Prevalence and frequency of menstrual cycle symptoms in exercising females and their perceived impact on exercise performance : a thesis presented in partial fulfilment of the requirements for the degree of Master of Health Science in Sport and Exercise, Massey University, Albany, New Zealand

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Background: Menstrual cycle symptoms (MCS), experienced by up to 93% of females, can negatively impact quality of life. Yet research investigating the impact of these symptoms on exercise/sport performance is still in its infancy and is largely focused on the elite athletic population. Furthermore, many studies do not account for the fact that 43% - 57% of females do not have a natural menstrual cycle (MC) and are using hormonal contraception (HC). Further investigation is needed to examine the impact of the potential perceived negative effects associated with MCS and HC use on physical performance in exercising females. Objectives: Identify and compare the prevalence and frequency of MCS in naturally menstruating (NM) females and females using HC. Identify and compare the perceived impact of MCS or HC side effects on exercise/sport performance and participation in NM females and females using HC. Methods: Two hundred exercising females (age 26 ± 6 years) participated in this study. Participants completed an online questionnaire which was an amalgamation of four independent validated surveys, including, the International Physical Activity Questionnaire – short form (IPAQ) to assess physical activity levels, the Reproductive Status Questionnaire for Menstrual Cycle Studies to assess MC status, the STRAVA x FitrWomen Survey to evaluate prevalence and frequency of MCS and their effect on exercise/sport participation, and the Exercise and Menstruation in Australia Questionnaire to assess perceived impact on exercise/sport performance. After data cleaning to remove incomplete responses, 182 participants were included in the final analysis. For each participant, total number, and frequency of MCS were added based on a Likert scale to receive a menstrual cycle index (MSi) score. Correlations between MSi and likelihood of missing exercise sessions and likelihood of reporting positive, neutral, or negative training outcomes were assessed. Results: Participants were 54.4% NM and 45.6% HC users, with the oral contraceptive pill (OCP) being the most used (23.6%) form of HC. The most prevalent MCS for both groups were, changes in mood/increased irritability, bloating/increased gas, stomach cramps, cravings/increased appetite, and increased tiredness/fatigue. MSi score did not differ significantly between NM females and HC users (p = 0.435). MSi score was weak - moderately correlated to and increased likelihood of missing training in both NM females (p < 0.001) to report negative training outcomes than HC users. Whereas HC users were more likely (P < 0.001) to report no changes to their training performance. Conclusion: Results from this study demonstrate that MCS are very common in exercising females, with no difference in prevalence or frequency between NM females and HC users. The large prevalence of MCS and associations to negative training outcomes and missing training sessions would suggest greater education and awareness on managing and reducing the risk of MCS is imperative to improve the wellbeing and exercise performance of females.