Context

The often complex interactions between menstrual symptoms, training demands, menstrual irregularity, and other people’s views of menstruation can have an impact on athletes’ mental health and wellbeing.

Psychological impacts of the menstrual cycle can occur in those who have functional menstruation, use hormonal contraception, and experience menstrual dysfunction. It’s important to understand how the brain and body interact, and the role of environmental factors to help navigate the interactions between yourself and your sport environment in a way that supports your mental health and wellbeing.

Premenstrual syndromes and disorders

A lot of menstruation research focuses on the physical symptoms of menstruation, such as stomach cramps, but there is also a lot going on for your brain throughout the menstrual cycle. 

Pre-menstrual syndrome (PMS)

PMS is a common form of menstrual disorder experienced by women globally, with an estimated 30-40% prevalence rate in the reproductive female population.

It involves a combination of psychological and somatic symptoms that occur in the late luteal phase prior to menstruation, impact daily functioning, and disappear after menstruation.

PMS can often have a significant impact on women’s academic or professional performance, social life, quality of life and negatively impact their mood.

Pre-menstrual dysphoric disorder (PMDD)

While definitions of PMS focus on impairment and a wide range of physical, behavioural, and psychological symptoms, PMDD is a clinical disorder that requires experiences of at least 5 symptoms across a range of symptom categories.

PMDD can have a significant psychological impact, for example, through experiences of affective lability (very strong and fluctuating moods), depressed mood, feelings of overwhelm and a loss of control, and anxiety.

The menstruation-mental illness interaction

For athletes who experience mental ill health, either diagnosed or not, the menstrual cycle can influence the severity and expression of mental disorder symptoms. For example, research suggests that some symptoms of mental illnesses such as anxiety, depression, and OCD can become worse during the pre-menstrual phase of the menstrual cycle.

If you experience a form of mental ill health, it is a good idea to be mindful of this to find out if your symptoms change throughout the cycle and recognise you may need to put that little bit more effort into managing these symptoms in and around your training and everyday life. 

Hormonal contraception and mental health.

Using hormonal contraception can often put athletes at ease and bring a sense of control, consistency, and reassurance that positively impacts their mental health and wellbeing. However, while many HC symptoms that are talked about are physical, it’s important to recognise the impact HC use can have psychologically.

Around 43% of HC users can experience mood changes from this use, which often aren’t discussed by medical professionals before being prescribed HC. This mood impact is sometimes particularly salient for those who already experience mental health issues. Every woman’s experience of HCs will be different, some people experience on side effects at all!

However, if you think you’re experiencing psychological side effects of certain types of HC, speak to someone you feel comfortable with, and your GP to help find a solution that suits you the best. 

RED-S and mental health

Mental health issues can be contributors to the development of and/or side effects of RED-S. Disordered eating, a drive for thinness and body dysmorphia, exacerbated by social media, societal pressures, sport staff, and beliefs that a specific weight or physique will improve performance, can lead to behaviours such as undereating and overtraining that ultimately result in RED-S.

Athletes with low energy availability or RED-S will often experience mood disturbances, reduced sleep quality, depressive symptoms, reduced wellbeing, and affective disorders, as a result of undertraining and overeating. 

The sport environment and societal influence

External factors in the sport environment and wider society can have an impact on women’s health and wellbeing in those with natural cycles, HC-dictated cycles, and menstrual dysfunction. For example, menstrual stigma and stereotypes present within society can often lead to the normalisation of women’s difficult menstrual experiences, which can act as a barrier to menstrual conversations and accessing appropriate menstrual support. These occurrences can lead to psychological stress, anxiety, fears of leaking, and mental fatigue. 

Actionable steps

• If you are concerned that you are experiencing mental health issues or negative impacts on your wellbeing, related to menstruation or not, then talk to someone you trust, and your sport psychologist or GP.
  
  
• If you feel you’re experiencing psychological menstrual disorders such as PMDD then speak to a GP.
  
• If you’re experiencing psychological side effects of your type of hormonal contraception that you are unhappy with, discuss these with your GP.
  
  
• Sport environments can be difficult to navigate, particularly in terms of menstruation.
  
  
• Creating a safe environment where you feel supported and heard is important...
  
  If this is difficult in your sport environment, try creating a support network with fellow teammates and support staff who you trust and feel comfortable with to help create a safe space where you can discuss your experiences and support each other.
  
  If you think your sport environment would benefit from learning more about menstruation and creating a more open culture, showing coaches and staff this information can be a good starting point to start a conversation.

Take Home Points

• The menstrual cycle can have impacts on women’s mental health and wellbeing.
  
  
• There are specific psychological syndromes and disorders women may experience related to menstruation, as well as menstrual exacerbations of already-established mental health issues.
  
  
• Hormonal contraception can have psychological side effects, which you can discuss with your GP.
  
  
• Mental health issues can contribute to the development of undereating, overtraining, and subsequent amenorrhea.
  
  
• RED-S can have psychological side effects, such as increased depressive symptoms.

To create this content, The Athlete Place has teamed up with...

Emma Quinn

BSc, MSc, PhD (ongoing)

Hello! My name is Emma, and I’m a doctoral researcher in menstruation.

Following my experiences of battling difficult menstruation and the performance expectations of competitive sport, I developed an interest in the topic of menstruation in sport. During my BSc and MSc in sport psychology I researched athletes’ experiences of menstruating in the culture of elite sport, and IDT practitioners’ experiences of menstrual support provision.

Alongside my PhD that focuses on menstruation, mental health, and stigma, I work with support staff and athletes to improve awareness and understanding of the menstrual cycle and develop discussions about menstrual support in sport.

If you’ve had difficult experiences with menstruation in sports, want to learn more, or have any questions, please reach out, and we can start a conversation.

Chat with Emma

Evidence-Based Research

• Ajari, E. E. (2022). Connecting the Dots Between Mental and Menstrual Health: An Exploratory Review. Journal of Health Reports and Technology, 8(1). https://doi.org/10.5812/jhrt.114869 (View Paper)
  
  
• Carlini, S. V., Lanza di Scalea, T., McNally, S. T., Lester, J., & Deligiannidis, K. M. (2022). Management of premenstrual dysphoric disorder: A scoping review. International Journal of Women’s Health, Volume 14, 1783–1801. https://doi.org/10.2147/ijwh.s297062 (View Paper)
  
  
• Martell, S., Marini, C., Kondas, C. A., & Deutch, A. B. (2023). Psychological side effects of hormonal contraception: a disconnect between patients and providers. Contraception and Reproductive Medicine, 8(1). https://doi.org/10.1186/s40834-022-00204-w (View Paper)
  
  
• Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073–1097. https://doi.org/10.1136/bjsports-2023-106994 (View Paper)