An integrated approach to understanding and improving menstrual health and support available to female footballers

Female athletes widely report perceived impacts to their health, wellbeing and sportingperformance as a result of their menstrual cycle (MC), and subsequent symptoms experienced.There remains a lack of understanding of menstrual health and cycle characteristics within a youthenvironment, along with limited evidence to highlight the current menstrual support to athleteswithin football. This PhD research therefore aimed to understand the current landscape of MCexperiences and perceptions within football from both players and coaches, and to develop andassess the effectiveness of targeted menstrual health education (MHE) resources in improving theknowledge and support from football coaches. Following a review of the literature to assess thecurrent landscape of menstrual health, performance associations, and support available to womenand girls within Chapter 2, Chapter 3 explored the role of age in the experiences and perceptionsof the MC. This was performed by analysing questionnaire data pertaining to adolescent and adultelite football players. The questionnaire explored experiences and perceptions of the MC and theperceived impact on performance, and communication practices and perceived support to players.This chapter showed that significant associations existed between the age category of athletes andthe perception of the MC impacting performance. Furthermore, with limitations in communicationidentified both generally in athletes’ personal lives, but also within sport, Chapter 4 sought tofurther investigate the available support to athletes within sport. This was performed byinterviewing football coaches to understand their awareness and perceptions of the MC relative tofootball performance, and explore their lived experience and the influence this has on MCknowledge and communication between coach and athlete. Chapter 4 showed that coachesperceived a culture of secrecy and limited visibility influenced their communication with athletesand their ability to develop their knowledge. The communication which did happen was impactedby the dynamic between coach and athlete, further influenced by various inter-personal factors.Importantly, coaches perceived themselves to have limited knowledge on the MC, impacting theirability to support players. Chapters 5 and 6 aimed to target this knowledge through developing aprotocol to improve coach education, aiding the culture of discussion within sport and in turnwidening the support accessible to athletes. Chapter 5 identified key determinants worthy ofinclusion within education, such as the need for practical information focused on communicationto athletes, and the development of education resources following a design-thinking model. Thisframework included feedback to model the concise nature of information to provide simple visualguides for coaches to make actionable steps towards improving support. Chapter 6 assessed theeffectiveness of this education, finding that whilst total assessed knowledge did not significantlyimprove following education, football coaches’ ratings of confidence in providing practicalsupport strategies did. In summary, the work in this PhD provides a significant and originalcontribution to the literature by establishing the importance of considering athlete age whendeveloping our understanding of menstrual health and the culture influencing the support available.Furthermore, this research provides clear and novel documentation of developing menstrual healthsupport resources, creating a vital step forward within both academia to improve understanding ofsport-specific support, but also within practice to ensure athletes and coaches are offered relevantprovision to improve discussion and support strategies. Collectively, this research aims to not onlyfill a notable gap within the literature, but also to provide a practical toolkit to embed menstrualhealth within athlete support systems.