PURPOSE: Research describing self-reported negative menstrual cycle (MC) or hormonal contraceptive (HC) symptoms in team-sport athletes has primarily focused on rugby- and football players. Similarly, only studies using multiple sports have compared symptom prevalence between different athletic competition levels, and almost no research has investigated symptom severity. Therefore, this study aimed to compare the frequency and severity of MC/HC symptoms between HC- and non-HC users, and between competition levels (local/regional; national; international) of female team handball players. A secondary aim was to describe the perceived influence of symptoms on training/competition performance, prevalence of tracking/logging symptoms, and the rate and type of HCs used. 

METHODS:136 Norwegian female team handball players completed a cross-sectional survey regarding their current and previous HC use (or lack-thereof), and occurrence and severity of negative MC/HC cycle-related symptoms. Players were also questioned regarding their previous history of HC use, menstrual function (e.g., regularity of menses), perceived influence of cycle-related symptoms on training and sports performance, and if they used pain medication and/or altered their training due to these symptoms. The majority of questions were close-ended, although additional free-text responses were available if necessary. Data were analyzed in R using either cumulative (logit) link, binominal logistic, multinominal, or linear regression depending on the response data type.

RESULTS: Approximately half of the cohort (47%) were currently using HCs, primarily in the form of long-acting reversible contraceptives, with no difference in HC rates between competition levels (p=.073). Regardless of HC use, the majority of all players (83%) noted the occurrence of at least one negative cycle-related symptom during most MC/HC cycles. Non-HC users reported a significantly higher frequency of mood changes and fatigue (p=.014 to .048), and more regular and severe cramping, compared to HC users (p=.001 to .012). Negative symptoms, such as fatigue, were more common (p=.001 to .047) and severe (p=.007 to .014) for players at lower levels (local/regional; national) compared to international level players. Despite 41% of all players perceiving that negative cycle-related symptoms interfered with training quality and athletic performance, only 2% altered their training in response to these symptoms, and only 14% regularly tracked cycle-related data.

CONCLUSION: Negative cycle-related symptoms are common amongst team handball players and are often perceived by the players to adversely influence their athletic performance. Despite this, relatively few players modify their training due to negative symptoms, or track/record menstrual-related data. Adverse cycle symptoms also occur more frequently and severely for non-HC users, and lower-level players, in contrast to HC users and international players, respectively. 

Disclosure(s): This study was funded by the Tromsø Research Foundation, through grants provided to the Female Endurance Athlete (FENDURA) project and the Female Football Research Centre (FFRC).