Does a menstrual state and hormonal contraception use determine exercise participation? A study of 8060 exercising women

Background: Menstrual states and hormonal contraceptive (HC) use may affect athletic training and performance. Prevalence of different menstrual states, menstrual dysfunctions (MD) and HC use is not well established in the exercising population. This study aims to describe this, as well as identify the impact that menstrual states may have on training and performance. Methods: 8,060 pre-menopausal women, aged 18 or over, from 6 territories were recruited through STRAVA(TM) exercise app. An online survey was completed to understand current menstrual states, hormonal contraceptive use, current exercise volume and perceived influence of the menstrual cycle on training and competition. Results: The most prevalent menstrual state was eumenorrhea (42.1%) and HC was used in 39.7% of participants. The occurrence of oligomenorrhea (14.5%), non-hormonal IUD (NonH IUD) (6.0%), amenorrhea (4.4%) and polymenorrhea (1.1%) was comparatively lower. HC users were significantly less likely to miss/change training compared with eumenorrhea (P<0.001) or polymenorrhea (P=0.035) cycles. HC users were significantly less likely to miss a race/event/competition than those with a eumenorrheic cycle (P<0.001) or amenorrhea (P=0.021). Those with polymenorrhea were significantly more likely to miss a race/event/competition than those with a eumenorrheic cycle (P=0.032,), oligomenorrhea (P<0.001), HC users (P<0.001) or NonH IUD users (P=0.017). Ovarian cysts (11.3%) and polycystic ovarian syndrome (7.9%) were the most reported forms of MD. Conclusions: Most participants were eumenorrheic or using hormonal contraception. Having polymenorrhoea or amenorrhoea was associated with an increased likelihood of negative outcomes on exercise participation. Those using HC were less likely to miss/change training.