Table 7.
Framework for female field-based interventions for monitoring and assessment of the endocrine milieu
| Outcome | Methodology | Athlete burden | Cost | Comments |
|---|---|---|---|---|
| Menstrual cycle tracking, menstrual cycle status assessmentsa | ||||
| Cycle tracking (cycle length, duration of bleeding) |
What: Appsb (e.g., Flo, Clue, Garmin) Calendar When: Calendar tracking throughout the cycle |
Relatively low to Medium | Low |
Allows for assessment of cycle length and duration of bleeding Easy to implement in the field Ideally implemented as a 3-month pre-tracking phase prior to the actual data collection period to gain an understanding of individual cycle characteristics and variability |
| Ovulation (day of ovulation) |
What: Urinary LH strips (e.g., Clearblue) When: On day ~ 8 until positive LH surge |
Relatively low | Relatively low to Medium (depending on brand) |
Confirms LH peak and assists in determining timing of sex hormone (and other markers) assessments Relatively easy to implement in the field (NOTE: not all LH peaks confirm ovulation, as anovulatory cycles can occur in the presence of an LH surge. Thus, a sustained (~ 3 day) increase (~ 0.5 ºC) in basal body temperature along with LH detection can further confirm ovulation [1]) |
| Sex hormone concentrations (physiological concentrations of sex hormones throughout the cycle can be used to plot the cycle characteristics) |
What: Urinary (e.g., Oova); Saliva samples Venous blood samples or; Fingerprick blood samples For the measurement of LH, FSH, E2, P4 When: Daily or at 4 time points throughout the cycle (e.g., days ~ 2, ~ 14, ~ 15, ~ 21) |
Medium to high depending on whether home or laboratory-based assessments or whether measured via blood or saliva sampling | High |
Required to confirm menstrual cycle status and hormonal milieu May be challenging to implement in the field; venous blood sampling relies on access to a laboratory or processing and storage of blood samples, likely requiring additional facilities Use of technology such as Oova home test kits provides an alternative solution to the field environment Important to consider test validity prior to implementation |
| Other female specific assessments | ||||
| Menstrual cycle related symptoms (can be used to assess negative and positive symptoms, management strategies and effects on training, recovery, sleep, performance associated with the cycle) |
What: Self-report surveys (e.g., [18]) When: Based on study aims |
Low | Low |
Surveys online or on paper, based on desired outcome Can be utilized to provide information on biopsychosocial considerations around female athlete specific issues Easy to implement in the field ^Can represent a burden to the athlete if long or implemented frequently |
LH, luteinizing hormone; FSH, follicle-stimulating hormone; E2, estrogen; P4, progesterone
aCan be assessed in athletes with irregular or absent cycles or those using hormonal or nonhormonal contraception but with use of different time points. For detailed methodology guidelines please refer to [163, 173]
bSection 4 highlights the need for very careful consideration regarding who has information access and subject confidentiality regarding third-party “apps,” which is especially true of period/menstrual tracking apps that have many benefits, but also potentially many drawbacks, including privacy and confidentiality of personal medical information [76, 77]