Text

Objectives and questions: Female professional sports are growing, prompting attention to hormonal fluctuations across the menstrual cycle, which may influence performance, mood, injury risk, and recovery, though evidence remains inconsistent. Menstrual irregularities and contraceptive use may affect musculoskeletal injury risk, with limited data suggesting cycle phase could influence ACL injury susceptibility, particularly in female football players. Despite potential benefits of individualized, cycle-informed approaches, current evidence does not support universal training modifications. The aim of this study was to assess coaches’ perceptions, knowledge, current practices, and need for guidance regarding the menstrual cycle in female athletes across sports in Switzerland.

Material and methods: A cross-sectional nationwide questionnaire was conducted among coaches of female athletes across multiple sports and competitive levels. Participants were recruited via sports federations, clubs, and professional networks. A structured online questionnaire assessed perceptions, knowledge, practices, and educational needs regarding the menstrual cycle’s impact on performance and injury risk. Data were analyzed descriptively, with comparisons across sport types, competitive levels, and coaching experience (p<0.05).

Results: A total of 251 coaches participated (52% female, 48% male), representing diverse sports and competitive levels. Self-rated knowledge of the menstrual cycle was moderate (mean 6.4/10) but lower for performance- and injury-related aspects (mean 5.7/10), with female coaches reporting higher knowledge. Attitudes toward cycle-based training were positive (usefulness 7.4/10; willingness to learn 8.5/10), yet only 10% incorporated menstrual cycle considerations into training, and 45% did not track it at all. Phase-specific injury observations were rare (12%), most often during menstruation or ovulation. Most coaches (89%) would adapt training if injury risk increased, and 77% would consider skipping competition under doubled risk, with female coaches showing greater tolerance for competition despite injury risk.

Discussion and conclusions: Coaches value menstrual cycle–informed training but rarely apply it, highlighting persistent knowledge gaps. Targeted education and practical tools are needed to support evidence-based, cycle-aware coaching and enhance athlete performance and injury prevention.