Purpose: To describe the self-reported menstrual health, symptomology and perceived effects of the menstrual cycle on performance for professional football (soccer) players in Australia. 

Methods: Elite and professional players from the Australian national football teams (youth and senior) and top-tier domestic league teams were invited to complete an online menstrual cycle questionnaire. The 22-item questionnaire assessed: 1) menstrual health, 2) hormonal contraceptive use, 3) symptomology and 4) perceived disruption of the menstrual cycle to training and performance. Descriptive statistics, including means and standard deviations, frequencies and percentages, were performed. Binomial regressions with Odds Ratios (OR) were used to determine the relationship of menstrual related variables with perceived performance disruption. 

Results: 199 players (20.9 ± 5.1y) completed the questionnaire. For menstrual health, 1 primary amenorrhea case detected, whilst 26% of players reported age of menarche as 15 years or older. For non-hormonal contraceptive users, the prevalence of secondary amenorrhea, oligomenorrhea and heavy menstrual bleeding (HMB) were 2%, 19% and 11%, respectively. Only 18% of players reported using hormonal contraceptives. Nearly all players (97%) reported experiencing physical or affective menstrual-related symptoms (average 5 ± 1.3, range 0-18), with the most prevalent being pelvic pain and mood changes/anxiety. 40% of players reported menstrual-related symptoms impacted their ability to work, study, train or compete. Further, 40% of players perceived their training or performance to be disrupted by the menstrual cycle, primarily whilst menstruating. Increasing number of menstrual-related symptoms (OR = 1.43; 95% CI 1.28-1.62; p<0.001), heavy menstrual bleeding (OR = 12.73; 95% CI 3.4-82.8; p=0.00099) and pelvic pain (OR = 3.40; 95% CI 1.7-7.2; p = 0.00084) increased the likelihood of perceiving the menstrual cycle to disrupt their training and performance. 

Conclusion: The prevalence of menstrual abnormalities (e.g., amenorrhea, oligomenorrhea, HMB) and hormonal contraceptive use amongst elite and professional football players in Australia was low. Nearly all players reported menstrual-related symptoms, and the number of symptoms was associated with a perceived effect on training or match performance. Future research exploring menstrual symptomology and symptom management strategies would help optimise the health and performance of female athletes, particularly in national teams and professional domestic competitions.