• An overview of the topic of menstrual cycle and what challenges female athletes face in comparison to male athletes.
• The impact of menstrual cycle on the performance, training, and injury frequency of female athletes.
• Any recent research on the topic of the impact of menstrual cycle on female athletes.
• The solutions adopted by female athletes to cope with the problem of menstrual cycle.
• Whether the problem has become big enough to cause any Olympic-level female athlete to miss any event/competition.

Data Availability

Overview of the Menstrual Cycle

• A difference in the dominant sex hormone is an important distinguishing characteristic between males and females. While estrogen and progesterone are the dominant sex hormones among females, it is testosterone among males.
• In females, estrogen and progesterone "are responsible for maintaining a healthy menstrual cycle," contributing to bone health, and influencing the performance of athletes.
• The menstrual cycle commences with menses, a phase when females bleed and shed the uterine lining. Menses, that lasts for 14 days, "is the start of the follicular phase, or low hormone phase, characterized by low luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone and slowly increasing levels of estrogens."
• The next phase in the menstrual cycle is the ovulation phase, "which is characterized by a spike in levels of estrogen and luteinizing hormone. This coincides with the release of the egg and is the time of the menstrual cycle when females can become pregnant."
• The final phase of the menstrual cycle is the luteal phase, which is "the high-hormone phase of the menstrual cycle when both estrogen and progesterone levels are higher."

How Menstrual Cycles Affect Female Athletes Compared to Male Athletes

• One of the most common injuries in sports occurs at the anterior cruciate ligament (ACL). The prevalence of ACL injuries is higher among female athletes compared to male athletes. The intrinsic factors that affect this injury rate are ligamentous laxity, biomechanical alignment, hormonal influences, and intercondylar notch width. Ligamentous laxity is more prevalent in females compared to males. "This increase in laxity in women can be attributed to the women’s menstrual cycle due to peak levels of estrogen and progesterone or an increase in the hormone relaxin during pregnancy."
• Lower extremity injuries are more common among female athletes compared to male athletes due to difference in sex hormones, anatomy, and dynamic neuromuscular imbalance. Research has shown that "the effects of sex hormones on lower-extremity neuromuscular control patterns differ across the menstrual cycle phases in female athletes."
• "Female Triad is a spectrum disorder where there is an altered relationship between energy availability, menstrual function, and bone mineral density." A lack of energy availability within the body mainly causes female triad and leads to abnormal menstrual function.

Overview of the Impact of Menstrual Cycle on The Performance, Training, and Injury Frequency of Female Athletes

• Various research papers have established the direct correlation between menstrual cycle (heavy menstrual bleeding (HMB)) and its impact on the performance, training, and injury frequency of athletes. In a study, 54% of female athletes and 36% of female marathon runners surveyed "reported that hormonal fluctuations during their menstrual cycle negatively affected their exercise training and performance capacity."
• In another study, 77.4% of female athletes surveyed reported negative side effects of menstrual cycle on their athletic performance. 81.6% of female athletes felt the most impact during the first 1-2 days of menstruation.
• In a study of elite female rugby players, 93% of the players surveyed "reported menstrual cycle-related symptoms" and 67% stated that these symptoms negatively affected their performance.

Summary of the Early Findings

• During the one hour allotted for our initial research, we were able to assess the wide availability of public information on this subject. We were also able to present an overview of the menstrual cycle, how menstrual cycle affects female athletes compared to male athletes, and an overview of the impact of menstrual cycle on the performance, training, and injury frequency of female athletes. However, due to shortage of time, we were not able to present the other required information.
• Our research indicates that there has been considerable research done on the impact of menstrual cycle and heavy menstrual bleeding (HMB) on the performance of female athletes. To present a list of such research papers and how the menstrual cycle affects the performance of female athletes, we will require additional hours of research.
• Details on our recommended research paths have been provided in our proposals below. Please select one or more of these proposals for further research on this subject.