Menstrual-related symptoms in athletes
Menstrual-related symptoms may include pain, heavy bleeding, irregular menstruation, absence of menstruation, or other symptoms affecting daily life and sport. Some variation is normal, but new or significant symptoms should be assessed.
Mild menstrual cramps, fatigue, headache, or other symptoms that are manageable and only minimally affect training.
Menstrual symptoms can have many causes. Examples include normal hormonal variation, heavy or painful periods, hormonal contraception, stress, low energy availability, or gynecological conditions.
Common symptoms
- •Menstrual cramps
- •Heavy menstrual bleeding
- •Irregular periods
- •Absent periods
- •Bloating and breast tenderness
- •Fatigue or headache
- •Mood changes
Not all menstrual symptoms can be prevented. It is important to create an environment where athletes can discuss menstruation without shame and where meaningful changes can be identified early.
- •Ensure adequate energy intake relative to training and growth
- •Encourage athletes to seek help for significant symptoms
- •Take absent or clearly changed menstruation seriously
- •Avoid presenting menstruation as something athletes should always train through
- •Modify training individually when symptoms affect function
Adjust training load according to the individual's symptoms. Rest, hydration, nutrition, and heat may help some people. Medication should be used according to medical advice.
Symptom-guided training
Training is adjusted according to symptoms and daily condition rather than treating menstruation itself as a limitation.
Goals
Maintain physical activity with good symptom control.
Progression criteria
Normal or appropriately modified training can be completed without significant symptoms.
- The athlete can train with manageable symptoms
- No medical red flags are present
- Adequate energy and hydration are maintained
- Training can be modified when needed
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Menstrual-related symptoms in athletes
Menstrual-related symptoms may include pain, heavy bleeding, irregular menstruation, absence of menstruation, or other symptoms affecting daily life and sport. Some variation is normal, but new or significant symptoms should be assessed.
Mild — Varierar beroende på symtom och bakomliggande orsak. Många menstruationsrelaterade symtom är övergående.
Symptoms
Mild menstrual cramps, fatigue, headache, or other symptoms that are manageable and only minimally affect training.
Acute Treatment
Adjust training load according to the individual's symptoms. Rest, hydration, nutrition, and heat may help some people. Medication should be used according to medical advice.
Rehabilitation
Training is adjusted according to symptoms and daily condition rather than treating menstruation itself as a limitation.
Goals
Maintain physical activity with good symptom control.
Progression criteria
Normal or appropriately modified training can be completed without significant symptoms.
Return to Play
- ☐ The athlete can train with manageable symptoms
- ☐ No medical red flags are present
- ☐ Adequate energy and hydration are maintained
- ☐ Training can be modified when needed
Moderate — Varierar från dagar till månader beroende på bakomliggande orsak och behandling.
Symptoms
Symptoms that repeatedly affect training, sleep, school, or daily life, such as significant menstrual cramps, heavy bleeding, recurrent headaches, or marked fatigue.
Acute Treatment
Recurring or significant symptoms should be medically assessed. Training can be temporarily modified according to symptoms.
Rehabilitation
The cause of symptoms is assessed, including menstrual pattern, energy availability, and other potential health problems.
Goals
Identify treatable causes.
Progression criteria
An appropriate medical plan is established.
Training gradually returns to normal while the underlying cause is addressed.
Goals
Normal training capacity and manageable menstrual symptoms.
Progression criteria
Training can be completed without significant symptoms or deterioration in health.
Return to Play
- ☐ Underlying medical causes have been assessed when appropriate
- ☐ Symptoms are manageable
- ☐ Training is tolerated
- ☐ Adequate energy and recovery are maintained
Severe — Beror helt på bakomliggande orsak och kan variera från dagar till månader.
Symptoms
Severe pain, very heavy bleeding, fainting, significant dizziness, or menstrual symptoms that substantially affect health and function require medical assessment.
Acute Treatment
Seek medical care for severe or rapidly worsening symptoms. Emergency care is required for fainting, very heavy bleeding, or other acute symptoms.
Rehabilitation
The underlying cause is assessed and treated individually.
Goals
Ensure health and address underlying problems.
Progression criteria
Medical assessment allows return to physical activity.
Physical load is reintroduced according to symptoms and medical status.
Goals
Return to normal sport without compromising health.
Progression criteria
Full training is tolerated and any required medical treatment is established.
Return to Play
- ☐ Serious causes have been medically assessed
- ☐ Acute symptoms are controlled
- ☐ Training is tolerated
- ☐ Adequate energy and recovery are maintained
- ☐ Medical clearance when relevant to the condition or treatment
When to Seek Medical Care
Menstrual symptoms should be assessed when they are new, significantly changed, recurrent, or affecting health, daily life, or sport.
- Absent periods
- Very irregular periods
- Very heavy bleeding
- Severe or newly developed menstrual pain
- Fainting or significant dizziness
- Symptoms significantly affecting training or daily life
- Signs of low energy availability or recurrent injuries
References
- 2023 International Olympic Committee's consensus statement on RED-S — International Olympic Committee / British Journal of Sports Medicine (https://doi.org/10.1136/bjsports-2023-106994)