-35% of female athletes have an iron deficiency, versus around 5% of the general population

-foods containing vitamin C enhances iron absorption while calcium and caffeine impairs absorption when consumed in close proximity to iron-rich foods/supplements.

-ensure daily energy intake is reached to avoid low energy availability

-It's shown that female athletes struggle to reach daily CHO intake possibly due to; High consumption of low energy, nutrient dense carbohydrates (e.g., fresh fruits and vegetables), Body weight and/or composition fears, Substituting sports drinks with low calorie sweetened, drinks during high-intensity and/or prolonged exercise, Lack of education regarding the importance of, carbohydrates

Negative perception of carbohydrates on social media

-6-10g/kg for endurance of 1-3 hours/day, 8-12g/kg for >4hrs

-Popular media would suggest that female athletes should alter their diet, including their carbohydrate intake, during different phases of the MC. However, there currently is not enough research to back this statement- GAP IN RESEARCH??

-There is some research to suggest that glycogen

storage may be reduced during the follicular phase of the menstrual cycle compared to the mid-luteal phase

-Burke, L. M., Hawley, J. A., Wong, S. H. S., & Jeukendrup, A. E. (2011). Carbohydrates for training and competition. Journal of Sports

Sciences, 29 Suppl 1, S17-27.

-A small number of studies have suggested that there is a small increase in protein utilization at rest and during exercise during the luteal phase

-Areta, J. L., Burke, L. M., Ross, M. L., Camera, D. M., West, D. W. D., Broad, E. M., Jeacocke, N. A., Moore, D. R., Stellingwerff, T.,

Phillips, S. M., Hawley, J. A., & Coffey, V. G. (2013). Timing and distribution of protein ingestion during prolonged recovery from

resistance exercise alters myofibrillar protein synthesis. The Journal of Physiology, 591(9), 2319–2331.

-Fats are essential for the synthesis and acts as the precursor molecule to produce steroid hormones (estrogen and progesterone)- aids reproductive health, hormonal balance and overall well-being.

-20-35% of total daily calorie intake for fats

-Burke, L. M., Kiens, B., & Ivy, J. L. (2004). Carbohydrates and fat for training and recovery. Journal of Sports Sciences, 22(1), 15–30.

-estrogen promotes calcium absorption and retention in the bone- amenorrheic and post-menopausal athletes may require additional calcium intake to maintain

bone health

-1000mg of calcium per day for 19-50 year old women- athletes should not consume more than ~500-600 mg of calcium at one time in order to maximize absorption.

-vitamin D plays a key role in estrogen production-deficiency may influence menstrual status and fertility, as well as bone health

-Supplement 1000-2000 IU of vitamin D3 daily in the winter

-A folate deficiency may result in iron deficiency

anemia, and performance may decline as a consequence

-Oral contraceptive use is also associated with reduced plasma folate and red blood cell folate concentrations, therefore athletes using oral contraception may require an increase in folate consumption

-400mcg of folate for women 19-50

-Haakonssen, E. C., Ross, M. L., Knight, E. J., Cato, L. E., Nana, A., Wluka, A. E., Cicuttini, F. M., Wang, B. H., Jenkins, D. G., & Burke, L.

M. (2015). The effects of a calcium-rich pre-exercise meal on biomarkers of calcium homeostasis in competitive female cyclists: A

randomised crossover trial. PloS One, 10(5), e0123302.

McCormick, R., Sim, M., Dawson, B., & Peeling, P. (2020). Refining Treatment Strategies for Iron Deficient Athletes. Sports Medicine,

50(12), 2111–2123.

McKay, A. K. A., Sim, M., & Peeling, P. (2023). Micronutrient considerations for the female athlete. GSSI Sports Science Exchange

#238.

-During the luteal phase there is an increase

in the threshold (body core temperature set point) for the onset of sweating and/or decreased sweating sensitivity.

However, there are no differences in whole body sweat rates during exercise across MC phases.

-Baker, L. B. (2023). Hydration in physically active women. GSSI Sports Science Exchange #237.

-may be differences in muscle glycogen storage during different phases of the MC; In follicular phase, There may be an increased risk of reduced resting muscle glycogen concentrations if carbohydrate intake is sub-optimal

In the luteal, When carbohydrate intake is sub-optimal, glycogen storage appears to be more effective during this phase in comparison to the follicular phase

-Rehrer, N. J., McLay-Cooke, R. T., & Sims, S. T. (2023). Nutritional Strategies and Sex Hormone Interactions in Women. In A. C.Hackney (Ed.), Sex Hormones, Exercise and Women: Scientific and Clinical Aspects (pp. 87–112). Springer International Publishing.

-caffeine elimination is slower during the luteal phase of the menstrual cycle, and with oral contraceptive use. This accumulation of caffeine

during high estrogen phases of the menstrual cycle may intensify the sympathetic effects of caffeine, as well as enhance pre-menstrual symptoms. Studies suggest that caffeine may decrease the perception of pain in females, which may allow for higher intensity and/or longer

duration training sessions to be completed, resulting in greater physiological adaptations

-to date no research has reviewed the effect of menstrual cycle phase on dietary energy intake.

-Estrogen is hypothesized to suppress appetite, while progesterone, in the presence of estrogen, may have the opposite effect

-Rates of carbohydrate and fat oxidation vary across the cycle, with greater glycogen storage at rest,¹⁰ and a stronger preference for fat utilization during exercise, in the luteal phase compared with the follicular phase.¹¹ Protein catabolism also appears to increase in the luteal phase,^12,13 potentially contributing to the greater resting metabolic rate observed during this time

-Changes in energy intake could have important implications for energy availability (the amount of dietary energy available per kilogram of fat-free mass, after accounting for the energy expended during exercise), particularly in athletes for whom training volume may not be modified to account for phase-related changes in energy intake

-It's seen to be a biopsychosocial phenomenon

-The MC will affect how women feel and interpret bodily changes, symptoms, and effects based on their knowledge, attitudes, and beliefs about it.

-Females have approximately 480 periods during their lifetime

-The brain regulates the MC, causing changes in female sex hormones throughout the cycle (estrogen and progesterone).

-progesterone keeps the uterine lining intact, while oestrogen repairs, thickens, and maintains it.

-follicle stimulating hormone (FSH) and luteinizing hormone (LH).

-FSH promotes the ovary's follicles' growth and development, which results in the production of oestrogen. Ovulation is triggered by an increase in LH during the middle of a MC.

-If females haven't started their period by 16, their period stops for several months, and/or experience severe symptoms they should seek medical advice (common in female athletes due to low energy availability)

-~77% experience negative symptoms during their MC

-82%) of symptoms are experienced in the first 1-2 days of menstruation

-PMS (pre-menstrual syndrome) experience symptoms the week prior to menstruation.

-most common symptoms: stomach cramps, back pain, and mood swings

-Symptoms in Ovulatory phase: Breast tenderness,Bloating

Cramps, Slight rise in body temperature, Increased cervical mucus, Pelvic or abdominal pain

-Symptoms just before and during period: Changes in appetite, Mood swings, Irritability, Fatigue, Bloating, Breast tenderness, Headaches, Cramps, Spotty skin, Lower back pain

-Oligomenorrhea: fewer than 6-8 periods per year

-Amenorrhea: complete loss of periods

-Heavy menstrual bleeding (HMB), which is also known as menorrhagia (one in three exercising females

experience HMB). can reduce confidence and cause iron deficiency.

menstrual health literacy in professional women’s football. Science & Medicine in Football, 1–7.

Brown, N., Knight, C. J., & Forrest Née Whyte, L. J. (2021). Elite female athletes’ experiences and perceptions of the menstrual cycle

on training and sport performance. Scandinavian Journal of Medicine & Science in Sports, 31(1), 52–69.

Bruinvels, G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2016). The prevalence and impact of heavy menstrual bleeding among

athletes and mass start runners of the 2015 London Marathon. British Journal of Sports Medicine, 50(9), 566–566.

Colenso-Semple, L. M., D’Souza, A. C., Elliott-Sale, K. J., & Phillips, S. M. (2023). Current evidence shows no influence of women’s

menstrual cycle phase on acute strength performance or adaptations to resistance exercise training. Frontiers in Sports and Active

Living, 5, 1054542.

D’Souza, A. C., Wageh, M., Williams, J. S., Colenso-Semple, L. M., McCarthy, D. G., McKay, A. K. A., Elliott-Sale, K. J., Burke, L. M., Parise,

G., MacDonald, M. J., Tarnopolsky, M. A., & Phillips, S. M. (2023). Menstrual cycle hormones and oral contraceptives: A multimethod

systems physiology-based review of their impact on key aspects of female physiology. Journal of Applied Physiology (Bethesda, Md.:

1985), 135(6), 1284–1299.

Elliott-Sale, K. J. (2024). History, ovarian hormones and female athletes. GSSI Sports Science Exchange #254.

Elliott-Sale, K. J., McNulty, K. L., Ansdell, P., Goodall, S., Hicks, K. M., Thomas, K., Swinton, P. A., & Dolan, E. (2020). The Effects of

Oral Contraceptives on Exercise Performance in Women: A Systematic Review and Meta-analysis. Sports Medicine, 50(10), 1785–

1812.

Holtzman, B., & Ackerman, K. (2021). Practical Approaches to Nutrition for Female Athletes. GSSI Sports Science Exchange #215.

Martin, D., Sale, C., Cooper, S. B., & Elliott-Sale, K. J. (2018). Period Prevalence and Perceived Side Effects of Hormonal Contraceptive

Use and the Menstrual Cycle in Elite Athletes. International Journal of Sports Physiology and Performance, 13(7), 926–932.

McKay, A. K. A., Minahan, C., Harris, R., McCormick, R., Skinner, J., Ackerman, K. E., & Burke, L. M. (2024). Female Athlete Research

Camp: A Unique Model for Conducting Research in High-Performance Female Athletes. Medicine and Science in Sports and

Exercise, 56(4), 706–716.

McNulty, K. L., Elliott-Sale, K. J., Dolan, E., Swinton, P. A., Ansdell, P., Goodall, S., Thomas, K., & Hicks, K. M. (2020). The Effects

of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis. Sports

Medicine, 50(10), 1813–1827.

Solli, G. S., Sandbakk, S. B., Noordhof, D. A., Ihalainen, J. K., & Sandbakk, Ø. (2020). Changes in Self-Reported Physical Fitness,

Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes. International

Journal of Sports Physiology and Performance, 15(9), 1324–1333.

Gatorade Performance Partner: https://performancepartner.gatorade.com/resources/resource/beginning-day-1-checklist-how-to-

coach-and-support-women-and-teen-girl-athletes

AIS Female Performance & Health Initiative: https://www.ais.gov.au/fphi/education

1) MENSTRUAL PHASE: The first day of your period, when you experience bleeding. 3-7 days.

2) FOLLICULAR PHASE: begins on the day you get your period and ends at ovulation (0verlaps Menses). Oestrogen rises

3) OVULATION PHASE: occurs roughly at about day 14 in a 28-day menstrual cycle. Sudden increase in Luteinising Hormone (LH)- causes ovaries to release egg.

4) LUTEAL PHASE: lasts from about day 15 to day 28. Progesterone rises to help prepare your uterine lining for pregnancy.

I aim to be finished collecting data by the 1st of March.

I have collected 10 participants.

some point

May be to prevent pregnancy, to alter MC around competition, or to prevent negative side effects of the MC

-Combined pill is most common; an ‘active’ pill is taken for

21 days, followed by an ‘inactive’ pill (or no pill) for 7 days, during which a withdrawal bleed occurs, a result of the levels of the artificial hormones temporarily

decreasing

-Hormonal Contraception reduce the amount of natural occurring estrogen and progesterone, because they provide artificial hormones into the body

'An increase of approximately 0.5 kg was observed during women's menstrual cycle, mostly due to extracellular fluid retention at menstruation days'

Previous studies examining the possible effect of menstrual cycle on body composition have failed to reach consistent results
Recommendations: Magnesium and calcium supplements — Magnesium and/or calcium supplements may help alleviate fluid retention caused by your menstrual cycle. A recent study found that low calcium and magnesium levels during the luteal phase lead to more severe PMS symptoms, including weight gain and bloating associated with fluid retention. Always talk to your health care provider before starting any new medication, including supplements, as they can interact with other medications that you may already be taking.

Consider athletes for whom training volume may not be modified to account for phase-related changes in energy intake. Low energy availability can lead to severe health consequences, including menstrual disturbances, impaired bone health, endocrinological effects, decreased athletic performance and increased risk of injury and illness.²¹ Consequently, if energy intake is lower during certain periods of the menstrual cycle, additional nutritional support may be required to ensure adequate energy availability (Mountjoy et al., 2018).

Verification of menstrual phase with serum estrogen and progesterone concentrations is now considered the gold standard protocol for research.

-physiological differences exist between the sexes, such that research conducted in males may not always be directly applicable to females.⁵ One of these differences is the MC

- Approximately 90% of females experience food cravings during the premenstrual phase/luteal phase (Chumpalova et al., 2020).

During the menstrual cycle, steroid hormones influence food cravings and consumption especially in the luteal phase, when craving for certain foods has been reported to increase (Krishnan et al., 2016).

-satiety hormones like leptin influence taste sensitivity and, consequently, dietary choices.

-women with higher estradiol during the luteal phase reported consuming more carbohydrate-rich foods and sweet foods

-Leptin was inversely associated with reported consumption of sweet tasting foods and fat-rich foods

-91.78% of adult women during the menstrual cycle with emphasis on high cravings for sweets (87%) and fast food (33.8%) during the luteal phase (Meneghesso et al., 2022).

-Potential role of inflammation in premenstrual symptoms as inflammatory markers, like C-reactive protein (CRP) and several cytokines (tumor necrosis factor (TNF)-α and interleukin (IL)-6), fluctuate throughout the menstrual cycle (Bertone-Johnson et al., 2014).

-Most studies don't focus on specific carbohydrates/fats etc-gap in research.

-the early-follicular phase, characterized by low estrogen and low progesterone; (2) the late-follicular phase, characterized by high estrogen and low progesterone; (3) the ovulatory phase, characterized by medium estrogen and low progesterone; and (4) the mid-luteal phase, characterized by medium estrogen and high progesterone

https://onlinelibrary.wiley.com/doi/full/10.1002/ajhb.23951

https://pmc.ncbi.nlm.nih.gov/articles/PMC10251302/

https://pubmed.ncbi.nlm.nih.gov/33004685/

https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.30.1_supplement.418.6

Chumpalova, P., Iakimova, R., Stoimenova-Popova, M., Aptalidis, D., Pandova, M., Stoyanova, M. and Fountoulakis, K.N. (2020) ‘Prevalence and clinical picture of premenstrual syndrome in females from Bulgaria’, Annals of General Psychiatry, 19(1). Available at: https://doi.org/10.1186/s12991-019-0255-1.

https://www.sciencedirect.com/science/article/pii/S2405457723001468#bib3

Meneghesso, B.R., Constâncio, G.R., Rinaldi, M.M., Silva, N.F. e, Dalmaso, P.T., Marcello, V.Z., Avance, A.D. de, Filho, D.R. and Costa, T. (2022) ‘Evaluation of premenstrual syndrome and its relationship with changes in food consumption during the luteal phase in a university center in northwest paulista: a prospective observational cross-sectional study’, International Journal of Nutrology, 15(3). Available at: https://doi.org/10.54448/ijn2236.

Bertone-Johnson, E.R., Ronnenberg, A.G., Houghton, S.C., Nobles, C., Zagarins, S.E., Takashima-Uebelhoer, B.B., Faraj, J.L. and Whitcomb, B.W. (2014) ‘Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women’, Human Reproduction, 29(9), pp. 1987–1994. Available at: https://doi.org/10.1093/humrep/deu170.

How Long Do You Take the Eloine Combined Pill?

1. Daily for 21 days:

   • Like other combined pills, you take the Eloine pill for 21 days, with one pill every day at the same time.

   • After finishing the 21 pills, you take a 7-day break (during this time, you won’t take any pills, and you'll likely experience a withdrawal bleed, similar to a period).

2. 21-day cycle, followed by 7-day break:

   • The cycle follows the pattern of 21 active pills (which contain hormones) and 7 inactive (placebo) pills or no pills at all.

   • After the 7-day break (during which you have your withdrawal bleed), you start a new pack of Eloine.

3. How long can you take it?

   • You can use the Eloine combined pill for as long as you need contraception, depending on your health and whether your doctor advises it. Some people may use it for several years, while others might switch to a different form of contraception if they experience side effects or wish to start a family.

Important Points About the Eloine Combined Pill:

1. Effect on Menstrual Cycle:

   • Regular, predictable withdrawal bleed: The Eloine pill typically provides regular and predictable bleeding during the 7-day break, which mimics a natural period. However, it's not a true menstrual period — it's a withdrawal bleed caused by the drop in hormone levels.

   • Some women may experience lighter, shorter periods or no bleeding at all over time, especially if they use the pill continuously or skip the 7-day break. However, this is usually not harmful and is sometimes preferred by users.

2. Effect on Hormonal Fluctuations:

   • Because the Eloine combined pill contains both estrogen and progestin, it suppresses ovulation (the release of an egg), which prevents pregnancy.

   • It also stabilizes hormone levels during the menstrual cycle, preventing the typical hormonal fluctuations that occur in a natural cycle. This could influence things like cravings, mood, and weight. Many women report feeling more stable and experience fewer mood swings or food cravings compared to natural cycles.

3. Side Effects:

   • While many women tolerate the Eloine pill well, side effects can include nausea, headaches, mood changes, and breast tenderness. It’s important to monitor how participants on the Eloine pill feel during the study, as these side effects could impact things like cravings or well-being.

This review aimed to synthesize the published literature on dietary energy intakes of naturally menstruating females in various phases of the menstrual cycle. The review critiques the relevant literature in light of recent publications on good practice for female research, explores the impact of the MC on energy intake, identifies gaps within the evidence base, and informs future research. Overall, energy intake appears to be lower in the follicular phase compared with the luteal phase, with a particular decrease in the days leading up to and including ovulation. The magnitude of these fluctuations is not yet clearly quantifiable and most likely varies, both between individuals, and from cycle to cycle. This review notes the lack of high-quality research investigating the energy intakes of females across the menstrual cycle, and the very limited data available for female athletes and others who undertake large amounts of physical activity. It also highlights the need for researchers to take into consideration anovulatory cycles and the potential effects of premenstrual disorders on dietary intake.

• Ethinylestradiol (a synthetic form of estrogen)

• Drospirenone (a synthetic form of progestin)

Key points about Yasmin:

• It works mainly by preventing ovulation (stopping the release of an egg).

• It also thickens cervical mucus (making it harder for sperm to reach an egg) and thins the uterine lining (making it less likely for a fertilized egg to implant).

• Drospirenone is different from older progestins — it has anti-androgenic and mild diuretic effects. This means Yasmin can help reduce acne, bloating, and water retention in some users.

• Each active pill contains 30 micrograms of ethinylestradiol and 3 mg of drospirenone.

• Yasmin is usually taken once daily for 21 days, followed by 7 days of no pills or placebo pills, during which a withdrawal bleed (similar to a period) occurs.

Important considerations:

• Like all combined pills, Yasmin slightly increases the risk of blood clots (venous thromboembolism), especially compared to some older pills.

• It is not recommended for people with certain risk factors (e.g., smokers over 35, history of clotting disorders, high blood pressure).

• Besides contraception, it’s sometimes prescribed to treat acne, polycystic ovary syndrome (PCOS) symptoms, and premenstrual dysphoric disorder (PMDD).

• Ethinylestradiol (30 micrograms — a synthetic estrogen)

• Levonorgestrel (150 micrograms — a synthetic progestin)

Key points about Microgynon 30:

• It prevents pregnancy by stopping ovulation, thickening cervical mucus, and altering the uterine lining.

• It's taken once daily for 21 days, followed by 7 days of no pills or placebo pills, during which a withdrawal bleed occurs.

• Levonorgestrel is an older generation progestin — compared to newer progestins (like drospirenone in Yasmin), it has slightly more androgenic activity, which can sometimes cause minor side effects like acne in sensitive individuals.

• Microgynon 30 is considered very effective, reliable, and well-tolerated. It’s often prescribed because it’s cheap, simple, and widely available.

• Like other COCPs, it carries a small increased risk of blood clots, but levonorgestrel pills (like Microgynon 30) are considered lower risk compared to pills with newer progestins.

Important notes:

• It’s sometimes preferred for first-time users of the pill because of its long safety record.

• It can also help with period regulation, lighter periods, and reduced menstrual cramps.