A self-contained path towards optimisation and awareness: an interview study exploring the management of menstrual cycle-related symptoms and hormonal contraceptives among elite female athletes in Sweden

Background: Female athletes face unique health challenges related to the menstrual cycle and hormonal contraceptives. Despite increased research, knowledge gaps persist, leading to inadequate training adaptations, underreported menstrual irregularities and insufficient support. Societal pressures and critical comments exacerbate body dissatisfaction and stress. The aim was to explore experiences of management regarding female health issues related to the menstrual cycle and hormonal contraceptives in Swedish female elite athletes from various sports.Methods A descriptive design with a qualitative inductive approach was used. Semi-structured interviews were conducted with 16 female elite athletes. Purposeful sampling ensured diversity in sport type, years of involvement, training hours, age and onset of menstruation. Qualitative content analysis was used, and an overarching theme, categories and subcategories were constructed based on the participants’ experiences and perceptions.Results An overarching theme, ‘A self-contained path towards optimization and awareness’, and five categories described the participants’ management: ‘Ignoring the symptoms’, ‘Eliminating the symptoms’, ‘Adaptation to the menstrual cycle’, ‘Taboos, security and communication’, and ‘Gaining knowledge and seeking support’. Twelve subcategories further illuminated these categories. The overarching theme reflected the athletes’ way of dealing with female health issues on their own due to lack of support, and the categories described how they handled the circumstances.Conclusion Although not all athletes experienced symptoms related to the menstrual cycle or hormonal contraception, many managed their menstrual health independently, highlighting the need for better education and support from coaches, medical teams and sports organisations. Future research should integrate menstrual health management into athlete development programs.