Objectives To examine whether menstrual health literacy (MHL) is associated with Australian female footballers' negative perceptions of the menstrual cycle and contraceptive use on athletic performance and availability, and to assess the influence of symptom count on these perceptions. Design Cross sectional survey. Methods Australian football players (n=147) completed a survey assessing menstrual cycle characteristics, contraceptive use, perceived impacts on training and competition, and MHL. Associations between MHL and perceived impacts of the menstrual cycle or contraceptive use were analysed. The relationship between symptom count and these perceptions was also examined. Results Whilst MHL scores were not significantly associated with perceived impacts of the menstrual cycle on training performance (ß=0.29, 95% CI [-0.37, 0.97]), a higher number of symptoms were linked to more frequent reports of negative training impacts (ß=0.09, 95% CI [0.05, 0.14]). Amongst non-contraceptive users, a substantial proportion reported that the menstrual cycle negatively affected their training (67% `sometimes`; 21% `often`) and competition (62% `sometimes`; 18% `often`) performance, as well as training availability (60% `sometimes`; 14% `often`). Conclusions No significant association was found between MHL and perceived menstrual cycle impacts in this cohort. However, symptom count emerged as a key factor, with athletes experiencing five or more symptoms more likely to report frequent negative effects on training performance. These findings suggest that addressing symptom recognition and management may be more critical than MHL alone in supporting athlete well-being and performance. Practical implications • Although MHL scores did not predict perceived impacts in this cohort, MHL remains a modifiable construct that may still support positive behaviours, symptom recognition, and open communication, particularly when paired with practical education that addresses stigma and broader psychosocial influences. • The positive association between symptom count and perceived performance impact highlights the value of helping athletes monitor and recognise their individual symptom patterns. • Given the sensitivity of outcomes to scoring approach and the absence of validated cut-offs, further refinement and validation of MHL questionnaires are needed to support consistent research and practice. • Athletes reported greater perceived impact of menstrual symptoms on training performance than on competition availability, suggesting that day-to-day training environments may permit more open acknowledgement of symptoms. This highlights the role of coaches and support staff in fostering supportive, flexible, and responsive training contexts.
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