Over the past ten years there has been a dramatic rise in female sport participation and accompanying female professional national leagues across multiple sports, yet research has not followed suit. Although there are known variations between female and male physiology, training protocols in female sport are predominantly underpinned by research undertaken in male athletes. The hormonal variability experienced by women across the menstrual cycle, as well as the menstrual cycle variability between women, may contribute to the complexity of conducting rigorous physiological studies, leading to a paucity of robust sports-specific research that can be confidently applied to female athletes. Moreover, barriers exist in female sport that potentially limit the ability to conduct research, including the lack of full-time programs and limited resources. Recently, there has been increased interest in the potential effects of fluctuations in the female sex hormones, progesterone and oestrogen, on sport performance across different phases of the menstrual cycle. However, current research evaluating the menstrual cycle and physical performance (such as strength, speed, aerobic fitness, and athletes’ perception of their performance) have shown inconsistent results. Additionally, methodological design across studies has shown little consistency, making it difficult to draw firm conclusions, which potentially prevents female athletes optimising their physical and sporting performance. It further impacts coaches and sports science researchers in their ability to provide appropriate training recommendations and educational opportunities. It is important to progress in female athlete research with an understanding of how the unique physiology of female athletes may influence their ability to physically perform in their respective sport, which requires representation in sports science research. This paper will provide an overview on current evidence and limitations within menstrual cycle research and provide considerations and directions for future research in this space within team sports.

Despite cross-cultural differences in knowledge and attitudes toward menstruation, most studies on menstruation in women’s sport have been conducted in high-income countries, such as in Europe, and none have been conducted in Africa. The aim of this study was to explore the knowledge, attitudes, and behaviors of African elite women football players, and their support personnel toward the menstrual cycle and menstruation. An anonymous questionnaire was distributed to all participants (n = 564) at two African women football tournaments. Ultimately, 238 women football players, 44 coaches, 18 health personnel, and 17 referees completed it. From 317 questionnaires analyzed, 17%, 27%, 56%, and 0% of players, coaches, health personnel, and referees, respectively, knew at least one menstrual cycle hormone; 91%, 95%, and 100% of players, coaches, and referees, respectively, did not know at least one menstrual cycle phase. Over 70% of health personnel believed that menstruation negatively affects women’s performance in sports compared with 36% of players; 18%, 28%, and 18% of players, health personnel, and referees, respectively, believed that, for convenience, the menstrual cycle should be changed by drugs like contraceptives; and 54%, 61%, 62%, and 40% of players, coaches, health personnel, and referees, respectively, were confident providing advice about the menstrual cycle to teammates. Minimal knowledge of the menstrual cycle has implications on the development of menstrual cycle considerate training environments and educational materials in African women’s football. Furthermore, the relatively low perceived effect of the menstrual cycle on sporting performance and belief in the use of contraceptives may be attributable to differences in community-level religiocultural and social contexts which influence menstrual experiences, and shape behavioral expectations.

Introduction: Musculoskeletal (MSK) injuries and associated pain disorders are one of the leading causes for soldiers not being medically fit for deployment, impacting force capability and readiness. Musculoskeletal pain continues to be a leading cause of disability within military services and is associated with a substantial financial burden. A better understanding of the effectiveness of MSK pain management strategies is required. This review was designed to determine the efficacy of nonsurgical interventions, such as physiotherapy, exercise, pharmacology, and multidisciplinary programs, to manage MSK conditions in active serving military populations. Materials and Methods: MEDLINE, Embase, CINAHL, and SPORTDiscus were searched to identify relevant randomized clinical trials. Recommended methods were used for article identification, selection, and data extraction. The Cochrane Risk of Bias tool and the Grade of Recommendation, Assessment, Development, and Evaluation were used to appraise the studies. Where possible, meta-analyses were performed. The review was conducted according to the PRISMA guidelines. Results: Nineteen articles (1,408 participants) met the eligibility criteria. Low back pain (LBP) was the most frequently investigated condition, followed by knee pain, neck pain, and shoulder pain. Early physiotherapy, exercise and adjunct chiropractic manipulation (for LBP), and multidisciplinary pain programs (physiotherapy, occupational therapy, and psychology) (for chronic MSK pain) improved pain (standardized mean difference ranged from −0.39 to −1.34; low strength of evidence). Participation in multidisciplinary pain programs, adjunct chiropractic manipulation, and early physiotherapy improved disability (for LBP) (standardized mean difference ranged from −0.45 to −0.86; low to very low strength of evidence). No studies evaluated pain medication. Dietary supplements (glucosamine, chondroitin sulfate, and manganese ascorbate), electrotherapy, isolated lumbar muscle exercises, home cervical traction, or training in virtual reality showed no benefit. The studies had a high risk of bias, were typically underpowered, and demonstrated high clinical heterogeneity. Conclusions: Currently available randomized clinical trials do not provide sufficient evidence to guide military organizations or health care professionals in making appropriate treatment decisions to manage MSK pain in active serving military personnel. Future research is essential to enable evidence-based recommendations for the effective management of MSK pain conditions in this unique population.

This study aimed to develop the first valid questionnaire to assess menstrual cycle (MC) and hormonal contraceptive (HC) knowledge in athletes and sports performance support staff. Questions were developed following a literature review and four knowledge domains were identified: (1) Normal MC Function, (2) MC Dysfunction, (3) Oral Contraceptive Pills, and (4) Other HCs. Experts ( n = 6) reviewed the initial questionnaire, followed by pre‐testing with athletes and support staff ( n = 19). Validity (item analysis, construct validity) and reliability (test–retest, internal consistency) were assessed following questionnaire administration to athletes and staff without MC education (“Low Knowledge” [LK] group; n = 156) and “High Knowledge” [HK] participants ( n = 30) with MC education. Most ( n = 122) LK participants completed the questionnaire twice to assess test–retest reliability. Expert review showed good agreement (> 80%) on item clarity and relevancy and pre‐testing indicated good content and face validity. The HK group scored significantly higher than LK participants across the questionnaire (43 ± 5 vs. 28 ± 10; p < 0.001; d = 1.48 [1.05, 1.90]) and all knowledge domains ( p < 0.05). High item discrimination parameters were found for all domains, indicating effective discrimination between respondents with different knowledge levels. Test–retest reliability was excellent (intra‐class correlation coefficient estimates from 0.93 [0.90, 0.95] to 0.98 [0.96, 0.99]), with all domains showing good‐to‐excellent reliability. Internal reliability (Cronbach's alpha) was considered acceptable (0.93 [0.92, 0.95]; α ≥ 0.7). This questionnaire delivers a valid and reliable tool to assess MC and HC knowledge amongst athletes and support staff and is recommended to guide and evaluate educational interventions to improve menstrual health literacy within sport.