What male coaches want to know about the menstrual cycle in women’s team sports: Performance,health,and communication

Abstract

This study aimed to identify what male coaches of elite female team sport athletes want to know about the menstrual cycle and its influence on athlete health and performance. Using a mixed-methods concept mapping approach, 18 male coaches of Australian female elite football-codes brainstormed what they wanted to know about the menstrual cycle to work more effectively with female athletes. Ideas were sorted into groups of similar ideas and rated for importance and influence. Thirty-eight unique statements emerged from the brainstorming. These were organised into five clusters/topics following multidimensional scaling and hierarchical cluster analysis: 1) How does training need to be managed; 2) How is physical performance impacted; 3) What are the medical and dietary considerations; 4) When and how should we communicate with athletes; and 5) How are athletes affected psychologically and emotionally. These findings highlight the need for a comprehensive education framework to improve the knowledge of and practices related to the menstrual cycle. This education should 1) facilitate better recognition and referral of female athletes regarding menstrual cycle dysfunction and related health concerns; 2) encourage collaboration between athletes, coaches, and medical and dietary professionals; and 3) promote effective communication between athletes and coaches about the menstrual cycle.

Keywords

Coach education,female team sport,football,physiology

Introduction

Numerous football codes are available for women to play in Australia, including soccer, rugby league, rugby union, rugby sevens, and Australian football. The recent launch of National elite level women’s football competitions, particularly within Australian football, rugby union, and rugby league, have seen grassroots participation increase by 20–50%.^1–3 While the growth in participation and access to elite competition pathways is positive, most elite female football teams are coached by men, with women underrepresented amongst coaching staff.⁴ In 2020, only 12.5% of elite women’s Australian football (AFLW), soccer (W-League), rugby league (NRLW) and rugby (Super W) teams had female head coaches.

Male coaches of elite female teams in traditionally male dominated football codes may not understand the potential influence of the menstrual cycle on a female athlete’s performance and recovery. Compared to female coaches, male coaches perceive menstrual irregularity as less harmful to health and are less comfortable communicating with female athletes about their menstrual cycle.⁵ Further, elite female rugby union players feel male coaches would be uncomfortable discussing their menstrual cycle with them, and players were more comfortable having these discussions with female coaches or doctors.⁶ Given the menstrual cycle can be a indicator of overal health in females,⁷ it is important for coaches to be aware of the potential health and performance implications of menstrual dysfunction, including the greater likelihood for bone fracture, iron deficiency, and impaired cardiovascular function.⁸,⁹ Similarly, even in the absense of dysfunction, understanding the relationship between individuals’ menstrual cycle phase and their performance, training, and recovery, may improve the interpretation of testing or training data. Male coaches are aware they lack knowledge about the menstrual cycle and want policies and/or an education framework about the menstrual cycle to guide training practices in female athletes and how they can comfortably and respectfully discuss the influence of the menstrual cycle on health and athletic performance with female athletes.⁵ However, developing an education framework to guide coaches (of either gender) about the influence of the menstrual cycle and hormonal contraceptives in team sport athletes is challenging since most research on these topics is in either endurance or weight-restricted athletes.^10–12

Professional development for coaches can be either formal, through specific courses or workshops, or informal, through discussion and observation with other coaches. In male-prevalent sports like these football codes, the predominant preference for informal coaching development¹³ may not be sufficient to upskill these coaches when working with female athletes. However, formal education programs may miss the mark for what coaches consider relevant or important to change their practice.¹⁴ As such, the use of a concept mapping approach, where coaches directly identify aspects that they consider important and influential to their practice, may help guide the development of educational resources¹⁵,¹⁶ and empower coaches to actively engage in the educational process. Understanding what coaches want to know may also be used to drive future areas of research that are relevant to improving the health, performance, and management of female athletes in relation to their menstrual cycle.

Given the prevalence of male coaches in women’s football codes in Australia, an understanding of what male coaches want to know about how the menstrual cycle influences female athlete performance and wellbeing is required. In this study, we used concept mapping to identify and prioritise what male coaches of elite female team sport athletes want to know about the menstrual cycle and its influence on female athlete health and performance. This information can then be used for the co-design of educational resources that address the perceived needs of coaches and will likely be well received.

Materials and methods

Study design

We used concept mapping (CM), a mixed-method participatory approach, to gather and analyse qualitative and quantitative data. Concept mapping involves project preparation (focus prompt development and participant identification), idea generation (brainstorming), statement structuring (sorting and rating), and analysis (map production).¹⁷,¹⁸ We used the Concept Systems Groupwisdom™ web platform to collect, analyse, and present data. Institutional ethics approval was obtained (approval number: HEC19066) and participants provided informed consent when they registered on the online platform.

Participants

Four Australian women’s team sports were targeted in this study – Australian football, soccer (association football), rugby league, and rugby union/sevens. These traditionally male-prevalent sports have high proportions of male coaches and support staff. Participants were eligible for this study if they were working as an elite women’s team head, assistant, or strength and conditioning coach. Teams playing in a national (AFLW, W-League, NRLW, Super W, AON 7 s) or international competition were considered ‘elite’. We recruited participants via email through the research teams’ professional networks and snowballing (e.g., word-of-mouth between participants).

Concept mapping process

Before commencing the CM activities, participants described how long they had coached female athletes and their qualifications related to their coaching role. Participants also rated (1 – low; 5 – high) their knowledge, interest, and confidence in discussing the menstrual cycle with their female athletes.

The focus prompt used in the brainstorming activity was “In order to work with female athletes more effectively, something I would like to know about the menstrual cycle is … ”. Participants could brainstorm as many ideas relating to this focus prompt as they could think of. Participants could view others’ responses and access the platform multiple times over two weeks in April 2020 to complete the activity. The research team synthesised all brainstormed statements to 1) remove duplicate ideas, 2) split compound statements, and 3) edit statements to improve clarity and reflect an agreed meaning.¹⁸ This iterative process continued until we agreed that the final statement list captured and clearly presented all relevant initial brainstormed ideas without repetition.

Following brainstorming, participants completed statement structuring by sorting and rating each statement.¹⁸ Participants 1) sorted the randomised synthesised statements into groups that made sense to them based on similarity of meaning and 2) named each group based on the theme or concept the statements represented. They were informed that between five and 10 groups was appropriate for the number of statements they were sorting.¹⁹ Participants were asked not to create value- or priority-based (e.g., ‘important’) or unrelated (e.g., ‘other’) groups. Statements that did not fit with any others could be placed in their own group. Participants also rated each statement using two rating questions which were developed based on guidance from Kane and Trochim:¹⁷ 1) On a scale from 1 (least important) to 5 (most important), how important is it for you to know this information? and 2) On a scale from 1 (least influential) to 5 (most influential), if you had this information, how influential would it be on your coaching practice? They were asked to use the full scale range and to rate each statement relative to other statements.

Statistical analysis

Before analysis, we (AC, AG and AD) reviewed all responses to ensure participants followed the sorting and rating instructions (i.e. that they have not created value-based groups and they had tried to use the full rating scales). Data analyses were undertaken using the Groupwisdom™ web platform.¹⁷ A square symmetric similarity matrix was created from the sorted statements, before two-dimensional non-metric multidimensional scaling was used to locate each statement as a point on an x-y spatial ‘point map’. Statements were partitioned into clusters on the point map using hierarchical cluster analysis. After examining the 3–10 cluster solutions, the research team identified the most appropriate solution that retained the most useful information between clusters, while merging clusters that seemed to logically fit. Statements that conceptually belonged in an adjacent cluster were reassigned to the neighbouring cluster.²⁰ We calculated mean importance and influence rating scores for each statement and generated a four-quadrant ‘go-zone’ map based on the mean rating for importance and influence for all statements combined.

Results

Participant demographics and brainstorming

Eighteen of the 19 coaches invited to participate completed all activities (brainstorming, sorting, and rating). The participants’ demographic data are presented in Table 1. Self-rated knowledge about the menstrual cycle and its influence on athletic performance were low (mean 2.3 out of 5, range 1–4, mode 2), while interest in learning was high (mean 4.6, range 4–5, bimodal 4 &5), and confidence in discussing an athlete's menstrual cycle with them was moderate (mean 3.1, range 1–5, mode 3). Fifty-five statements were generated in the brainstorming, which were synthesised into 38 statements (Table 2).

Table 1.

Participant demographic data (n = 18).

		Count (% total)
Sport	Australian football	5 (28%)
	Rugby league	6 (33%)
	Rugby union/Sevens	5 (28%)
	Soccer	2 (11%)

Role in team	Head coach	5 (28%)
	Assistant coach	5 (28%)
	Strength & conditioning coach	8 (44%)

Experience coaching female athletes	0–2 years	4 (22%)
	3–4 years	10 (56%)
	5 + years	4 (22%)

Qualifications^a	Sport-specific qualification (e.g., coaching qualification)	12 (67%)
	Industry qualification (e.g., ASCA, ESSA)	6 (33%)
	Bachelor’s degree – sport-related course	6 (33%)
	Master’s degree – sport-related course	1 (6%)

ASCA: Australian Strength and Conditioning Association; ESSA: Exercise and Sport Science Australia.

^aParticipants could report multiple qualifications.

Table 2.

Statements generated during brainstorming process, grouped within clusters, with mean ratings for importance and influence and go-zone quadrant (n = 18 respondents for both rating activities).

		Mean rating (1–5)^a for		Go-zone quadrant^b
Statement		Importance	Influence	Go-zone quadrant^b
How does training need to be managed?		4.02	4.06
17	Are there certain types of training (e.g. strength, power, aerobic training) that are best suited for different stages of the menstrual cycle?	4.50	4.61	1
30	How can workload best be managed during different phases of the menstrual cycle?	4.39	4.44	1
6	How do different training loads affect physical performance at different phases in the menstrual cycle?	4.22	4.50	1
4	What could be done to limit the effect of the menstrual cycle on a given training session?	4.11	4.16	1
12	Which aspects of training should be avoided during certain phases of the menstrual cycle?	4.00	4.44	1
23	Are there any simple tests to monitor the impact of an athletes’ cycle?	3.94	3.72	2
37	At certain phases of the menstrual cycle, do athletes prefer to perform activities in a group or by themselves?	2.94	2.61	4
How is physical performance impacted?		3.89	3.86
1^c	Does the menstrual cycle impact performance?	4.83	4.67	1
7^d	Does injury risk vary during different phases of the menstrual cycle?	4.61	4.44	1
5^c	What physical characteristic (power, speed, strength, endurance etc.) does the menstrual cycle have the biggest effect on?	4.44	4.56	1
27	At what stage of the cycle do athletes feel the most positive from a physical point of view?	4.11	3.78	1
19	How does the menstrual cycle affect fatigue levels?	4.06	4.17	1
38	Does the menstrual cycle impact some athletes' ability to perform normal day-to-day activities (i.e., work and/or sport)?	3.78	3.56	2
9	How does the menstrual cycle affect post-exercise recovery?	3.72	4.17	3
22	Do athletes in a team environment sync their menstrual cycle?	3.22	3.50	4
36	Is the menstrual cycle impacted by being involved in sport and physical activity?	3.22	3.28	4
24	Is there a consistent point where very fit athletes start to lose their cycle?	2.94	2.50	4
What are the medical and dietary considerations?		3.70	3.54
20	Can nutritional supplements aid performance during certain stages of a menstrual cycle?	3.89	3.72	2
18	Are there any dangers of restricting the menstrual cycle during competition phases?	3.83	3.89	1
21	What impact does hormonal contraception have on performance during certain phases of a menstrual cycle?	3.67	3.56	4
28	Can adverse physical symptoms of the menstrual cycle be controlled to reduce severity?	3.67	3.28	4
25	How can diet impact the effects of the cycle?	3.61	3.50	4
16	Can medication impact athlete wellness at different phases of the menstrual cycle?	3.56	3.28	4
When and how should we communicate with athletes?		3.64	3.61
15	Are there certain management strategies that can best help coaches look after their athletes during their period?	4.22	4.11	1
8	What are the best communication strategies for discussing an athlete's menstrual cycles?	4.17	4.00	1
32	How can we better educate players and staff about the values of discussion about the menstrual cycle?	4.00	4.06	1
35	Are different communication styles preferred among different athletes when discussing their menstrual cycle?	3.94	3.94	1
33	How should the coach speak with player/s about their cycles?	3.94	3.78	1
34	How do athletes like to be treated during different phases of their menstrual cycle (i.e., do they want to be engaged with in a different, more personal way)?	3.67	3.78	3
13	At what age should we start discussing it with our athletes?	3.56	3.11	4
14	During what phase of an athlete's menstrual cycle are they most comfortable discussing it with coaches?	3.33	3.39	4
31	As a male coach, is it considered offensive to discuss the menstrual cycle with players?	3.22	3.39	4
3	Would a female athlete object to a section of the daily wellness form being about the menstrual cycle?	3.22	3.28	4
10	Should coaching staff let other team members know if an athlete is on their period?	2.72	2.89	4
How are athletes affected psychologically and emotionally?		3.63	3.56
29	What are the common psychological changes at different phases of the menstrual cycle?	4.22	3.83	1
2	Does the menstrual cycle affect the emotion/mood of athletes?	3.78	3.89	1
26	At what stage of the cycle do athletes feel the most positive from a psychological point of view?	3.61	4.00	3
11	Do athletes use the menstrual cycle as an excuse to get out of training?	2.89	2.50	4

^a1, least important/influential; 5, most important/influential.

^bGo-Zone quadrants: 1, top right (above mean for importance and influence); 2, bottom right (above mean for importance, below mean for influence); 3, top left (below mean for importance, above mean for influence); 4, bottom left (below mean for importance and influence).

^cReassigned from ‘training prescription’ cluster.

^dReassigned from ‘medical and dietary considerations’ cluster. The mean rating for all statements were 3.78 for importance and 3.74 for influence.

Sorting and rating

Participants sorted the 38 unique statements into an average of 5.8 ± 2.1 groups (range 3–10 groups, mode = 6 groups). The relative position of each point on the cluster map (Figure 1) is a proxy indicator for the similarity between each statement, with statements participants grouped together more frequently located closer together on the map. For example, statements 8 (What are the best communication strategies for discussing an athlete’s menstrual cycle) and 35 (Are different communication styles preferred among different athletes when discussing their menstrual cycle?) were grouped together by 16 of the 18 participants. Alternatively, statements 1 (Does the menstrual cycle impact performance?) and 16 (Can medication impact athlete wellness at different phases of the menstrual cycle?) were never grouped together. Statement 22 (Do athletes in a team environment sync their menstrual cycle?) was inconsistently grouped with other statements (e.g., six participants grouped it with 28 and five grouped it with 2, 5, 9, 24, 27, 36, 37 and 38) so it is centrally located on the map and not strongly conceptually related to other statements in its cluster.

Figure 1.

A five-cluster map of what male coaches want to know about the menstrual cycle in order to work more effectively with their female athletes. Dotted line indicates original cluster grouping, and solid areas represent final cluster groupings.

A five-cluster grouping—How does training need to be managed?; How is physical performance impacted?; What are the medical and dietary considerations?; When and how should we communicate with athletes?; and How are athletes affected psychologically and emotionally?—was identified as the best representation of how participants had grouped similar statements. The stress index was 0.20 indicating the arrangement of the points on the two-dimensional map is highly unlikely to be random.¹²

Figure 2 shows the Go-Zone graph for all 38 statements. Eighteen statements across all five clusters appear in Quadrant 1, indicating they were rated above the all-statement mean for both importance and influence (see Table 2 for the mean importance and influence rating and quadrant location for each statement).

Figure 2.

Go-Zone of menstrual cycle information needs for male coaches of female athletes. Statements were rated for importance and influence on a 1 (least) – 5 (most) scale. Quadrants are created by the mean ratings of importance and influence across all statements. Numbered dots refer to specific statement numbers (see Table 2 for statements and mean rating values). Different cluster groups are represented by the statement dot colour. r = 0.90.

Discussion

To our knowledge, this is the first study to explore what male coaches of female team sport athletes want to know about the menstrual cycle and what information would most influence their coaching practice. We identified five clusters/topics of information that male coaches would like to know regarding the menstrual cycle. These focused on 1) training, 2) performance, 3) medical and dietary information, 4) communication, and 5) psychology. All clusters were rated >3.5 out of 5 for both importance and influence and at least two statements in each cluster appear in Quadrant 1 or 2 of the Go-Zone map. We have detailed in Figure 3 topics that should be included in a female athlete coach education framework based on the findings of this study.

Figure 3.

Proposed structure for a coach education framework developed to support coaches working with female team sport athletes to better understand the influence of menstrual cycle on athletic performance.

Training and performance

The training management and physical performance clusters were rated most important to know by coaches and most likely to influence their coaching practice. The closeness of these clusters on the map suggests participants considered the concepts represented (i.e., the relationship between the menstrual cycle and training and performance) closely related. Similarly, five statements in each of the training and performance clusters were rated within Quadrant 1 of the Go-Zone map, Given the participants were field (head/assistant) coaches and strength and conditioning coaches, the high ratings for the statements in these clusters probably reflect their primary roles. The key aspects that were covered within these two clusters were around how to optimise training prescription and monitoring practices (Cluster 1 - How does training need to be managed?) and understanding the influence of the menstrual cycle on physical capacity, recovery, and injury risk (Cluster 2 - How is physical performance impacted?). While there is insufficient evidence about optimal training prescription relative to menstrual cycle phase,²¹ some exercise capacities are potentially improved, reduced, or remain unchanged during the early follicular and luteal phases,¹¹ suggesting that fluctuations in performance and recovery over the menstrual cycle are highly individual. While it may not be feasible to individualise training to each athlete’s menstrual cycle, recovery practices and general athlete support could be more athlete specific. Coaches can also encourage females to regularly monitor their mood and how their performance responds to specific training stimuli during different menstrual cycle phases (e.g., via a phone app).¹¹ Regular menstrual cycle monitoring may help athletes understand how their menstrual cycle affects their training and performance and communicate this with their coaches. We recommend that coach education resources include evidence-informed information about 1) how changes in female hormones during menstrual cycle phases influences physical capacities (e.g., strength, speed, power and endurance) and 2) how daily menstrual cycle monitoring can inform coaching practice.

Medical and dietary information

While coaches ranked the medical and dietary considerations cluster third highest for importance, it had the lowest perceived influence on coaching practice. This resulted in only one statement ranked within Quadrant 1 (“Are there any dangers of restricting the menstrual cycle during competition phases?”), and four ranked within Quadrant 4. The overall lower ratings for statements in this cluster are likely because the statements are outside the scope of practice or role of most coaches. Within this cluster statements were mainly focused around understanding menstrual cycle symptoms, hormonal contraceptive use and its influence of health and performance, and how diet and the use of supplements may aid in menstrual cycle symptom resolution. Research with women playing elite Australian Football highlighted that their total energy expenditure and iron intake was inadequate for their training demands.²² Similarly, female athletes had poor knowledge about nutrition, dietary supplements,²³ the menstrual cycle, and hormonal contraception.²⁴ There are numerous health and physiological consequences, such as poor bone health and impaired cardiovascular function⁸,⁹ that may arise due to the inappropriate prescription of training, recovery, and nutritional practices. As such, coaches in elite environments should be aware of the medical and/or dietary issues associated with female athletes (e.g., menstrual cycle dysfunction, low energy availability, and iron deficiency)⁹,²⁵,²⁶ so they can refer athletes to doctors or sports dietitians when required. More information is needed about the nutritional practices of elite women’s team sport athletes, including the prevalence of nutritional deficiencies such as iron deficiency.²⁷ More research is also required in elite women’s team sport athletes to understand hormonal contraceptive use, including the types of hormonal contraceptives used, reasons for use and/or stopping use, and associated symptoms. Engaging athletes, coaches, medical staff, and dietitians involved in female football codes to co-design educational materials is important to deliver evidence-informed and context-specific information. Coach education should include information about 1) how to recognise, and the consequences of, menstrual cycle dysfunction, 2) dietary considerations, such as low energy availability, iron deficiency, and recovery nutrition across the menstrual cycle, and 3) hormonal contraceptives available and their associated side effects. This information should also be included in athlete education programs to promote athlete health and wellbeing and the early identification of menstrual cycle-related medical or dietary concerns.

Communication and psychology

The communication cluster was the largest cluster, incorporating 11 statements, including five within Go-Zone Quadrant 1. Male coaches appear interested in understanding the female athletes’ perspective of how best to communicate about the menstrual cycle and associated symptoms. Statements within this cluster were focused on understanding optimal communication strategies, and how to improve the education and perceptions of athletes and support staff. Research suggests that elite female athletes currently feel uncomfortable discussing their menstrual cycle with male coaches,⁶ and although research shows some female-specific communication preferences,²⁸^–³⁰ there are currently no evidence-informed best practice guidelines detailing communication strategies male coaches can use to discuss the menstrual cycle with female athletes. This leaves male coaches to rely on their personal experiences and interpersonal skills, which may be problematic if they cannot recognise the early signs that require medical referral to a doctor or dietitian, in lieu of effective communication with their athletes. This is further exacerbated in community sport where education and medical support is scarcer. An evidence-informed framework is required to support male coaches to effectively communicate with female athletes regarding their menstrual cycle and should be co-developed by coaches, athletes, and psychologists. Identifying strategies to empower athletes to understand their body and improve communication about the menstrual cycle with coaching staff should also reflect socio-cultural norms relevant for athletes and coaches from various cultural backgrounds. However, some athletes may never feel comfortable discussing this topic with a male staff member. Therefore, supporting more women to pursue careers in coaching and other support roles in women’s sport should also be encouraged.

Within the psychological and emotional cluster, statements focus on the personal experiences of athletes rather than on how coaches can engage with athletes. The only statement in this cluster located in the Go-Zone Quadrant 1 was “What are the common psychological changes across the menstrual cycle?”. During the pre-menstrual phase and during menstruation athletes experience lower motivation and mood, which may be a reason to modify their training during this time.³¹ However, not all athletes experience the same mood fluctuations over their menstrual cycle. Indeed, 20–30% of women may experience premenstrual syndrome (PMS),³² and those with PMS experience greater negative affect (e.g., sadness, lethargy), lower positive affect (e.g., joy, enthusiasm), and exhibit a greater stress response independent of menstrual cycle phase.³³ While understanding the psychological influence of the menstrual cycle may assist coaches to engage with their athletes, a greater affect may be possible when athletes better recognise and understand their normal mood fluctuations throughout their menstrual cycle thereby improving their communication with their coach.

Limitations and delimitations

The concept mapping approach used in this study did not include the common methodological step of engaging stakeholders in the interpretation of the data.¹⁷ Coaches identified the ideas in response to the focus prompt as well as sorted and rated the relative importance and influence of these ideas on coaching practice. However, the final cluster groupings and names of each group were determined by the research group, and a consensus from all participants was not sought. As such, while we believe we have respectfully collated and expressed the ideas of this group, we did not confirm our interpretation with the coaches from this study. The outcomes of this study would still benefit from a coach consensus. While the clusters identified here can guide coach education, participants’ self-selection may influence the generalisability of our results. Study participants were already working in women’s elite team sports and their willingness to participate in this research, along with their self-rated interest, confidence, and knowledge, alludes to their engagement in understanding more about this topic. Alternatively, many male coaches currently working with female team sport athletes may be unaware that menstrual cycle monitoring is an important component of athlete management. This perspective is not captured in the current research and future education or policies should consider the scope of knowledge and interest of coaches when developing and disseminating information and best practice guidance. Similarly, the statements obtained during this study represent the ‘known unknowns’ that coaches believe important to know regarding the menstrual cycle. However, there are likely also ‘unknown unknowns’ not captured in this research. For example, no statement queried the influence of the menstrual cycle on coordination or cognitive processing, despite research indicating an impairment during the midluteal phase,³⁴ which may influence athletes’ ability to learn new technical aspects of play or undertake technical lifts in the gym. Also, no statements queried hormonal contraceptive use in relation to training adaptations, dietary considerations, or psychological and emotional responses, even though ∼40% of Australian athletes are likely using hormonal contraception.³¹ This study also grouped multiple coaching roles which does not reflect the different roles played within teams and potentially different educational and experiential backgrounds. Finally, this study was delimited to male coaches given their high prevalence in female teams within these football codes. However, we believe that female coaches would also benefit from a coach education framework informed by this research.

Conclusion

There is currently insufficient evidence available to appropriately modify an athlete’s training based on an individuals’ cycle phase.¹¹,²¹ Nonetheless, coaches should treat menstrual-related symptoms (either physical or emotional) with the same approach they would other routinely monitored aspect of athletes’ wellbeing (e.g. fatigue, soreness). We recommend the development of a comprehensive coach education framework that is co-developed with coaches, athletes, sport scientists, dietitians, psychologists and medical staff. Concurrent and supplementary education for athletes about what a normal menstrual cycle is would also improve the management and early referral process for athletes at risk. Enhancing both coaches’ and athletes’ ability to recognise abnormal menstrual cycle signs and symptoms and feel comfortable discussing its influence on performance and wellbeing is essential to improve the monitoring and management practices in female team sport athletes. More research around the menstrual cycle and athlete health and performance within team sports is also encouraged to support this growing body of evidence. Finally, while the education of athletes and coaches is important, it is also essential that athletes feel comfortable discussing this topic with others. Ensuring gender and cultural diversity within coach and support staff will help facilitate this.

Footnotes

Acknowledgements

The authors would like to thank all participants for their involvement in this study. We would also like to thank Dr Pip Inge for her suggestions and feedback to improve this manuscript from a medical perspective.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was financially supported by the Victorian Government Change our Game grant initiative and the La Trobe University School of Allied Health, Human Services, and Sport Strategic Research grant.

ORCID iD

Anthea Clarke

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