How does menstruation affect sportswomen?

There is still lack of research in sports science dealing only with women and for this reason, findings from studies conducted on men are applied to women. The menstrual cycle and the changes associated with it are the main reason for not including women in research.

3 Mar 2023 Michaela Beníčková

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But it's the menstrual cycle that makes women unique and can affect many aspects from physical performance, motivation to sleep and nutritional needs. It is also one of the primary indicators of women's health, and the absence of a menstrual cycle is one of the manifestations of Relative Energy Deficiency Syndrome (RED-s). For this reason, we designed a research to provide data on female athletes in the areas of health, nutrition and exercise. In women, energy availability, menstrual cycle, chronotype and possible effects of low energy availability or body weight manipulation on the health of female athletes will be investigated.

In general, women are underrepresented in sport science research than men. Study data even show that only 6% of all sports science publications from 2014-2020 included women (Cowley et al., 2021). In particular, the presence of the menstrual cycle is a reason why women are often excluded from research, despite it being one of the most fundamental indicators of women's health. Based on current data, it is possible to conclude that the menstrual cycle influences, among other things, sports performance (McNulty et al., 2020; Carmichael et al., 2021) and motivation (Crewther and Cook, 2018). There is even a relationship between phases of the menstrual cycle and sports performance and circadian rhythms (Birch and Reilly, 2009).

Nutrition and physical activity are also closely related to women's health. Low energy availability (low ED) combined with high training loads can lead to the development of relative energy deficiency syndrome (RED-s). The latter can result not only in disturbances to absence of the menstrual cycle, but also, for example, in deterioration of bone health (Mountjoy et al., 2018). The consequences for bone health can range from short-term changes in bone metabolism and increased risk of fatigue fracture to long-term consequences of low bone density such as osteoporosis and associated fractures due to bone fragility (Popp et al, 2022). There is also a link between bone health and the gut microbiome through the gut-bone axis (gut-bone pathway) (Tu et al., 2021) and research showing a relationship between low energy intake and gut microbiome composition (Mörkl et al., 2017). In weight-manipulating sports, such as combat sports, there is a high risk of developing Relative Energy Deficiency Syndrome in Sport (RED-S), with the literature describing sporadic cases in elite male athletes (Kasper et al., 2019; Langan-Evans et al., 2020) and data on women completely lacking.

Participate in research

and support the representation of women in science. In doing so, you can contribute to individualized approach to women athletes that is often underestimated.

Our research Health, Nutrition and Exercise-Specific Determinants in Women Athletes is divided into 4 parts. For the first, initial part of the research, we are looking for women aged 18-35. Only pregnancy, motherhood and physical inactivity prevent participation.

The aim of this part of the research is to collect data on women's sport level, the prevalence of relative energy deficiency syndrome and the representation of different chronotypes. Based on the results of this part, you may, if you are interested and agree, be included in part 2, 3, 4 or terminate your participation in the research.

How will the participation be conducted?

This will be a one-time data collection in which you will: complete online questionnaires for physical activity classification, RED-S prevalence (RST questionnaire), low energy availability (LEAF-Q questionnaire), chronotype questionnaire (MEQ questionnaire); and submit a 3-day nutritional prospective record including physical activity record.

The information will be used to assess your nutritional, health status and training load characteristics. If you fill in your email in the online questionnaire, we will send you the evaluated questionnaires and records within 3 months. You will receive feedback on your performance level, any risk of low energy and chronotype.

How to get involved?

Complete the online questionnaire and email us at with your completed 3-day nutrition and exercise record, which can be found HERE. The 3-day record also includes an informed consent form – please be sure to read and sign this as well.

By signing the informed consent and completing the online questionnaire, you agree to participate in the study.


If you have any questions, please feel free to contact us at
Alternatively, contact the principal investigator of the project Mgr. Michaela Beníčková ( or the Research Ethics Committee (


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