The Menstrual Health Manager (MHM): A Resource to Reduce Discrepancies Between Science and Practice in Sport and Exercise

Abstract

Inadequate research on female health and performance; the complexity of the research; low menstrual health literacy of athletes, coaches, and support staff; and ethical and cultural sensitivities are all recognized as barriers to effective health monitoring for females in sports. Frameworks have been developed for academics to follow to help improve the quality of female-specific research. However, a similar resource that enables correct terminology, and use of health monitoring techniques has not been provided for sporting organizations, coaches, support staff or athletes. Therefore, this critical commentary presents a new resource, the Menstrual Health Manager. This resource may be used to determine the level of menstrual health monitoring detail that may be used by organisations, coaches or athletes, and specifies what reproductive health details the data will provide. This resource aims to provide organizations and coaches with a means of understanding the data that inform their decisions for female athletes. Utilization of this resource may aid in the consistent use of terminology and methods for female-specific health monitoring in both sports and research.

Fig. 1

A basic decision tree for determining menstrual cycle status. Commencing at the black root node ‘female’, simple binary questions (orange) can be completed to move progressively until a leaf (blue) node is reached. If responses to binary questions land on the green leaf node, then the individual using the resource should progress to Fig. 4. IUD intrauterine device

Fig. 2

An extension of Fig. 1 that can be used to determine the menstrual cycle status of a naturally menstruating female (black root node). Answering the menstrual cycle monitoring binary questions (orange) will progressively move the individual towards a leaf (blue), helping to establish the menstrual cycle status of the individual in each cycle. Detailed descriptions of each leaf (blue) are provided in Table 1. The menstrual cycle monitoring techniques and questions (orange) that are required to complete this decision tree are outlined in Table 2. Of note, ovulation in the decision tree has been stated as probable if a urinary ovulation test (LH surge) has been completed and is positive. To confirm ovulation a progesterone (P4) blood test will need to be completed 7–9 days after the urinary ovulation test. LH luteinizing hormone

Fig. 3

An overview of the continuum of female hormonal profiles, adapted from Allaway et al. [43], that correspond to each leaf in the naturally menstruating female decision trees (Figs. 1 and 2). After the individual has worked their way through the decision trees to identify the appropriate leaf and hence the menstrual cycle status of the individual, the assigned code on each leaf can be linked to the image and lay summary provided here or to a written description provided in Table 1. E1G urine metabolite of estrogen, estrone-3-glucuronide, PdG urine metabolite of progesterone, pregnanediol glucuronide, LH luteinizing hormone, FSH follicle-stimulating hormone

Fig. 4

Basic decision tree for hormonal contraceptive users. Commencing at a root node (black), binary questions (orange) can be completed until a leaf node is reached (blue). Details of each leaf node are provided in Table 3 and can be used collectively to provide education on the different types of hormonal contraception available to females. Details on menstrual health monitoring techniques for hormonal contraceptive users are provided in Table 2. OCP oral contraceptive pill, IUD intrauterine device