A Systematic Literature Review on Menstruation Management and Suppression in Female Athletes Including Performance in Remote Environments
DOI:
https://doi.org/10.53646/18gvj154Keywords:
Endurance, Menstruation, Menses, Suppression, Management, Expedition, Wilderness, Remote, Menstrual CycleAbstract
BACKGROUND: This review aims to analyze general principles, current evidence and management options of menstrual management and suppression. It is aimed at those who are involved in sports participation with an additional focus on endurance events within remote environments and wish to further educate themselves on menstruation management, regardless of sex and/or gender.
METHODS: A systematic search was conducted using the Boolean method through the Scopus database and Google Scholar. A list of inclusion and exclusion criteria was formed along with a parallel search of resources. Results regarding the suppression or manipulation of menstruation were synthesized.
RESULTS: This review demonstrates that there is no ‘correct way’ to manipulate menstrual cycles. The information has been collated and presented with considerations given to the challenges female athletes face.
CONCLUSION: Several challenges unique to female athletes, especially in remote environments, have been identified in this review. It is the responsibility of everyone involved in performing and managing female athletes to educate themselves and abolish the taboo of menstruation in sports performance. In doing so, we can encourage more females to participate, including adventurous activities in extreme environment.
References
1. Adam MEK. Bristow A. Neely KC. Erlandson MC. Do Women Athletes’ Experiences of Menstrual Function and Dysfunction Vary Across Competition Levels? A Mixed Methods Exploration. 2022;63:102270
2. Murphy M. The Gender Play Gap: Why Aren’t More Women Playing Sport? Available at: https://www.rte.ie/brainstorm/2017/1129/923613-the-gender-play-gap-why-arent-more-women-playing-sport/ (Accessed: 3 August 2022)
3. Gould L. Adventure Tourism: Next Trend in Travel Treasure. Available at: https://www.travel-intel.com/adventure-tourism/ (Accessed: 2 November 2022)
4. Scheer V. Participation Trends of Ultra Endurance Events. Sports Medicine and Arthroscopy Review. 2019;27(1):3-7. https://journals.lww.com/sportsmedarthro/abstract/2019/03000/participation_trends_of_ultra_endurance_events.2.aspx
5. Valentin S. Pham LA. Macrae E. Enablers and Barriers in Ultra-Running: A Comparison of Male and Female Ultra Runners. Sport in Society. 2022; 25(1):2193-2212. https://www.tandfonline.com/doi/full/10.1080/17430437.2021.1898590#abstract
6. Anderson S. Dallimore J. Davies C. Dawood R. Harvey P. McIntosh I. et al. Chapter 2: Preparations. In: Johnson C. Anderson S. Dallimore J. Imray C. Winser S. Moore J. Warrell D. Oxford Handbook of Expedition and Wilderness Medicine. 2nd ed. Oxford: Oxford University Press; 2015:15-81
7. Sommer, M., Phillips-Howard, P. A., Mahon, T., Zients, S., Jones, M. and Caruso, B. A. Beyond menstrual hygiene: Addressing vaginal bleeding throughout the life course in low and middle-income countries. BMJ Global Health. 2017;2(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717954/
8. Nash M. People Stationed in Antarctica Menstruate Too – And It’s a Struggle. Here’s How We Can Support Them. Available at: https://theconversation.com/people-stationed-in-antarctica-menstruate-too-and-its-a-struggle-heres-how-we-can-support-them-187617 (Accessed: 3 November 2022)
9. Band B. Diversity in The Outdoors & Why the Only Barrier Is Definitely Not Just Yourself. Available at: https://www.theordinaryadventurer.com/personal-journal/diversity-in-the-outdoors/ (Accessed: 3 November 2022)
10. Burns, S. What is Boolean Search? Available at: https://www.nypl.org/blog/2011/02/22/what-boolean-search (Accessed: 4 August 2022)
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. The BMJ. 2021;372(71). https://doi.org/10.1136/bmj.n71
12. The American College of Obstetricians and Gynecologists. General Approaches to Medical Management of Menstrual Suppression. Obstetrics & Gynecology. 2022;140(3):528-541. https://journals.lww.com/greenjournal/Fulltext/2022/09000/General_Approaches_to_Medical_Management_of.32.aspx
13. Jacobson JC. Likis FE. Murphy PA. Extended and continuous combined contraceptive regimens for menstrual suppression. Journal of Midwifery & Women’s Health. 2012;57(6):585-592. https://doi.org/10.1111/j.1542-2011.2012.00250.x
14. Coutinho FM. Rebelo-Marques A. Andrade R. Espregueira-Mendes J. Bombas T. Moura P. Menstrual Pattern and Contraceptive Choices of Portuguese Athletes. The European Journal of Contraception & Reproductive Health Care. 2021;26:240-245.
15. Hewett TE. Myer GD. Ford KR. Anterior Cruciate Ligament Injuries in Female Athletes. The American Journal of Sports Medicine. 2006;34(2):299-311. https://journals.sagepub.com/doi/abs/10.1177/0363546505284183
16. Herzberg SD. Motiapuaka ML. Lambert W. Fu R. Brady J. Guise J. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2017;5(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524267/
17. Parsons JL. Coen SE. Bekker S. Anterior Cruciate Ligament Injury: Towards a Gendered Environmental Approach. British Journal of Sports Medicine. 2021;55(17):984-990. https://pubmed.ncbi.nlm.nih.gov/33692033/
18. Brit KM. McCarthy HE. The Effect of Estrogen on Anterior Cruciate Ligament Structure and Function: A Systematic Review. Journal of Musculoskeletal Disorders and Treatment. 2023;9(3). https://clinmedjournals.org/articles/jmdt/journal-of-musculoskeletal-disorders-and-treatment-jmdt-9-127.php?jid=jmdt#ref5
19. Herzog MM. Young JC. Lund JL. Pate V. Mack CD. Marshall SW. Oral Contraceptive Use and Anterior Cruciate Ligament Injury: Comparison of Active Comparator New User Cohort and Case-Control Study Designs. Injury Epidemiology. 2020;7. https://injepijournal.biomedcentral.com/articles/10.1186/s40621-020-00282-x#citeas
20. White L. Losciale JM. Squier K. Guy S. Scott A. Prior JC. Whittaker JL. Combined Hormonal Contraceptive Use Is not Protective Against Musculoskeletal Conditions or Injuries: A Systematic Review with Data From 5 Million Females. 2023;57:1195-1202
21. Faculty of Sexual & Reproductive Healthcare. FSRH guideline (January 2019, amended November 2020) combined hormonal contraception. BMJ Sexual & Reproductive Health. 2019;45(1). https://srh.bmj.com/content/45/Suppl_1/1.info
22. Bauer IL. (2021) Health, safe and responsible: The modern female traveler. Tropical Diseases, Travel Medicine and Vaccines. 2021;7: 1-16.
23. Gerschultz K. Sucato GS. Eliminating monthly periods with combined hormonal contraception. Women’s Health. 2007;3(5):541-545. https://doi.org/10.2217/17455057.3.5.541
24. Strandjord SE. Rome ES. Monthly periods – are they necessary? Pediatric Annals. 2015;44(9):e231-236.
25. Martins SL. Boraas CM. Contraceptive counselling: An essential travel medicine service. Journal of Travel Medicine. 2020;27(4). https://academic.oup.com/jtm/article/27/4/taaa023/5762312?login=false
26. Centers for Disease Control and Prevention (2022) Blood Clots and Travel: What You Need to Know. Available at: https://www.cdc.gov/ncbddd/dvt/travel.html#:~:text=Move%20your%20legs%20frequently%20when,pulling%20your%20toes%20toward%20you). (Accessed: 28 December 2022)
27. Rafiei F. Tabesh H. Farzad S. Farzaneh F. Rezaei M. Hosseninzade F. Mottaghy K. Development of Hormonal Intravaginal Rings: Technology and Challenges. Geburtshilfe Frauenheilkd. 2021;81(7):789-806. https://pmc.ncbi.nlm.nih.gov/articles/PMC8277443/#R13699395-14
28. National Health Service: Vaginal Ring. Available at: https://www.nhs.uk/contraception/methods-of-contraception/vaginal-ring/ (Accessed 22 October 2024)
29. Sulak PJ. Smith V. Coffee A. Witt I. Kuehl A. Kuehl TJ. Frequency and Management of Breakthrough Bleeding With Continuous Use of the Transvaginal Contraceptive Ring: A Randomized Controlled Trial. Obstetrics & Gynecology. 2008;112(3):563-571. https://journals.lww.com/greenjournal/fulltext/2008/09000/Gabapentin_s_Effects_on_Hot_Flashes_in.10.aspx
30. Lete I. Cuesta MC. Marin JM. Guerra S. Vaginal Health in Contraceptive Vaginal Ring Users – A Review. The European Journal of Contraception & Reproductive Health Care. 2013;18(4):234-241. https://www.tandfonline.com/doi/full/10.3109/13625187.2013.801954
31. Plagianos MG. Ramanadhan S. Merkatz RB. Brache V. Friedland BA. Haddad LB. Risk Factors For and Outcomes of Ring Expulsions with a 1-year Contraceptive Vaginal System. The American Journal of Obstetrics & Gynecology. 2024;230(5):548.e1-548.e8. https://pubmed.ncbi.nlm.nih.gov/38295968/#:~:text=Results%3A%20Most%20participants%20(75%25),in%20cycle%201%20(9%25).
32. Dean J. Kramer KJ. Akbary F. Wade S. Huttemann M. Berman JM. et al. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: A randomized trial. BMC Women’s Health. 2019;70. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0766-6
33. BNF. Norethisterone. Available at: https://bnf.nice.org.uk/drugs/norethisterone/ (Accessed: 11 December 2022)
34. Critchley HOD, Babeyev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, et al. Menstruation: Science and society. American Journal of Obstetrics and Gynecology. 2020;223(5):624-664. https://doi.org/10.1016/j.ajog.2020.06.004
35. Hicks CW. Rome ES. Menstrual manipulation: options for suppressing the cycle’, Cleveland Clinic Journal of Medicine. 2010;77(7):445-453. https://www.ccjm.org/content/ccjom/77/7/445.full.pdf
36. Jain V. Wotring VE. Medically induced amenorrhea in female astronauts. NPJ Microgravity. 2016; 2.:16008. https://doi.org/10.1038/npjmgrav.2016.8
37. Da Silva Filho AL, Caetano C, Lahav A, Grandi G, Lamaita RM. The difficult journey to treatment for women suffering from heavy menstrual bleeding: A multi-national survey. The European Journal of Contraception & Reproductive Health Care. 2021;26(5). https://doi.org/10.1080/13625187.2021.1925881
38. Grimes DA. Lopez LM. Manion C. Schulz KF. Cochrane systematic reviews of IUD trials: lessons learned. Contraception. 2007;75:S55-S59. https://reader.elsevier.com/reader/sd/pii/S0010782407000054?token=BE9DEE9D93B2549E8DD6FA8D5C1654972ED1EAF7B2131DCA6A5985CACE177E6724BB61D34BEB503403EA84795A36F69E&originRegion=eu-west-1&originCreation=20221216124730
39. Buck E. McNally L. Vadakekut ES. Jenkins SM. Menstrual Suppression. StatPearls. 2024. https://www.ncbi.nlm.nih.gov/books/NBK592411/
40. Ricker EA. Goforth CW. Barrett AS. Deuster PA. de la Motte. SJ. Female Military Officers Report a Desire For Menstrual Suppression During Military Training. Military Medicine. 2021;186(1):775-783. https://doi.org/10.1093/milmed/usaa339
41. Imray C. Anderson SR. Campbell-Smith T. Wilson-Howarth J. Chapter 13: Treatment: Abdomen. In: Johnson C. Anderson S. Dallimore J. Imray C. Winser S. Moore J. Warrell D. Oxford Handbook of Expedition and Wilderness Medicine. 2nd ed. Oxford: Oxford University Press; 2015:383-413.
42. Medina-Perucha L. Lopez-Jimenez T. Holst AS. Jacques-Avino C. Munros-Feliu J. Martinez-Bueno C. et al. Use and perceptions on reusable and non-reusable menstrual products in Spain: A mixed-methods study. PLoS. 2022;17(3):e0265646. 10.1371/journal.pone.0265646
43. Boulware DR. Gender differences among long-distance backpackers: A prospective study of women Appalachian trail backpackers. Wilderness & Environmental Medicine. 2004;15(3):175-180. https://doi.org/10.1580/1080-6032(2004)15[175:GDALBA]2.0.CO;2
44. Morino S, Hinako H, Matsumoto D, Yokota I, Aoyama T. Patterns of premenstrual syndrome in collegiate women: A cross-sectional study. Medicine. 2022;105(35):E30186. https://oce-ovid-com.ergo.southwales.ac.uk/article/00005792-202209020-00075/HTML
45. Kolic PV, Sims DT, Hicks K, Thomas L, Morse CL. Physical activity and the menstrual cycle: A mixed-methods study of women’s experiences. Women in Sport and Physical Activity Journal. 2021;29:47-58. https://web.s.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=0&sid=dbcff7b3-9f6a-4c7b-8acd-36c5eebc0dff%40redis
46. Roupas ND. Georgopoulos NA. (2011) Menstrual function in sports. Hormones. 2011;10(2):104-116.
47. National Health Service: Iron Deficiency Anaemia. Available at: https://www.nhs.uk/conditions/iron-deficiency-anaemia/ (Accessed: 10 December 2023)
48. Kappen M. Raeymakers S. Weyers S. Vanderhasselt M. Stress and rumination in premenstrual syndrome (PMS): Identifying stable and menstrual cycle-related differences in PMS symptoms severity. Journal of Affective Disorders. 2022;319:580-588. https://reader.elsevier.com/reader/sd/pii/S0165032722010576?token=F226767B33A37803B3B78FD730FCB17C47ACD5441BADC44A739034BF5CFCA9311325F0461110230ED203201CA2F8F961&originRegion=eu-west-1&originCreation=20221123123545
49. Lete I. Hausler G. Pintiaux A. Jamin C. Nappi RE. Fiala C. et al. The inconvenience due to women’s monthly bleeding (ISY) survey: A study of premenstrual symptoms among 5728 women in Europe. The European Journal of Contraception & Reproductive Health Care. 2017;22(5):354-359. https://web-p-ebscohost-com.ergo.southwales.ac.uk/ehost/pdfviewer/pdfviewer?vid=0&sid=aeab1cae-c2c5-4741-ba8f-473cfdfe3068%40redis
50. Phillips AK. Wilson C. Menstrual practices in operational military women. Military Medicine. 2021;186(1):767-774. https://doi.org/10.1093/milmed/usaa345
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Journal of Women's Sports Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.