Bad Blood? Menstrual pain, stigma, and mental illness in competitive sport cultures

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The impact of menstruation on female athlete performance and wellbeing has emerged as a priority issue within sport. Menstruation is often accompanied by psychological, physical, and behavioural symptoms that disrupt daily functioning in many aspects of life. Half the world's population menstruates, yet it is associated with significant societal and cultural taboo. Elite athletes, such as Iga Swiatek have been credited with breaking the silence on the impact menstruation can have on athletic performance and the lack of professional knowledge on how to manage it. The current programme of research aims to prioritise female athletes' voices to explore menstruation challenges within competitive sport cultures.Most menstrual research has focused on how female athletes objective symptoms, such as reduced focus and extreme pain, disrupt training and performance. Framing menstruation as a physiological issue has raised awareness of athlete's struggles, however, it places the "problem" of menstruation inside women's bodies. The risks associated with demonising a natural biological process has resulted in some athletes preferring not to menstruate at all, by taking continuous hormonal contraception. Purely physiological perspectives ignore the social and cultural influences on menstrual experiences and do not consider the role elite sporting environments may have on athlete menstrual health and performance. Within the general population, menstruation can be deemed unclean and disgusting, leading to psychological stress and shame. Menstrual issues can lead to the development of mental disorders, such as pre-menstrual dysphoric disorder and for some women, suicidal ideation. Despite the proliferation of mental health research in sport, athlete menstrual stigma, shame, and mental ill health are yet to be studied. This stigma leaves athletes too fearful to disclose menstrual issues and unable to access support. Addressing these gaps, this research will broaden the focus of athletes' menstrual experiences beyond performance impacts, to include wider mental health. Specifically, through a series of studies, we will explore personal narratives of athletes who experience severe menstrual symptoms and mental ill health. The first phase of this studentship will deploy narrative research to explore athletes' experiences of menstruation and mental illness in sport, particularly exploring how sport environments and associated social factors interact to shape challenging menstrual experiences. Building upon this, phase 2 will utilise reflexive thematic analysis to explore how athletes disclose menstrual issues to their coaches and/or teammates. There will be an explicit focus on what led to the disclosure, how the disclosure was made, and the perceived response and associated impacts. In phase 3, participatory research will be used to co-produce an interactive psychoeducational intervention to support healthier sport environments for female athletes, by female athletes. Results will hold relevance for organisations and applied practitioners committed to improving practices that support female athletes to manage menstrual cycle challenges in a performance setting.