Daily Symptom Tracking Across the Menstrual and Hormonal Contraceptive Cycle in Exercising Females: A Daily Record of Severity of Problems-Based Prospective Cohort Study

Purpose : This study aimed to investigate phase-specific symptom patterns across the menstrual and hormonal contraceptive (HC) cycles in exercising females. A total of 42 participants were initially screened; eight were excluded due to not meeting hormonal criteria for eumenorrheic status, resulting in a final sample of 20 eumenorrheic and 14 HC users. Participants completed the Daily Record of Severity of Problems questionnaire daily over one hormonal cycle. Hormonal profiles were verified through serum hormone analysis. Symptom data were analyzed by grouping days into hormonal phases. Results : In eumenorrheic females, symptom severity peaked during the early follicular and late luteal phases, particularly in mood, behavior, and pain dimensions. The ovulatory, early luteal, and midluteal phases were the most stable, with minimal symptom expression. In contrast, HC users showed fewer fluctuations, though pain-related symptoms increased during the withdrawal bleeding phase. When comparing groups, eumenorrheic participants reported significantly more intense and frequent symptoms across all phases, especially in behavior and impairment dimensions during bleeding and late luteal phase. Conclusions : These findings highlight the importance of monitoring menstrual beyond the bleeding phase, as key symptomatology arises in less visible phases, such as the late luteal phase. Moreover, the relative stability observed in ovulatory, early luteal, and midluteal phases may represent favorable phases for athletic performance, given the minimal presence of adverse symptoms. HC use appears to attenuate but not suppress symptoms.