“Do elite sport first, get your period back later.” Are barriers to communication hindering female athletes?

Competitive female athletes perceive their hormonal cycles to affect their training, com-petition performance and overall well-being. Despite this, athletes rarely discuss hormonal-cycle-related issues with others. The aim of this study was to gain an in-depth understanding of the perceptions and experiences of endurance athletes and their coaches in relation to barriers to athlete– coach communication about female hormonal cycles. Thirteen Swedish national-/international-level female cross-country skiers (age 25.8 ± 3.6 y) and eight of their coaches (two women and six men; age 47.8 ± 7.5 y) completed an online survey relating to their educational background, prior knowledge about female hormonal cycles and a coach–athlete relationship questionnaire (CART-Q). They then participated in an online education session about female hormonal cycles and athletic performance before participating in semi-structured focus-group interviews. Thematic analyses revealed three main barriers to communication: knowledge, interpersonal, and structural. In addition, the results suggested that a good coach–athlete relationship may facilitate open communication about female hormonal cycles, while low levels of knowledge may hinder communication. To over-come the perceived barriers to communication, a model is proposed to improve knowledge, de-velop interpersonal relationships and strengthen structural systems through educational exchanges and forums for open discussion.