Contraceptive Usage And Associations With Menstrual Cycle Symptom Clusters In An Athletic Population

PURPOSE: Menstrual cycle-related symptoms are commonly reported and have been shown to affect exercise performance. Limited research exists examining how symptoms present, especially between hormonal contraceptive (HC) users and non-users. Therefore, our aim was to establish menstrual cycle-related symptom clustering in an exercising population of women and compare symptom clusters between HC users & non-users METHODS: An electronic cross-sectional survey about contraceptive use and menstrual cycle symptoms localized to 7 countries was sent to women aged ≥18 years who were members of the STRAVA™ exercise tracking App database. Chi-squared tests and logistic regression models were used to investigate associations between the outcomes of interest. Principal component analysis with varimax rotation was performed to identify menstrual cycle symptom clusters. RESULTS: 7,766 women were included in the final analytic sample. 3,110 (40.1%) reported using some form of hormonal contraceptive with type of contraceptive varying by age (p < 0.001) and country (p < 0.001). The most common reason for contraceptive use was avoidance of pregnancy (81.8%), followed by to control/regulate cycles (37.9%). 6,454 (83.1%) reported not remembering or never having received information about the relationship between the menstrual cycle and sports. Three unique menstrual cycle symptom clusters were retained with eigenvalues >1, and hormonal contraceptive use was associated with lower frequency of all three clusters compared to non-users. The first cluster consisted of disrupted sleep, poor concentration, trouble breathing, and temperature fluctuations. Cluster 2 presented as cramps, headaches, back pain, nausea, and diarrhea and cluster 3 comprised of water retention, bloating, cravings, and breast tenderness. Oral contraceptive pill (combined & progesterone only pill) use was associated with lower frequency of all three clusters, hormonal IUD use was associated with lower frequency of clusters 1 and 2, and non-hormonal IUD use was associated with lower frequency of cluster 2 only. CONCLUSIONS: Contraceptive usage trends are important to consider among women participating in sport as menstrual cycle-related symptom clusters are influenced by contraceptive type and use vs non-use.