Knowing isn’t enough: Menstrual symptoms drive perceived performance impacts in women’s football

Objectives: To examine whether menstrual health literacy (MHL) is associated with Australian female footballer’s negative perceptions of the menstrual cycle and contraceptive use on athletic performance and availability, and to assess the influence of symptom count on these perceptions. Design: Cross sectional survey. Methods: Australian football players (n = 147) completed a survey assessing menstrual cycle characteristics, contraceptive use, perceived impacts on training and competition, and MHL. Associations between MHL and perceived impacts of the menstrual cycle or contraceptive use were analysed. The relationship between symptom count and these perceptions was also examined. Results: While MHL scores were not significantly associated with perceived impacts of the menstrual cycle on training performance (β = 0.29, 95% CI [-0.37, 0.97]), a higher number of symptoms was linked to more frequent reports of negative training impacts (β = 0.09, 95% CI [0.05, 0.14]). Among non-contraceptive users, a substantial proportion reported that the menstrual cycle negatively affected their training (67% ‘sometimes’; 21% ‘often’) and competition (62% ‘sometimes’; 18% ‘often’) performance, as well as training availability (60% ‘sometimes’; 14% ‘often’). Conclusion: No significant association was found between MHL and perceived menstrual cycle impacts in this cohort. However, symptom count emerged as a key factor, with athletes experiencing five or more symptoms more likely to report frequent negative effects on training performance. These findings suggest that addressing symptom recognition and management may be more critical than MHL alone in supporting athlete well-being and performance.