Role of the menstrual cycle on performance and injury risk: a survey of female professional rugby players in the United Kingdom

Background: Female athletic performance and injury risk is impacted by variations in the menstrual cycle (MC), but the understanding of the impacts and mechanisms influenced by the menstrual cycle on exercise performance are not fully delineated. Aims and Objectives: Evaluate associations between the menstrual cycle, perceived performance, and injury risk of elite female rugby players using an online survey. Methods: An anonymous online questionnaire was completed by 150 elite female rugby players from two English rugby leagues, the Betfred Women’s Super League (BWSL) and the Allianz Premier 15s (AP15s). The collected data were analysed thematically. Results: The Chi-square test was used to assess associations between age groups and contraception usage, weight change, and training and playing performance; none of the associations were statistically significant (all p values > 0.05). Thematic analysis of 11,660 words of data revealed four themes: (a) MC impact on training and competition, (b) education and period management plans, (c) openness of conversations and comfort taking time off, and (d) injury risk. The impacted performance areas were physical (83.7%), psychological (85.7%), and nutritional (80.3%); players experienced decreased appetite, nausea, fatigue, strength declines, heighted emotions, and worsened focus. In total, 87.8% of athletes perceived the MC to negatively impact performance, 85.7% of players desired to be educated further to prevent injuries, improve nutrition, and training adaptions, 51.7% of participants perceived risk of injury to be higher during MC, and 86.4% of participants did not feel comfortable taking time off due to the MC, worrying that selection would be affected and about opinions from others. Conclusion: A clear negative impact on perceived performance and injury risk was reported by survey participants. The interaction of physical, psychological, and nutritional factors, and a lack of awareness and education emphasise the need for further comprehensive studies and interventions, with measures such as MC monitoring and profiling, education, and training adaptions to develop openness, knowledge, and understanding.