Menstrual Cycle Literacy in Varsity Female Athletes and Coaches

Abstract

Purpose: Menstrual Cycle Literacy (MCL), knowledge, perspectives, attitudes, and behaviours toward menstruation—is internationally low among athletes and coaches but has been underexplored in Canadian varsity sport. Given the menstrual cycle’s influence on cardiovascular, musculoskeletal, and neuroendocrine systems, it can affect performance, recovery, and well-being. Understanding MCL in this population may inform training and health strategies that optimize performance and overall health. This study assessed MCL among Canadian varsity female athletes and their coaches, examining differences by sex (coaches), sport type (team vs. individual), and academic background (health-science vs. non-health-science). Relationships between knowledge, perspectives/attitudes, and behaviours were also explored, and questionnaire reliability was evaluated. Methods: The MCL questionnaire included demographics/training background, knowledge, perspectives/attitudes, behaviours, and a menstrual distress section. A subset (n = 13) completed the questionnaire twice for reliability testing. Analyses included 95% confidence intervals (CI), two-way ANOVA, Mann-Whitney U, Pearson correlation, and Cohen’s weighted kappa (SPSS v.29; p<0.05). Results: Seventy-two athletes and six coaches completed the full questionnaire. Athletes scored higher on total MCL (M = 159.79 ±10.67) than coaches (M = 147.67 ±12.19; 95% CI: -21.25 to -3.00), with significant differences in Perspectives and Attitudes (137.81 ±8.15 vs.128.50 ±10.10) and Behaviours (15.04 ±2.78 vs.12.50 ±3.15). No athlete–coach differences were found in Knowledge scores. Among coaches, female participants scored higher in Behaviours than males (14.25 ±2.06 vs. 9.00 ±0.00). Health-science athletes demonstrated significantly higher Knowledge (p = .005) and Behaviours (M = 16.04 ±3.04 vs. 14.44 ±2.45; p = .003) than non-health-science athletes, with a sport type × program interaction (p = .021). No significant differences were observed by sport type alone. Knowledge was weakly but significantly correlated with Perspectives and Attitudes (r = .353, p = .002) and Behaviours (r = .272, p = .016). Reliability testing showed almost perfect agreement in some items, with most demonstrating moderate to substantial agreement. Conclusion: MCL was low among athletes and coaches, with coaches showing particularly limited literacy. Differences by academic background highlight the influence of formal education. These findings underscore the need for targeted educational interventions to enhance MCL, supporting female athlete health and performance in Canadian varsity sport.