Hormonal contraceptive use prevalence and its association with menstrual cycle symptom clusters among exercising women in 7 different countries

Objectives: We aimed to identify factors associated with the prevalence of contraceptive use in exercising women, including reason for usage and receipt of information about the relationship between menstruation and sports, and menstrual cycle symptom clusters in hormonal contraceptive (HC) users and non-users. Design: A survey about contraceptive use and menstrual cycle symptoms was sent to women via the STRAVA™ App. Methods: Associations between country, age, training intensity, contraceptive use, reason for use, receipt of information about the relationship between the menstrual cycle and sports, were examined. Principal component analysis identified menstrual cycle symptom clusters. Results: Of 7,766 women, 40.1% reported using a hormonal contraceptive, and type varied by age (p<0.001) and by country (p<0.001). The most common reason was avoidance of pregnancy (81.8%), followed by to control/regulate cycles (37.9%). Three symptom clusters were observed with eigenvalues > 1, and hormonal contraceptive use was associated with lower frequency of all three clusters compared to non-users. Among contraceptive users, factor-based scores for Cluster 3 varied significantly by contraceptive type (p=0.008), while Cluster 1 (p=0.144) and Cluster 2 (p=0.611) did not. Conclusion: These findings underscore the importance of providing exercising women with tailored information about hormonal contraception options to support informed decision-making.