Importance of respect for the menstrual cycle in sports training and competition: a nationwide multisport coach questionnaire.

BACKGROUND: Emerging evidence suggests that menstrual cycle phase may influence injury risk in female athletes, yet whether coaches possess the awareness and tools to act on this information remains unknown in the Swiss sporting context. METHODS: A nationwide, cross-sectional questionnaire-based study was conducted among active coaches working with female athletes across multiple sports and competitive levels in Switzerland. Data were collected electronically between October and December 2025. Outcomes included self-rated knowledge, attitudes toward cycle-based training, current implementation practices, perceived barriers, and hypothetical injury risk decision-making. RESULTS: A total of 261 coaches completed the survey (51% female, 49% male). Self-rated general knowledge of the menstrual cycle was moderate (mean 6.4/10), while self-rated domain-specific knowledge related to performance, recovery, and injury risk was lower (mean 5.8/10). Female coaches reported significantly higher self-rated general knowledge than male coaches (p < 0.0001), whereas self-rated domain-specific knowledge did not differ significantly between genders (p = 0.168). Despite this, attitudes toward cycle-based training were strongly positive across all genders, with coaches rating perceived usefulness at 7.4/10 and willingness to learn at 8.5/10, with no significant gender difference. Implementation, however, was limited: 45% of coaches did not track the menstrual cycle at all, and only 10% actively considered it in training planning, with no significant gender differences in practice. Only 34 of 261 coaches (13%) reported observing specific injuries occurring more frequently in particular cycle phases. When presented with hypothetical risk scenarios, 172 of 200 coaches (86%) indicated they would adapt training, and 138 of 198 (70%) would consider recommending competition avoidance, at some level of elevated hypothetical injury risk. Gender differences emerged in competition-related decision-making, with female coaches showing greater tendency to maintain competition participation (p = 0.003). The most frequently reported barriers were lack of knowledge (68%), insufficient coverage in coaching education (53%), and lack of practical tools (36%). CONCLUSION: Swiss coaches recognize the relevance of the menstrual cycle for female athlete health and demonstrate strong willingness to adapt practices when supported by evidence. However, a substantial gap between awareness and implementation persists, driven by insufficient education and the absence of institutional guidelines. Targeted educational interventions and evidence-based injury risk data are needed to translate coach receptiveness into practice.