History and knowledge of menstrual cycle status and hormonal contraceptive use in female equestrian athletes

There is a high prevalence of hormonal contraceptive (HC) use in athletic populations despite reported impacts on performance such as cognitive control and muscle functions. Whilst research is emerging in female athletes, there is a paucity of evidence concerning female equestrian athletes. Therefore, the objectives of this study were to: 1) identify the prevalence of HC use, menstrual cycle disturbances and symptoms of their cycle and HC use in female equestrian athletes and 2) to assess knowledge of the menstrual cycle and oral contraceptives. One hundred sixty-six female semi- and professional equestrian athletes (mean ± SD; age, 27 ± 8 years; body mass, 65.8 ± 13.6 kg; height, 166.6 ± 7.8 cm) completed an online survey using two adapted questionnaires from Oxfeldt et al. (2020) and Larsen et al. (2020). In total 57% of athletes were currently using HC, with the majority using the combined pill (51%). Over half (67%) of HC users reported using HC to avoid bleeding. While 30% of non-HC users reported menstrual disturbances in the last three months, 14% and 4% were classified as being secondary amenorrhoeic and primary amenorrhoeic, respectively. Although 57% of all athletes reported that negative menstrual cycle symptoms caused them not to participate or complete their scheduled training, non-HC users experienced more negative physical symptoms across their menstrual cycle compared to HC users pill cycle (p<0.02). The total knowledge score achieved by all athletes was 7.0±2.3 points (out of 12 points), with only 14% of athletes scoring >10 points (classed as a good knowledge score). There was a significant difference reported between HC and non-HC users in their total knowledge score (p<0.01), with current HC users scoring 0.9 points higher than non-HC users in their total knowledge score. Female equestrian athletes require further education about the menstrual cycle and HC to facilitate optimal management. As support teams for the equestrian are less integrated than many athlete support systems, governing bodies may be ideal to support the dissemination of such literature.