Influencing factors of sport performance during menstruation in elite female football players: a semi-structured interview-based study

This interview study used qualitative content analysis to identify and explain the factors that influence female football players' sport performance during menstruation and to examine the interrelationships among these main factors. Semi-structured interviews were conducted with 19 elite female football players from a professional club in Beijing. The interview transcripts were first analysed using a three-stage coding process to identify the main influencing factors. Subsequently, the connections among these factors were examined within the Stimulus-Organism-Response (S-O-R) model. Within the S-O-R framework, the Stimulus component comprises menstrual stressors and the team ecosystem; the Organism component comprises psychological states, cognitive integration, and regulatory strategies; and the Response component comprises sport performance-related abilities. When female athletes are menstruating, the stimuli may not only have a direct impact on the response, but may also influence it indirectly through the mediating processes represented by the organism. According to the results, several practical recommendations were proposed: (1) a tiered menstrual-status assessment protocol should be established to differentiate training and leave procedures, integrate menstrual health monitoring, and implement periodized training models. (2) menstrual stigma should be reduced through adolescent education and coach training. (3) stress-response simulation training and a 'menstrual coping repository' should be designed to facilitate personalized interventions.