In 2023, Associate Professor Mette Hansen was contacted by her colleague Knud Ryom after DBU had requested a report on how the menstrual cycle affects women playing football at a high level.

“Knud said the topic was at the edge of his research area, but that I should be involved to cover the physiological aspects. Not long after, we were sitting in a meeting with DBU, who were truly passionate about the project. The demand for research-based knowledge came directly from players and coaches,” says Mette Hansen.

Work then began to secure funding to set up a so-called ‘journal club’ with Mette Hansen, postdoc Mette Bisgaard, and several sport science students. Meanwhile, Knud Ryom and a colleague looked at the broader issues of wellbeing, welfare, and culture in women’s football.

The group’s work culminated in a report reviewing 52 scientific articles, mapping how the menstrual cycle influences female football players’ performance, wellbeing, and overall health.

You can’t just order specific research

However, the collaboration required a good deal of expectation management.

“DBU wanted age-specific recommendations from the report, but the existing research is not robust enough to support that. We had to clearly indicate what the report could say and what it couldn’t. For example, the findings are only relevant to players not using hormonal contraception - which is less than half,” explains Mette Hansen.

For Mette Hansen and her colleagues, the project was about gathering knowledge and communicating it in a way that could be used in practice.

“DBU wanted clear, definitive conclusions, but in research, things are rarely black and white. It’s a classic challenge: balancing scientific nuance and necessary caveats with providing useful recommendations,” she says.

White shorts are a no-go for women

The report found that between 70 and 100 percent of participating female football players experience physical or mental symptoms either sometimes or during every menstrual cycle - such as stomach cramps, lower back pain, fatigue, mood swings, or reduced energy. All factors that can affect training and performance.

At the same time, it showed that 83 percent of players do not talk to their coaches about the subject. For many, menstruation is still taboo, which can impact their wellbeing.

“Something as practical as removing the requirement to wear white shorts can make a big difference. If a player is more worried about leaking than the game itself, it directly affects performance,” Mette Hansen explains.

Offering a counterbalance to the tone on social media

The work didn’t stop with the publication of the report earlier this year. DBU has since used the findings in podcasts, webinars, and presentations for coaches, with Mette Hansen and her colleagues also taking part.

“It’s important to break the taboo. And we’ve also discussed the dilemmas that greater focus on the issue might bring. If a player mentions symptoms before an important match, there’s a risk she won’t be selected. So how do you create a safe space for open dialogue without unintended consequences? That’s something DBU has become much more aware of,” says Mette Hansen.

When asked why she feels it’s important to contribute to a report like this and the ongoing communication work, the answer is clear.

“The debate about the menstrual cycle’s role in elite sport has received massive attention, often with exaggerated messages,” she says, elaborating:

“I wanted to provide a counterweight to the type of coverage the topic often gets on social media. We must distinguish between well-documented knowledge and compelling stories from influencers on TikTok. Otherwise, we risk placing unnecessary pressure on players who feel they must always take their cycle into account - even though symptoms only occur sometimes and vary greatly.”

Keen to do even more communication work

For Mette Hansen, it's a constant balancing act to prioritise between new projects and the communication of existing knowledge.

“I do feel a bit guilty that we haven’t launched a major lecture series aimed at Danish football coaches. But my core task is to conduct new research, and time unfortunately has to be weighed carefully. Still, it’s obvious that we should do even more with this topic and get the report out into the clubs,” she says, and adds:

“I’m motivated when someone truly needs the results. Then you know the research doesn’t just live in scientific articles and academic recommendations. It can make a real difference in practice and improve people’s lives. That’s when my work truly feels meaningful.”

According to DBU, the report is only the first step in developing guidelines on how the menstrual cycle can be addressed as a natural part of everyday life in football environments.

Contact

Associate Professor Mette Hansen
Aarhus University, Department of Public Health
Phone: +45 51 66 65 51
Email: mhansen@ph.au.dk