Menstrual Cycle-Related Symptoms and Disorders and Their Impact on Physical, Psychosocial, and Environmental...

Menstrual cycle (MC)-related symptoms and disorders are common in female athletes, but their effects on exercise performance remain insufficiently characterized. Growing evidence highlights that physical, psychosocial, and environmental determinants should be seen as interrelated performance-influencing domains.

The objective of this scoping review was to synthesize the current evidence on the influence of MC-related symptoms and disorders on exercise performance within a biopsychosocial and environmental framework. Its aims were to (1) examine the physical determinants of subjective and objective performance outcomes, (2) explore psychosocial and environmental moderators, (3) identify variations across sport types and athlete levels, and (4) appraise methodological approaches and limitations.

A total of 31 studies (from 2003 to January 2025) meeting the Population-Concept-Context criteria (nonhormonal contraceptive users-analysis of MC-related symptoms/disorders and physical, psychosocial, or environmental determinants of exercise performance-any sport type or activity level) were identified by systematic search of the PubMed, Medline, Embase, and Web of Science databases. The extracted data covered study characteristics, outcomes, and assessment methods.

MC-related symptoms and disorders were consistently linked to perceived performance impairment, although the evidence on the objective outcomes was heterogeneous. The methodological quality of the included studies (assessed using a modified Downs and Black checklist) was generally low because most relied on non-validated tools or lacked hormonal concentration measurements to confirm the MC phase, thus limiting comparability. Psychosocial (motivation, anxiety, stigma) and environmental (clothing, sanitary facilities) factors amplify the MC effect on performance, but these factors remain underexplored.

The available data suggest that MC symptom burden could be a major determinant of perceived exercise performance impairment. Future research should adopt an integrative design that combines physical, psychosocial, and environmental perspectives and standardized symptom assessments to advance evidence-based, context-sensitive approaches in female sport.