Article Title



Shiloah A. Kviatkovsky1, Stacy T. Sims2, Casey E. Greenwalt1, Tucker Zeleny3, Matthew D. Vukovich4, Abbie E. Smith-Ryan5, Christopher W. Bach6, David Presby7, Kristen Holmes7, Michael J. Ormsbee, FACSM1. 1Florida State University, Tallahassee, FL. 2Auckland University of Technology, Auckland. 3Whoop Inc, Boston, MA. 4South Dakota State University, Brookings, SD. 5University of North Carolina Chapel Hill, Chapel Hill, NC. 6University of Nebraska, Lincoln, NE. 7Whoop Inc., Boston, MA.

BACKGROUND: Monitoring female athlete menstrual cycles is recognized as an important metric to assess and monitor optimal health. Additionally, phases of the menstrual cycles are thought to correlate with differences in performance outcomes. Historically, collegiate-level athletes have relied on hormonal contraceptive (HC) use to promote menstrual cycle regularity and/or as a method to reduce menstrual cycle dysfunction. Recent global trends indicate a decrease in HC use in female athletes but has not been quantified across a diverse range of collegiate NCAA level athletes. Therefore, the purpose of this study is to quantify HC use vs. non-use, and to characterize menstrual cycle patterns of non-HC users, in a diverse population of collegiate level female athletes. METHODS: Female collegiate athletes (N=410) from four different universities, participating in one of 13 sports assessed, completed a questionnaire through the WHOOP (WHOOP, Inc) application platform. The responses were categorized by groups using oral contraceptives (OC) (n=175), other forms of HC (n=60), and by non-users of HC (n=175). The group using other forms of HC were subcategorized into either IUD, implant, ring, or other, groups. The number of typical bleeding days per cycle, and periods in the past year, were examined for the non-users of HC group. Prevalence and type of HC use and non-use was calculated as percentage of total sample and HC population, respectively. Days of menstruation is reported as percentage of the non-HC user population, trichotomized by range of days. RESULTS: HC use was 57% (n=235, age = 21±2 yrs., weight = 67.0±10 kg, height = 170±9 cm) of total population, of which 74% (n =175) used OC, 7% (n=31) used IUDs, 3% (n=16) used a hormonal implant, and 2% (n=11) reported other HC use. Current non-users of HC were 42% (n=175, age = 21±2 yrs., weight = 66.6 ±10 kg, height = 170±8 cm). Sixty percent (n=105) of non-HC users reported a normal bleed pattern of 3 to 6 days, while 1% (n=2) reported 1 to 2 days, and 3% (n=5) reported 7 to 8 days. Of the non-HC users, 2% (n=5) reported 5 or less periods in the last year, while 60% (n=139) reported 9 or more in the last year. CONCLUSIONS: This is the first study to investigate HC vs. non-HC use, as well as menstrual cycle patterns in female collegiate athletes from a wide range of sports at the NCAA level. Understanding the prevalence of HC use, and the normal bleeding patterns of naturally cycling sportswomen is important for developing appropriate monitoring and management practices for collegiate level female athletes. Future outcomes of this dataset include investigating menstrual cycle irregularities across a competitive season, variations by sport, and any changes induced by stress of training modalities and lifestyle behaviors.

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