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Updated: Aug 6, 2026
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Published on: May 10, 2022
Optimizing Iron-Deficiency Screening for Female Athletes: Do We Need to Consider the Menstrual Cycle?
Alannah K A McKay1, Rachel McCormick1, Madison Pearson2
1Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
Summary
Iron status in female athletes is not significantly affected by menstrual cycle phase. Hormonal contraception users showed higher C-reactive protein, but iron markers remained stable across cycle phases.
Area of Science:
- Sports Medicine
- Exercise Physiology
- Biochemistry
Background:
- Iron deficiency is a concern for female athletes, impacting performance.
- Screening practices often consider the menstrual cycle, but evidence is limited.
- Hormonal contraception use is common and may influence iron status markers.
Purpose of the Study:
- To investigate the influence of menstrual cycle phase on iron status in female athletes.
- To compare iron status markers between naturally cycling athletes and those using hormonal contraception.
- To examine the impact of a training camp on iron status and inflammation markers.
Main Methods:
- Twenty-four elite female rugby players (n=11 naturally cycling, n=13 on hormonal contraception) were studied over a 5-week training camp.
- Blood samples (venous and capillary) were collected at multiple time points corresponding to menstrual cycle phases (for naturally cycling) or equivalent time points (for hormonal contraception users).
- Analyzed markers included ferritin, hepcidin, serum iron, transferrin saturation, hemoglobin, creatine kinase, and C-reactive protein.
Main Results:
- No significant differences in ferritin, hepcidin, transferrin, or hemoglobin were observed across menstrual cycle phases or between groups.
- Serum iron and transferrin saturation increased from Phase 1 to Phase 2 in naturally cycling athletes only.
- Ferritin and hepcidin levels decreased significantly across the training camp in all athletes.
- C-reactive protein concentrations were consistently higher in athletes using hormonal contraception compared to naturally cycling athletes.
Conclusions:
- Menstrual cycle phase appears to have a minimal impact on iron status markers in female athletes compared to other factors.
- Hormonal contraception use may be associated with elevated C-reactive protein levels, independent of iron status.
- Current iron deficiency screening protocols may not require significant adjustments based on menstrual cycle phase alone.
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