Abstract
The menstrual cycle (MC), which is often seen through a lens of limitation, has not consistently shown an effect on measurable performance, challenging longstanding assumptions. However, female athletes perceive their MC and hormonal contraceptive (HC) use to affect the way they feel and train. In part, this dichotomy arises due to a diversity of symptoms associated with the menstrual cycle and hormonal contraceptive use (menstrual cycle-related symptoms; MCS), such as painful menstruation or bleeding (dysmenorrhoea), fatigue, fluctuations in mood, changes in appetite and cravings. Thus, while measured performance remains stable across the cycle, the experience of athletes does not, warranting more research into symptom experiences and management. Until recently, most studies relied on surveys and semi-qualitative methods that documented MCS prevalence, largely missing a deeper understanding of the lived experiences of female athletes. Nevertheless, findings have highlighted active females are affected by symptoms in nuanced ways, urging for a change in perspective where these symptoms are viewed as more than a minor inconvenience.Considering fast-growing interest in the realm of MCS in active females, this thesis endeavoured to firstly synthesise the MCS experiences and perceptions in diverse active female groups. Using a systematic review and meta-aggregation approach, findings from 17 qualitative studies were integrated, revealing a series of interconnected barriers that hinder individuals’ ability to manage MCS effectively. Furthermore, findings underscored the urgent need for comprehensive solutions within sports settings including efforts to initiate more meaningful menstrual-related conversations. Secondly, this thesis sought to focus on female athletes from various sport backgrounds to understand how they were impacted by and managed MCS, and their perspectives on how they wanted these symptoms addressed in sporting contexts. A qualitative study investigated the perspective of 30 female athletes from 17 sports using reflexive thematic analysis under a constructivist paradigm approach. The main findings from this study highlighted a significant impact from MCS on female athletes including changes in how they felt and trained, uncertainties around the effectiveness of management strategies, a desire for non-pharmacological management options and for more MC conversations to take place, yet reticence.
Despite the prominent impact of MCS on female athletes, understanding of their causes and management remains limited. Inflammation, particularly around bleeding, may play a key role in MCS occurrence and severity, and diet, especially plant-derived polyphenols found in cocoa and cocoa-rich foods like dark chocolate, have potential to modulate immune responses. Chocolate cravings are common during menstruation, yet often provoke mixed feelings, especially in athletes concerned with health and body image. This tension raises questions about chocolate’s role in MCS management.
Nevertheless, given its appeal, dark chocolate may offer a practical, athlete-aligned intervention. Hence, the final study in this thesis was a randomised controlled trial (RCT) evaluating the effects of 70% vs 25% cocoa chocolate on MCS, brain fog and systemic inflammation in female athletes. While no statistically significant reductions in MCS, brain fog or inflammation were found, chocolate was well tolerated, feasible, and associated with individual perceptions of comfort and modest symptom improvement. These findings highlight the potential of athlete-led, diet-based strategies for MCS management.
Together, the findings of this thesis advance understanding of the MC and HC use experience in female athletes, moving beyond performance outcomes to highlight the complexity of navigating MCS. By integrating qualitative insights and testing a novel preference-aligned dietary intervention, this work underscores the need for athlete-informed, practical approaches to MCS management, opening avenues for future research and improved support within sport environments (Figure 1).
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Michelle Minehan (Supervisor) & Andrew MCKUNE (Supervisor) |