Methodological guidelines on how to perform studies in sport and exercise science with women as participants can result in demanding, high-cost research projects, both for researchers and female athletes. Although the use of gold-standard methodology results in high-quality research, the possible exclusion of, for example, female athletes with menstrual disturbances and hormonal contraceptive use limits the external validity of the results obtained and thereby the generalizability of results for the female athletic population. Methods for menstrual cycle or hormonal contraceptive cycle tracking may be a useful tool in research and to assist in monitoring athlete health, but its application must be appropriate for the population or research questions it is used for. While traditionally lab-based research is used to inform applied practice, the converse of this should be considered where real-world issues should be used to inform research questions. The tracking of female health can provide useful contextual understanding when monitored alongside other data inputs e.g. resting heart rate and readiness. However, this needs to be done with intention, appreciating the individual nature of each athlete’s cycle. The session targets individuals working with female athletes in the laboratory, field, and clinical settings. Our aim is to facilitate discussion regarding menstrual and hormonal contraceptive cycle tracking.
ECSS Paris 2023: IS-AP01
The female ovarian hormones, estrogen and progesterone, fluctuate throughout a 21-35 cycle and result in four distinct hormonal environments i.e., menstrual cycle phases. Since, the ovarian hormones exert an effect on more than just production, there is recently great interest in studying the effect of menstrual cycle phase on training, recovery and performance. Recent methodological guidelines on how to perform studies in sport and exercise science with women as participants recommend the use of the so called “three-step method” when investigating the effect of menstrual cycle phase on training, recovery and/or performance in non-hormonal contraceptive users (1,2). The three-step method consists of calendar-based counting (i.e., reporting the first day of menses in a diary), daily urinary ovulation testing starting at day 8, and a mid-luteal venous blood sample (3). When recruiting participants for such studies, only regularly menstruating women i.e., having menstrual cycles lasting ≥ 21 and ≤ 35 days in the two months prior to recruitment, resulting in ≥9 menstrual cycles per, and not having used hormonal contraceptives in the three months prior to recruitment, can volunteer (1,2). Subsequently the three-step method is used to determine and verify the menstrual cycle phases in which participants are tested. A posteriori, data of menstrual cycles that are not considered eumenorrheic i.e., menstrual cycles <21 or >35 days, anovulatory cycles (no positive urinary ovulation test before the next menses), and/or a mid-luteal (7-9 days after a positive urinary ovulation test) progesterone level <16 nmol٠L-1, need to be excluded from analysis (1). As these disturbed menstrual cycles do not show the expected hormonal fluctuations, failure to exclude these cycles could mask potential changes in training, recovery and/or performance over the menstrual cycle. Finally, the exercise tests performed should be repeated over two menstrual cycles for the study to be classified as following “gold standard methodological control” (2). This presentation will highlight the benefits of using such a demanding and rigorous approach and experiences obtained when performing studies following these guidelines. Consequently, this presentation will be relevant for all researchers and sport practitioners considering starting projects in which they will investigate the effect of menstrual cycle phase on training, recovery and/or performance. 1 Elliott-Sale et al. Sports Med 2021; 51(5):843-861. 2 Smith et al. Int J Sport Nutr Exerc Metab 2022; 32(2):114-127. 3 Schaumberg et al. J Sci Med Sport 2017; 20(11):965-969.
Read CV Dionne NoordhofECSS Paris 2023: IS-AP01
The popularity and interest in female sport has grown exponentially over the last few years. With this, the professionalism of female athletes and associated sporting environments has increased. Female athletes are pushing boundaries and breaking barriers all the time, however best practice for optimal training and support is still relatively in its infancy. The increasing evidence base highlighting the self-perceived impact of the menstrual cycle on exercise performance emphasizes the need for menstrual health screening and longitudinal tracking. However, with limited and potentially challenging guidelines, many practitioners are unsure how a proactive female athlete health monitoring approach can be implemented without ‘opening a can of worms’. Little longitudinal research has been conducted in applied settings, and the application of research pertaining to female health from lab-based studies can be challenging. Typically, only a couple of hormonal time points are studied, which do not reflect the known day-to-day hormonal changes through a menstrual cycle, the implications of menstrual dysfunction, or the effects of hormonal contraception use. Given that athletes need to be able to perform on any day of their cycle this must be considered in future research. However, gold standard testing methodologies are extremely challenging to implement in applied settings, but this must not deter, and ideally research can be conducted alongside tracking. The effects that hormonal changes can have on other physiological systems and homeostatic processes are well established. Therefore, collecting and tracking female health data can provide useful contextual understanding, while also indicating any potential need for medical input. As women’s sport is becoming more professional with more data analysis and given the self-reported data on the potential performance detriments that the menstrual cycle can have, tracking female health markers is an important consideration. Opportunistic ‘real world’ research should also be considered as this could provide a good way to bridge the overt gap between research and practice. This presentation will discuss an approach to tracking and monitoring female athletes in an applied setting, discussing how ‘on the ground’ monitoring can be used as a tool for practitioners and how research can be conducted in conjunction.
Read CV Georgie BruinverlsECSS Paris 2023: IS-AP01
The female athlete population includes several unique hormonal profiles (1). Some athletes are naturally menstruating, others use combined or progestin-only hormonal contraceptives, still others have menstrual disturbances ranging from sub-clinical to clinical and which may or may not be caused by low energy availability or the multistressor environment of elite sport. Where the three-step or two-step methods for identifying menstrual cycle phases or characterizing the hormonal profiles of naturally menstruating females are important for research striving to identify the influence of sex hormone concentrations and ratios on specific mechanisms or characteristics of sports performance (2,3), it is important to recognize that these methods are not appropriate for females that are not naturally menstruating. Furthermore, these laboratory methods are not easily applied to practice and are not necessarily feasible. As a universal blueprint for training according to a natural menstrual cycle phase does not exist, the need for menstrual cycle tracking for purposes beyond menstrual (and thereby physical) health are questionable. Nevertheless, monitoring the menstrual cycle (including ovulation) and hormonal contraceptive cycles and identification of patterns in symptoms or performance that may be related to changes in hormonal concentrations may be useful for athletes, coaches, and support staff like physicians as well as researchers. In practice, menstrual and hormonal contraceptive cycle monitoring are helpful for avoiding/identifying menstrual dysfunction and decreased health and performance that are often linked to low energy availability and relative energy deficiency in sport (4). In addition, menstrual and hormonal contraceptive cycle monitoring may allow us to modify approaches to training and/or nutrition if consistent negative patterns in subjective feelings around training or within performance emerge. Communication and collaboration are needed between science and practice to better inform research and practice. In addition, communication and collaboration with clinicians regarding ´the relationship between menstrual health and health and performance is important to best serve our female athletes and improve their (and clinician) body literacy. This presentation will highlight the variety in hormonal profiles that may be observed in the female athlete population and will present practical reasons for cycle tracking and reporting of / considering hormonal profiles in both research and practice including considerations for female athletes without natural/eumenorrheic cycles. 1 Colenso-Semple et al. Front Sports Act Living 2023; 5: 1054542. 2 Elliott-Sale et al. Sports Med 2021; 51(5):843-861. 3 Janse DE Jonge et al. Med Sci Sports Excer 2019; 51(12):2610-2617 4 Mountjoy et al. Br J Sports Med 2023;57(17):1073-97.
Read CV Ritva MikkonenECSS Paris 2023: IS-AP01