A Conceptual Framework for Menstrual Health in Sport Research: Integrating Theory, Causality and Validation

Background: Menstrual health in sport represents a complex domain shaped by biological, psychological, and contextual factors, with the menstrual cycle serving as a fundamental physiological process affecting female athletes across multiple dimensions. While research in this area is growing, it often lacks a unifying sport-specific framework to guide theory development, data interpretation, and practical application. The absence of coherent theoretical structures has hindered the advancement of knowledge regarding how menstrual-related phenomena influence athletic performance, health, participation, and behavior. A comprehensive framework capable of integrating diverse constructs and supporting rigorous empirical inquiry is therefore urgently needed. Methods: This review synthesizes evidence from sports medicine, endocrinology, and research methodology to propose an overarching conceptual framework for menstrual health in sport. The framework integrates key constructs into a nomological network, with menstrual-related effects representing primary mechanisms through which menstrual phenomena are theorized to causally influence sport-related outcomes. The utility of causal directed acyclic graphs for formal empirical testing is examined, and the integration of heuristic frameworks with formal causal modeling approaches is explored. Results: The proposed framework brings together key elements, linking constructs to outcomes through clearly identified mechanistic pathways that enhance biological and theoretical plausibility. When constructs are connected through explicit mechanisms, it reinforces justification within a broader system of theory and strengthens the evidential basis for validation. However, while useful for organizing constructs and stimulating theory-driven inquiry, the informal framework offers primarily heuristic value and is insufficient for formalized empirical testing. The adoption of causal directed acyclic graphs is advocated for investigating specific research questions, as these mathematical models explicitly encode variables, hypothesised causal pathways, mechanisms, and confounders in a formal causal structure enabling systematic estimation of causal effects from observational data. Conclusion: The integration of a heuristic conceptual framework with formal causal directed acyclic graph methodology provides both a structured foundation for organizing knowledge and the formal modeling approach required to address specific research questions. This dual approach enhances transparency, interpretability, and rigor in menstrual health research, ultimately strengthening empirical inquiry and supporting evidence-based practice.

کلیدواژه ها:

Menstrual health ، Sport ، Conceptual framework ، Causal inference ، Directed acyclic graphs ، Female athletes