New research across elite European clubs shows growing openness around menstrual health but also reveals persistent knowledge gaps that could influence athlete wellbeing, training decisions, and support strategies.
Study: Menstrual cycle knowledge, first- and second-hand experiences, personal opinions, and practices of players and staff from elite European women’s football clubs. Image Credit: Shutterstock
In a recent study published in the journal Science and Medicine in Football, researchers evaluated menstrual cycle knowledge, experiences, opinions, and practices among players and staff in elite European women’s football clubs.
Growth of Women’s Football and Female-Specific Health Gaps
Women’s football revenues recently surpassed €500 million globally, yet research on female-specific health still lags behind the men’s game. As competition intensifies, understanding how the menstrual cycle may influence an athlete’s health and performance has become increasingly important. Athlete health may be influenced by both hormonal contraceptive use, including the combined oral contraceptive pill and the progesterone-only pill, and the need for menstrual health literacy.
Despite increased media coverage and advocacy for women’s sports, structured education remains limited. Without clear guidance, misconceptions may shape training decisions, injury beliefs, and overall well-being. Further research is needed to clarify knowledge gaps and practical needs within elite football environments.
Mixed-Methods Study of Elite European Football Clubs
This mixed-methods study involved 320 elite women football players and 46 staff members from 15 top-tier European clubs affiliated with the European Club Association. Ethical approval was obtained from Manchester Metropolitan University, and all participants provided informed consent. Data were collected in person or through live online sessions to ensure independent responses.
Participants completed a structured questionnaire assessing demographic characteristics, knowledge of the menstrual cycle and hormonal contraception, and personal or observed experiences. Each correct answer was awarded 1 point, with a maximum score of 19 for players and 18 for staff.
An additional 16 players and 15 staff members participated in semi-structured interviews designed to gather deeper insight into attitudes, comfort levels, and perceived performance effects. Interviews were recorded and transcribed verbatim.
Ovarian Hormone Status and Self-Reported Classifications
Players reported their ovarian hormone status and were categorized as naturally menstruating with cycle lengths of 21 to 35 days, hormonal contraceptive users, or suspected menstrual dysfunction cases. Reported dysfunction categories included amenorrhea, defined as the absence of menstruation for more than 90 days, oligomenorrhea, defined as cycles longer than 35 days, polymenorrhea, defined as cycles shorter than 21 days, or irregular cycles. These classifications were self-reported and not confirmed by objective clinical or biochemical measures.
Statistical analyses compared knowledge scores between groups, with statistical significance set at p ≤ 0.05.
Knowledge Scores and Educational Disparities
Players scored an average of 39 percent, while staff scored 47 percent, with staff demonstrating significantly higher knowledge. Participants who had previously received education on the female reproductive system, menstrual cycle, or hormonal contraceptives scored significantly higher than those without prior training. Female staff scored substantially higher than male staff, highlighting disparities in familiarity with female-specific health topics.
Knowledge gaps were evident. Some participants did not clearly distinguish between menstruation, referring to bleeding, and the menstrual cycle, which encompasses the hormonal and physiological processes leading to and including bleeding. Participants also demonstrated limited understanding of how hormonal contraceptives function and the differences between combined oral contraceptives and progesterone-only contraceptives. Inconsistent knowledge regarding amenorrhea was observed, despite its potential association with underlying health or training-related issues that warrant clinical evaluation.
Knowledge of these topics may influence decision-making and perceptions of athlete well-being, although it does not directly determine performance outcomes.
Perceptions of Performance Effects and Evidence Gaps
Seventy-two percent of athletes and 94 percent of staff reported believing that menstruation affects performance. Additionally, 39 percent of athletes and 57 percent of staff perceived that hormonal contraceptive use influences performance. However, current scientific evidence does not consistently demonstrate a universal causal effect of menstrual cycle phase or hormonal contraceptive use on athletic performance or injury risk.
When asked about the biggest challenges in women’s football, few participants prioritized menstrual health. Instead, they emphasized financial instability, fixture congestion, injuries, infrastructure limitations, and insufficient research on female-specific issues. This suggests that although menstrual health is recognized as important, broader structural issues dominate daily concerns.
Phase-Based Training Practices and Squad Diversity
Eighteen percent of players and 22 percent of staff reported implementing menstrual cycle phase-based training programs, while slightly more reported using phase-based nutrition strategies. Current scientific consensus does not support universal phase-based programming, suggesting that some practices may be guided more by perception than by established evidence.
Self-reported ovarian hormone status revealed substantial diversity within squads. Sixty percent of players were naturally menstruating, 26 percent used hormonal contraceptives, most commonly oral contraceptive pills, and 14 percent reported suspected menstrual dysfunction. This variation highlights the presence of diverse physiological profiles within teams and underscores the need for individualized approaches rather than uniform strategies. Hormonal contraceptive use itself reflects personal health, medical, or performance-related choices.
Seventy-six percent of players and 92 percent of staff expressed strong interest in further education, particularly through workshops, presentations, and brief digital content.
Implications for Menstrual Health Education in Elite Football
Elite European women’s football demonstrates openness to discussing menstrual health, yet significant knowledge gaps remain. While most players and staff believe the menstrual cycle and hormonal contraceptives influence performance, understanding of biological mechanisms and health implications is limited. Approximately 40 percent of athletes were either using hormonal contraception or reported menstrual concerns, reflecting physiological diversity rather than a uniform clinical issue.
Evidence-based, structured educational programs could support informed health decision-making, reduce misconceptions regarding injury risk, and promote supportive team environments. As women’s football continues to expand globally, integrating menstrual health education into elite sport systems may contribute to sustainable athlete well-being and performance.
Journal reference:
Elliott-Sale, K. J., Clausen, E., & Bloomfield, C. (2026). Menstrual cycle knowledge, first- and second-hand experiences, personal opinions, and practices of players and staff from elite European women’s football clubs. Science and Medicine in Football, 1–12. DOI: 10.1080/24733938.2026.2634312, https://www.tandfonline.com/doi/full/10.1080/24733938.2026.2634312