in daily questionnaires. Mood swings, tiredness, and pelvic pain were the most common retrospective symptoms, while bloating, tiredness, and pelvic pain were most frequent in daily entries. MC athletes reported more symptoms than HC users in both methods. According to the daily follow-up, symptoms were more frequent during menstruation and the prebleeding phase for MC athletes and the break phase for HC users. A significant negative correlation was observed between symptoms and well-being indicators. In football players, high-speed running distance significantly declined on symptomatic days. Conclusion: Retrospective questionnaires shows a greater symptom prevalence than daily monitoring. Symptoms, more frequent during bleeding phases, negatively impacted athletes' well-being and also high-speed running performance for football players. These findings highlight the importance of individualized monitoring and tailored interventions to optimize athlete health, well-being, and performance.