A systematic review and meta-aggregation of the experiences and perceptions of menstrual and hormonal contraceptive cycle-related symptoms in female athletes

Objectives: Symptoms related to the menstrual cycle impact the participation, perceived performance, and quality of life of the individual. Yet, the way these symptoms are experienced has not been synthesised, missing the opportunity to reconcile our understanding of best avenues for support. Design: This systematic review and meta-aggregation focused on female athletes' experiences and perceptions of cycle-related symptomatology. Methods: Guided by the Preferred Reporting of Systematic and Meta-Analyses protocol, MEDLINE, SPORTDiscus, Scopus, and Web of Science were searched between January 2000 and November 2024. Included qualitative studies focused on female athletes (tiers 2 to 5) and exercisers (tier 1) of reproductive age (13 to 45 years) and reported on their experiences of cycle-related symptoms. Findings were pooled using the Joanna Briggs Institute System for the Unified Management of the Assessment and Review of Information and rated using ConQual. Results: Seventeen original studies were included. The review generated 4 meta-aggregated findings: (1) myriad cycle-related symptoms negatively affected athletes; (2) performance and participation were hindered by cycle-related symptoms; (3) adaptation to and/or concealing cycle-related symptoms helped athletes to continue to train and compete; and (4) frustration with support and communication about cycle-related topics. Conclusions: Overall, a surging number of qualitative studies report cycle-related symptoms affect athletes in numerous ways. Better understanding of ways to manage symptoms and open conversations about how menstrual and hormonal contraceptive cycles are experienced are needed to support sports participation.