A cross-sectional exploration of associations between menstrual health and eating behaviours in female athletes

Females remain underrepresented in sport and exercise research (1) , and studies examining menstrual health in in conjunction with nutritional behaviours are limited. Evidence indicates that many female athletes have suboptimal dietary intake and diet quality and report disordered eating behaviours (2) , yet the interrelations among these factors and menstrual health across sporting levels are not well characterised. Therefore, this study has two aims. Firstly, to identify associations existing between menstrual health and eating behaviour in female athletes and, secondly, to explore perceptions of this group regarding the impact of menstrual health on athletic performance. An exploratory cross-sectional online survey ( was disseminated during April and May 2024 (ethical approval Ref: LRU/DP-23/24-41676). UK or Republic of Ireland (ROI) residents, ≥18 years old, who trained and/or competed as an athlete prior to and/or during pregnancy within the last eight years were eligible. Demographic characteristics, menstrual health and cycle symptom frequency, disordered eating behaviour (measured by an adapted Eating disorders Screen for Primary Care (3) ) and fruit and vegetable intake were collected and statistically analysed by descriptive statistics, ANOVA and Pearson correlations (significance indicated by p < 0.05) using IBM SPSS. Content analysis was used to interpret participants open-response perspectives on the impact of menstrual health on athletic training and performance.https://doi.org/10.17605/OSF.IO/NCSZK One hundred and sixty athletes were included in this analysis (88.8% UK; 11.2% ROI), with a mean age of 35.1 years ±3.7. Fifty-four (33.8%) trained at national level or above. In relation to their menstrual health, only 33.1% of athletes reported having regular periods. Athletes reported experiencing pre-menstrual symptoms often or always, including pain (32.5%), bloating (45.1%), mood changes (42.6%), cravings (33.8%), and gastrointestinal symptoms (36.3%). Regarding eating behaviours, daily portions of fruit and vegetables were 3.0 ±1.4 and 3.4 ±1.3, respectively. Secret eating was reported by forty-three (26.9%) participants, and fifty-five (34.4%) were dissatisfied with their eating patterns. One hundred and twenty-four (77.5%) reported their self-perception was influenced by their weight. Exploring the interrelations between menstrual health and eating behaviours, no associations were found between high-frequency symptoms and diet quality or differences between diet quality and athlete level. A significant positive correlation was found between high-frequency menstrual symptoms and disordered eating scores (r=0.25, p=0.001). Athletes perceived cramps, pain, GI discomfort, motivation and fatigue as negatively influencing their training. This study highlighted that a minority of athletes report regular periods, whilst experiencing a range of menstrual symptoms that they perceive influence their training. Although no relationship was found between menstrual health and diet quality, the association between high-frequency symptoms and disordered eating behaviours highlights a potential vulnerability among female athletes. This underscores the need for greater attention to the intersection of menstrual health, nutrition, and psychological well-being in athlete care and policy frameworks.