Cycle Symptoms in Female Athletes: Why Asking “From Memory” Inflates Them Twofold

Discussion of the menstrual cycle in sport is usually built on questionnaires: an athlete is asked what symptoms she typically gets and how much they interfere with training. A French research group came at it from the other side — they asked athletes to keep a daily diary and collected sensor data in parallel. Comparing the two pictures produced a result that changes not so much our understanding of physiology as our understanding of how we measure it in the first place.

How the study was set up

The participants were 108 elite French athletes from seven sports: cycling, rowing, skiing, football, swimming, triathlon and wrestling. The observation covered 554 complete cycles and 16,491 daily entries — with an impressive completion rate of 88.9%.

Hormonal contraception was used by 45 athletes (41.7%), 80% of them combined oral contraceptives. The remaining 63 (58.3%) had a natural cycle.

The main finding: how you ask changes the answer

This is where the real value lies.

In the retrospective questionnaire (recall what you usually get) the leaders were: mood swings — 48.1%, fatigue — 47.2%, pelvic pain — 47.2%.

In the daily diary (mark what you have today) the picture turned out noticeably more modest: fatigue — 32.4%, bloating — 32.4%, pelvic pain — 27.8%.

The difference for fatigue, pelvic pain, mood swings, breast pain and food cravings was statistically significant. The authors explain it directly: the retrospective approach leads to overestimation of symptoms because of how memory works. We remember the bad days better and build a pattern out of them.

The practical takeaway for coach and athlete: planning training load based on recollections means planning based on a distorted picture. A diary that takes two seconds a day gives you data of a different quality.

A second observation: athletes with a natural cycle reported symptoms more often than those using hormonal contraception — both in the retrospective questionnaire and in the daily one. This is an observation, not proof that contraception helps: women with severe symptoms may be more likely to turn to it for exactly that reason. Cause and effect are inseparable here.

What happens in training

Here the study did what is usually missing: it matched how athletes felt against objective sensor data.

Football (33 players). On symptom days the volume of high-speed running dropped significantly: the share of distance in the 13–19 km/h range fell from 8.9% to 8.0% of total training volume.

Cycling (31 athletes). Normalized power did not differ between "symptom" and "symptom-free" sessions.

This is an important divergence. It looks as though what suffers is not performance in general but specifically readiness for intense surges — the thing that requires both physical and motivational sharpness. Steady work at a given power is tolerated normally.

Well-being, meanwhile, dropped consistently: fitness rating 6.2 versus 5.5 (p < 0.001), mood 6.7 versus 6.4 (p < 0.001), sleep quality with a smaller but still significant difference (p = 0.017).

How to apply this

Keep a daily diary rather than relying on recall. Even a minimal one: two or three entries a day. Retrospection systematically errs on the side of exaggeration.
Don't cancel the session entirely — change its character. The data hint that on symptom days it is more sensible to shift the emphasis from short intense surges to steady work than to scrap the session.
Don't copy other people's schemes. The variation between athletes is enormous, and "train by phase" as a universal rule is not supported by the data — we have a separate piece on that.
Track well-being alongside training load. A dip on the subjective scales turned out to be a more sensitive marker than the power numbers.

Limitations

The authors do not hide the weak spots. Symptom severity was not assessed — only whether a symptom was present, which means athletes with a high pain threshold could have underestimated their state. Objective data were available only for the sports with sensors — football and cycling. Cycle phases were determined by self-report, without hormonal confirmation. And even with high completion rates, fatigue from making daily entries inevitably accumulates.

Key points

108 elite athletes, 554 cycles, 16,491 entries; 41.7% used hormonal contraception.
Retrospective questionnaires inflate symptoms: mood swings 48.1% from memory versus fatigue 32.4% in the diary; the discrepancy is significant.
Athletes with a natural cycle reported symptoms more often than those using contraception — but that is an association, not a proven cause.
In football, high-speed work dropped on symptom days (8.9% → 8.0% of distance), while in cycling power did not change.
Well-being fell consistently: fitness 6.2 → 5.5, mood 6.7 → 6.4.
In practice: a daily diary instead of recollections, and a change in the character of training instead of cancelling it.

Sources: “Menstrual cycle or hormonal contraceptive related symptoms in elite female athletes from retrospective self-questionnaires and daily monitoring: impact on well-being and objective performance metrics”, Frontiers in Sports and Active Living, 2025. https://doi.org/10.3389/fspor.2025.1693190. “Effects of Hormonal Contraceptives on Non-Bone Related Injury Risk and Athletic Performance in Female Athletes: A Systematic Review of the Literature”, Annals of Sports Medicine and Research. “Hormonal Contraceptives and the Gut Microbiome in Female Athletes”. https://pmc.ncbi.nlm.nih.gov/articles/PMC12378088/