Menstrual-related conditions are associated with optimal menstrual cycle timing for sports performance in female athletes

Abstract

Although the effects of menstrual cycle phases on objective exercise performance are generally trivial, athletes frequently report substantial subjective impairment. We examined 14-year temporal trends in menstrual-related conditions in elite Japanese athletes and tested whether perceived optimal menstrual cycle timing for sports performance is explained by menstrual-related conditions. We analyzed 9,130 records from 3,693 female athletes (2008–2021) derived from a standardized retrospective questionnaire, excluding records indicating the use of hormonal preparations (e.g., combined oral contraceptives or progestin preparations). Temporal trends in menstrual-related conditions (dysmenorrhea, premenstrual syndrome (PMS), heavy menstrual bleeding (HMB)) were assessed using multivariate logistic regression. We also evaluated associations between the number and type of menstrual-related conditions and the self-reported optimal menstrual cycle timing for sports performance. From 2008 to 2021, the prevalence of dysmenorrhea (AOR: 1.040, p < 0.001) increased, and PMS (AOR: 0.934, p < 0.001) decreased. The self-reported optimal menstrual cycle timing for sports performance was strongly influenced by menstrual-related conditions: athletes with three conditions predominantly reported “Post-Menstruation” (68.4%), whereas those with no conditions most frequently reported “No Relation” (51.1%). A clear dose–response pattern was observed; having three conditions increased the odds of reporting “Post-Menstruation” by 3.54-fold versus no conditions (p < 0.001). In models including all three conditions, PMS was the strongest predictor of reporting “Post-Menstruation” (AOR: 2.53), exceeding HMB (AOR: 1.51) and dysmenorrhea (AOR: 1.15). Athletes’ perceived optimal timing of the menstrual cycle for sports performance is strongly influenced by menstrual-related conditions—particularly PMS. • Perceived optimal menstrual cycle timing for sports performance in elite female athletes was strongly associated with menstrual-related conditions, showing a clear dose–response relationship; athletes with three conditions were 3.54 times more likely to report “Post-Menstruation” as their optimal timing than those with no conditions. • Premenstrual syndrome (PMS) was the strongest predictor of perceived optimal menstrual cycle timing for sports performance, exerting a greater subjective impact than dysmenorrhea or heavy menstrual bleeding (HMB).