THE EFFECTS OF THE MENSTRUAL CYCLE ON BOTH TRAINING & MATCH DAY PHYSICAL PERFORMANCE USING SUBJECTIVE & OBJECTIVE MEASURES

Introduction

The interest in female football over the last 10 years has increased (Tremback-Ball et al, 2021) this has led to an increase in the amount of research into the female game. Tremback-Ball et al, (2021) suggests that injuries that are related to training and games have increased holistically as the number of women that participate in sport increases, in turn women are more likely to suffer from ligament injuries compared to a male athlete in the same sport (Zuckerman et al, 2018; Baugh et al, 2018 and Stijak et al, 2015).

An emerging topic in contemporary research is the effect of the menstrual cycle on physical performance in women (Meignie et al, 2021). Oestrogen has been found to have an anabolic effect on the skeletal muscle and is responsible for the changes in glycogen stores and the utilisation of fats (Julian et al, 2017). Progesterone has thought to be an anti-oestrogen effect suggesting that the changes in these hormones during the different phases would influence player performance with performance being defined as short duration activities such as speed and power (Carmichael et al, 2021). McNulty et al, (2020) states that using performance markers such as the work done, time to complete, peak output and ratios and the amount of force generated, concluded with the fluctuation in these hormones lead to a decrease in muscular performance, submaximal and maximal intense exercise in the early follicular phase of the cycle. They found that performance was consistent through the other phases.

The relaxin, hormone known to increase joint laxity to accommodate the body to prepare for childbirth (Bond et al, 2004 and

Reed and Carr, 2018), regulates the activity of the muscles in the uterus to prevent them contracting during the menstrual cycle. The levels of this hormone are at their highest during the mid-luteal phase and reduce as menstruation begins (Reed and Carr, 2018). Research suggests that at certain points in a female’s menstrual cycle that they may be at a higher risk of injury, thought to be because of the effects the hormone has on connective tissue (Stijak et al, 2015 and Zuckerman et al, 2018), in reducing joint stability.

Further, Sawai et al, (2018) suggests that the physiological symptoms of the menstrual phases can affect performance in some athletes in both training and competition. Lack of sleep quality and quantity can be a factor which can result in a decrease in cognitive performance that in turn may affect the athlete’s ability to perform. Fullagar et al, (2015) and Ihalainen, (2019) states that 75% of the participants reported to experience negative performance side effects at certain times of the cycle including loss of strength, inflammation, metabolism, fluid balance and body temperature. Bruivels et al, (2020) looked at the menstrual cycle and the effects that it has on performance and found that there was a link. This study was completed via a wellness app that included questions based on mood, tiredness, fatigue and stomach cramps. The results showed that symptoms had an effect on the player missing training or training being adapted (P<0.05), missing a competitive event/fixture (P<0.05), taking time off work (P<0.05) and taking medication to help supress the symptoms (P<0.05). Further, 90.6% of the participants reported mood changes and anxiety during the menses active phase. These findings could pose both negative and positive response impeding performance, such as increase in levels of impulsivity with potential increases in injury risk. A result in a positive performance on the pitch could be due to the player not thinking about their symptoms as they are focussed on the game or training session (Hickmann, 2004). McNulty, (2020) supports this suggestion that hormone levels fluctuate through the different phases of the cycle.

The effect of the menstrual cycle on a female’s physical performance has been identified as a key consideration for women’s sport and the need for further research in this area has been identified. There is a limited amount of research to provide clarity on whether performance is affected during menstruation in a female football population, and available literature offers conflicting results. Further research and consideration of different performance measures may therefore be required. The aim of this study therefore is to investigate the effects of the menstrual cycle on multi measures of subjective and objective performance measures within mid-competitive season across training and matches in a population of female footballers.

Fifteen female football players agreed to take part in the study. All players were participating regularly in training and playing in competitive matches at academy level playing against both boys and girls. Before every training session and match, participants were required to complete a wellness form the morning of training and on match day which reported their date and length of menses, energy levels, stress, mood state and sleep quality. Catapult One GPS devices were assigned to a participant and worn at each training and match fixture. The measures included distance covered and minutes, sprint distance, player load and top speed. RPE scores were taken after each training and match to determine how the participants rated the session (to provide a score of session intensity).

On initial analysis post hoc it appears there is no significant main effect of the menstrual on performance metrics when ran through on SPSS on training data. However, significant main effects were reported for match day subjective data.

When collapsing the data, a significant difference in RPE scores (P=0.044) and energy levels (P=0.054) were noted. Further, when condensing the data and only considering averages of players where there are significant instances of Menses Active (n=3 or more in Training Data, n=2 or more in Game Data) in the players recording, comparisons of individual athlete’s average between active and inactive menses stages can be drawn across 4 players in both Training (Table 3) and Game (Table 4) data. In the Training Data (Table 3), the performance data on average across the 4 players shows a significant decrease in Sprints Distances, Power Plays and Impacts of 30% and more. Player 9 was an anomaly to this data and showed signs of increased performance, on average this still showed significant differences as a whole. All other performance data also shows decreases in output on average with players training loads dropping on average of 13.24% and players covering 11.11% less in total at training (KM).

On Wellness scoring players also were 10.38% higher on average in their Mood States and 12.41% lower in Stress Levels on average when combining these scores. In analysis of this, athletes appear happier and less stressed during training when Menses is active.

On reflection of game data (Table 4) this shows a different set of metrics and performance outcomes when considering the large drops in performance data at training in comparing players Menses Active vs Inactive stages. Whilst Sprint Distance (m) is lower at 15.66% it is not as significant a change as the 31.34% that is seen in the training data (Table 3). Total distance covered (KM) is marginally higher by 7.81% on average and player load is also on average slightly higher by 8.98% on average. Most significantly the number of recorded impacts (which according to Catapult GPS data is “Accelerometer data measured at 400 times per second in each of three axis is used to detect impacts that rate above 5g (49 m/s2). As such, impacts are considered significant events that exclude footsteps during walking and running”.) in game actions this would be considered high impact tackles, body collisions and players coming together in aggressive moments is 150% higher when Menses Active.

On Wellness scoring for Game Data (Table 4) RPE scores are on average 11.47% higher across the 4 players, with energy levels 9.85% lower and players report on average being 10.37% less stressed.

The results of the study are in support of the menstrual cycle effecting an individual players performance on both subjective and objective measures. There is a significant drop of performance in training rather than game data. One potential factor for this could be due to the difference in environment with training being a more learning focused environment versus match day which is a more focused, competitive environment. Another finding was there appeared to be an increase in impacts during a game which could explain the reason there are more ligament injuries in female football with making tackles without thinking of the consequences.

This increase in impulsivity can also be a positive factor with more sanctioned aggression leading to positive impacts of the outcome of the game.

Training Performance was impacted significantly with players training levels dropping by around 30% in some cases, player Mood and Stress levels were also affected. The implications of this are players training levels will dip during this phase of the menstrual cycle, without taking this into consideration, GPS Performance data could be misconstrued and players performance could be negatively looked upon in this stage of the menstrual cycle outside of context.

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