Purpose: To compare the frequency and severity of self-perceived negative symptoms associated with the menstrual cycle or hormonal-contraceptive (HC) cycle between (1) HC users and non-HC users and (2) different competition levels. An additional aim was to describe the rate and type of HC use and prevalence of potential menstrual-cycle disturbances in female team handball players. Methods: A total of 136 team handball players, competing at different levels (international, 48; national, 52; local/regional, 36), completed a cross-sectional survey regarding self-reported negative cycle-related symptom frequency and severity, perceived influence on training/competition performance, menstrual function, and current and/or past HC use. Results: Although most players regularly experienced negative cycle-related symptoms, non-HC users reported more frequent and severe cramps (P = .001 to .026), as well as a higher occurrence of fatigue and skin problems (P = .019 to .045), compared with HC users. Negative symptoms such as fatigue were more common and severe for local/regional-level players compared with players at higher (international) competition levels (P = .006-.046). Half (47%) of the players currently used HC, primarily long-acting reversible contraceptives (52%), as well as the combined oral (33%) or progestin-only pill (14%). Notably, only 2% of players altered their training in response to negative cycle-related symptoms, despite 41% perceiving that these symptoms interfered with training quality and athletic performance. Conclusions: Negative cycle-related symptoms are common among team handball players, regardless of HC use, and are perceived by many players to adversely influence their athletic performance.
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