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Prevalence and frequency of menstrual cycle symptoms are associated with availability to train and compete: a study of 6812 exercising women recruited using the Strava exercise app
  1. Georgie Bruinvels1,2,
  2. Esther Goldsmith2,
  3. Richard Blagrove3,
  4. Andrew Simpkin4,5,
  5. Nathan Lewis1,2,
  6. Katie Morton2,
  7. Ara Suppiah6,
  8. John P Rogers7,8,
  9. Kathryn E Ackerman9,
  10. John Newell4,5,
  11. Charles Pedlar1,2,10
  1. 1 Faculty of Sport, Health and Applied Science, St Mary's University Twickenham, Twickenham, London, UK
  2. 2 Orreco, Galway, Ireland
  3. 3 School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  4. 4 School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
  5. 5 Insight Centre for Data Analytics, National University of Ireland, Galway, Ireland
  6. 6 University of Central Florida, Orlando, Florida, USA
  7. 7 Sports Medicine, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
  8. 8 Manchester Institute of High Performance, Manchester, UK
  9. 9 Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  10. 10 Institute of Sport, Exercise and Health, UCL, London, UK
  1. Correspondence to Dr Georgie Bruinvels, Faculty of Sport, Health and Applied Science, St Mary's University Twickenham, Twickenham, London, UK; georgie.bruinvels{at}


Objectives The menstrual cycle can affect sports participation and exercise performance. There are very few data on specific menstrual cycle symptoms (symptoms during various phases of the cycle, not only during menstruation) experienced by exercising women. We aimed to characterise the most common symptoms, as well as the number and frequency of symptoms, and evaluate whether menstrual cycle symptoms are associated with sporting outcomes.

Methods 6812 adult women of reproductive age (mean age: 38.3 (8.7) years) who were not using combined hormonal contraception were recruited via the Strava exercise app user database and completed a 39-part survey. Respondents were from seven geographical areas, and the questions were translated and localised to each region (Brazil, n=892; France, n=1355; Germany, n=839; Spain, n=834; UK and Ireland, n=1350; and USA, n=1542). The survey captured exercise behaviours, current menstrual status, presence and frequency of menstrual cycle symptoms, medication use for symptoms, perceived effects of the menstrual cycle on exercise and work behaviours, and history of hormonal contraception use. We propose a novel Menstrual Symptom index (MSi) based on the presence and frequency of 18 commonly reported symptoms (range 0–54, where 54 would correspond to all 18 symptoms each occurring very frequently).

Results The most prevalent menstrual cycle symptoms were mood changes/anxiety (90.6%), tiredness/fatigue (86.2%), stomach cramps (84.2%) and breast pain/tenderness (83.1%). After controlling for body mass index, training volume and age, the MSi was associated with a greater likelihood of missing or changing training (OR=1.09 (CI 1.08 to 1.10); p≤0.05), missing a sporting event/competition (OR=1.07 (CI 1.06 to 1.08); p≤0.05), absenteeism from work/academia (OR=1.08 (CI 1.07 to 1.09); p≤0.05) and use of pain medication (OR=1.09 (CI 1.08 to 1.09); p≤0.05).

Conclusion Menstrual cycle symptoms are very common in exercising women, and women report that these symptoms compromise their exercise participation and work capacity. The MSi needs to be formally validated (psychometrics); at present, it provides an easy way to quantify the frequency of menstrual cycle symptoms.

  • female
  • exercise physiology
  • sports and exercise medicine
  • women in sport

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  • Twitter @gbruinvels, @EGoldsmithPhys, @rich_blagrove, @drkateackerman

  • Contributors GB, CP, KM and EG contributed to the design of the study. GB, AnS and JN contributed to the statistical analysis of data. GB, CP, KM, EG, AnS, JN, KEA, NL, RB, JPR, KM and ArS all contributed to the interpretation of the results and the writing of the manuscript.

  • Funding A small grant was received from Strava to conduct the survey.

  • Competing interests GB, EG, NL, KM, ArS and CP are employees or consultants for Orreco, creators of the FitrWoman app.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Ethics Committee of St Mary’s University (SMEC_2018-19_011), Twickenham, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available on request from the corresponding author (GB;