Menstrual Cycle

“The Effect of Physical Activity on Symptoms Associated With Premenstrual Syndrome: A Critically Appraised Topic” (Harris et al, 2024) S-218. Three RCTs on women with premenstrual syndrome and premenstrual dysphoric disorder found that physical activity (swimming, aerobic workouts, yoga) significantly reduced emotional, physical, and behavioral symptoms. This evidence suggests physical activity is an effective, non-pharmacological treatment for moderate to severe premenstrual symptoms. 

  

“Menstrual Cycle Symptoms Among Female Distance Runners” (Golden & Hertel, 2023) S-31. A survey of female distance runners (ages 18-40) found that menstrual cycle (MC) symptoms often interfere with training and competition. Over a third modified training due to symptoms. The most reported symptoms affecting training/competition were cramps, fatigue, and feeling weak, suggesting a need for better support.

  

“Characterization of Risk Classification Using the Relative Energy Deficiency in Sport Clinical Assessment Tool” (Uriegas et al, 2022) S-218. This study used the RED-S Clinical Assessment Tool (CAT) on 125 female collegiate athletes and dancers and found that the majority were at risk for relative energy deficiency in sport. Specifically, 13.6% were classified as "Red-Light" (requiring a full stop to training/competition), and 74.4% were "Yellow-Light" (conditional play with a treatment plan). This research highlights the utility of the RED-S CAT for clinicians to identify risk and implement appropriate return-to-play strategies.

“Adolescent Female Athletes With Menstrual Dysfunction Report Worse Sleep and Stress Than Those Without Menstrual Dysfunction” Meyers et al, 2025. There was a higher-than-expected prevalence of MI in adolescent flag football athletes and links MI to significantly worse perceived sleep quality and more stress during the season. However, no differences were found in weekly ratings of energy or mood between athletes with and without MI. The findings emphasize that ATs should monitor MI due to its association with key well-being factors like stress and sleep.

  

“Gait Biomechanics Among Female Endurance Runners: Comparing Days With Or Without Menstrual Cycle-Related Symptoms” Golden et al, 2025. This study of female endurance runners found no differences in running gait biomechanics on days when athletes reported menstrual-related symptoms versus asymptomatic days, with average run speed remaining nearly identical between groups. Despite every person reporting at least one symptom, the results suggest that menstrual symptoms may not directly impair objective running performance. The high prevalence of symptoms highlights the need for better education for athletes and support staff to combat the lack of knowledge and the prevailing taboo surrounding the menstrual cycle in sport.

  

  

“Improving Menstrual Health Literacy in Sport” McGawley et al, 2023. Menstrual health literacy (MHL) is often low among female athletes, coaches, and practitioners, primarily due to a lack of sport-specific knowledge and poor communication about how the menstrual cycle and hormonal contraceptives affect training, performance, and health. Practitioners, including ATs, may lack clear guidance on their role in providing this support, and athletes often prefer to consult with medical doctors, who themselves may provide conflicting or generic advice. To address this, the paper recommends using a six-step intervention mapping approach to systematically design, implement, and evaluate evidence-based education and support strategies to improve MHL and communication among all stakeholders in sport.    

Collectively, these findings emphasize that athletic trainers should normalize menstrual-cycle conversations, screen routinely for MI and RED-S, and collaborate with nutrition and mental-health professionals to ensure comprehensive athlete care. 

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