Hormone cycle-related symptom management in international female athletes: A qualitative study of strategies, constraints, and support needs

Elite athletes experience menstrual and hormonal contraceptive cycle-related symptoms that can negatively affect training, performance and health, yet a significant gap remains regarding how these symptoms are managed within high-performance sport environments. The purpose of this study was to investigate strategies to manage cycle-related symptoms and report related practices adopted by international-level female athletes, and the contextual factors influencing these practices. Nine senior athletes registering at least two severe cycle-related symptoms completed semi-structured interviews. The participants were individual athletes representing eight different countries and six sports. Data were analysed using reflexive thematic analysis within a qualitative descriptive orientation and from this, three overarching themes were generated: (i) Factors influencing individual management; (ii) Sociocultural and environmental factors; (iii) Sport science, medicine and coaching support. Eight of the nine athletes reported tracking cycle characteristics, symptoms or physiological metrics. Individual, sociocultural and environmental factors constrained management strategies, whilst support from coaching and support staff was varied. Experiences differed between athletes and management strategies were often reactive and inconsistent. Moreover, adopted strategies predominantly aimed to alleviate physical rather than psychological symptoms. Athletes frequently described bloating and breast pain as difficult to manage, with few management strategies perceived to be available. In conclusion, cycle tracking was common in this sample of senior international athletes, but symptom management practices were highly individual and support varied. These findings identify a need for applied, sport-specific research on feasible cycle-related symptom management options, and improved application into practice within female athlete care systems that take sociocultural environments and support into consideration.