Implementing menstrual cycle tracking: A pilot concept mapping study investigating considerations of coaches, support staff, and female athletes.

OBJECTIVES: To identify what coaches, support staff, and athletes believe should be considered when implementing menstrual cycle tracking in sport. DESIGN: Concept mapping (mixed-methods participatory approach). METHODS: Participants brainstormed statements in response to the focus prompt "What should be considered when tracking menstrual cycles in sport?" Participants then sorted the statements into groups according to meaning and rated each statement on its importance and feasibility to address. RESULTS: Twenty-six participants (12 athletes and 14 coaches/support staff) generated 53 ideas that the research team synthesised to 57 unique statements. Sixteen participants sorted the statements into an average of 8 (±4) groups. Six clusters were identified as the most appropriate representation of the sorting data following multidimensional scaling and hierarchical cluster analysis: 1) Ethics, 2) Tracking Tools and Methods, 3) Performance and Health, 4) Education, 5) Interpretation and Framing and 6) Communication. Participants rated each statement based on their importance (n = 12) and feasibility (n = 10), respectively. The most important (mean = 3.88 out of 5) and feasible (mean = 3.85 out of 5) cluster was Ethics, whilst the least important (mean = 3.17) and feasible (mean = 3.04) was Communication. CONCLUSIONS: Ethical considerations pertaining to privacy, consent, and scope of practice should be prioritised when tracking menstrual cycles in sport. A low burden method of tracking, which allows for some individualisation based on athletes' preferences or needs, and menstrual health education should also be undertaken to improve the uptake and impact of menstrual cycle tracking.

Exploring the physiological factors relating to energy balance in women with polycystic ovary syndrome: a scoping review.

Polycystic ovary syndrome (PCOS) occurs in 8%-13% of reproductive-aged women and is associated with reproductive, metabolic, and psychological dysfunction. Overweight and obesity are prevalent and exacerbate the features of PCOS. The aim of this review is to evaluate the extent of evidence examining the physiological factors affecting energy homeostasis, which may impact weight gain, weight loss, and weight maintenance in PCOS, and identify research gaps and recommendations for future research. Literature searches using MEDLINE, EMBASE, PsycInfo, AMED, CINAHL, and Cochrane Central Register of Controlled Trials were conducted up to June 22, 2022. Abstracts, non-English-language articles, and reviews were excluded. A total of n = 78 (n = 55 energy intake and n = 23 energy expenditure) primary research papers were included. Papers with multiple outcomes of interest were counted as separate studies. Energy-intake studies (n = 89) focussed on assessing food, nutrient, or supplements stimuli and were grouped into the outcomes of gastrointestinal appetite hormones (n = 43), adipokines (n = 34), subjective appetite (n = 9), functional brain imaging (n = 3), and neuropeptides (n = 0). Energy-expenditure studies (n = 29) were grouped into total energy expenditure (n = 1), resting energy expenditure (n = 15), meal-induced thermogenesis (n = 3), nutrient oxidation (n = 5), and metabolic flexibility (n = 5). Across both energy-intake and -expenditure papers, 60% of the studies compared outcome responses in women with PCOS with a control group. Results were inconsistent, with 57% reporting no differences and 43% reporting altered responses in PCOS compared with controls, including blunted appetite hormone responses, metabolic inflexibility, and reduced energy expenditure. The authors identified that there is inconsistent, yet preliminary, evidence of possible altered physiological factors, which may impact energy balance and weight management. Further work is needed to act on the identified clinical and research gaps to support women with PCOS and health professionals in informing and achieving realistic weight-management goals for women with PCOS. Systematic Review Registration: The protocol was prospectively registered on the Open Science Framework on February 16, 2021 (https://osf.io/9jnsm).

A Pilot Study on the Impact of Menstrual Cycle Phase on Elite Australian Football Athletes.

The effect of the menstrual cycle on athlete performance, wellbeing and perceived exertion and fatigue is not well understood. Furthermore, it has not been investigated specifically in Australian Football athletes. This pilot study aimed to explore how naturally menstruating Australian Football athletes may be affected by menstrual cycle phase. The data collected from the routine monitoring of five naturally menstruating athletes (average menstrual cycle length of 28 ± 3 [SD] days) in one team (athlete age range 18-35 years) competing in the Women's Australian Football League during the 2019 season were retrospectively analysed to compare performance (countermovement jump parameters and adductor squeeze pressure), perceived exertion, perceived fatigue and wellbeing (perceived sleep quality, stress and soreness) outcomes between the follicular and luteal phases. Performance, perceived exertion, stress and soreness did not appear to be affected by menstrual cycle phase (p > 0.17). However, perceived fatigue appeared to be significantly greater (p = 0.042) and sleep quality worse (p = 0.005) in the luteal phase. This pilot study suggests further research focusing on the effect of menstrual cycle phase on subjective fatigue and wellbeing is warranted.

The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review.

The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies.