Health Epidemiology in the women’s Rugby (HER) World Cup 2025
Project Lead: Dr Izzy Moore
14.10.2025
Research team: Dr Sandro Vella, Ms Elin James & Dr Molly McCarthy-Ryan
1 Introduction
Female health is a crucial part of sports medicine in Women’s rugby. In 2023, the female athlete health domains were proposed as a step towards addressing the unique health needs of female athletes (1). Stepping away from a traditional time-loss injury surveillance approach to consider health problems that do not lead to missing training or matches requires a new surveillance system to be developed.
Following suggestions put forward to move the rugby field forward with female health research, the “Health Epidemiology in the women’s Rugby (HER) World Cup 2025” project was created (2).
The HER World Cup 2025 project aimed to:
- Develop and pilot a GDPR compliant non-time-loss female athlete health surveillance system
- Embed the female athlete health domains into the system
- Collect and analyse data from two national teams during the World Cup 2025
- Quantify the prevalence of female health problems in the World Cup context
2 Results
2.1 Prevalence of female health problems
A high prevalence of female health problems was observed in the 2025 World Cup (Table 1). Nearly half of the players sustained a female health problem, with 1 in 10 of the health problems requiring training to be modified. A quarter of the female health problems were ongoing issues, whilst almost all were recurrent in nature.
Table 1: Top-level summary of the HER World Cup 2025 data
| Variable | Prevalence |
|---|---|
| Players with health problems (% of cohort) | 45 |
| Modified training (% of health problems) | 11 |
| Ongoing health problem (% of health problems) | 26 |
| Recurrent health problem (% of health problems) | 93 |
2.2 Female athlete health domains
One-third of the health problems were related to the menstrual and gynceacology health domain (Figure 1). The pelvic floor health domain and breast health domain had a similar prevalence (~10%).
The three health domains reported in the HER World Cup 2025 project have a lower prevalence than previous retrospective data on each domain (pelvic floor health (3); menstrual and gynceacology (4); breast health (5)). This discrepancy between prospective and retrospective data highlights the importance of developing a health surveillance system that can accurately capture these non-time-loss health problems and support national governing bodies to appropriately resource each domain.Figure 1: Prevalence (%) of all health problems and of players affected by female health problems grouped by female health domain in the 2025 World Cup
The pevlic floor health domain was the most prevalent domain for training modifications and ongoing issues (Figure 2), followed by the menstrual and gynceacology health domain.
In contrast, previous retrospective studies report two-thirds of elite rugby players perceive an impact on their training due to the menstrual health compared to one-third of players reporting modified training due to pelvic floor health (3,4).
All female health domains had a very high recurrence prevalence, indicating players experience a variety of repeated health problem episodes across several domains.
Figure 2: Prevalence (%) of modified training, ongoing health problems and recurrent health problems by female health domains in the 2025 World Cup
2.3 Domains and menstrual cycle day
The female health surveillance system recorded the day of the menstrual cycle that health problems occurred. This is only relevant for health problems that are not ongoing and was not possible to record for all health problems.
As Figure 3 shows, there is a clear cyclical pattern to the breast and menstrual and gynceacology health domains. The start and end of the menstrual cycle appear to lead to the greatest prevalence of health problems.
Figure 3: Overall prevalence (%) of female health domains by day of menstrual cycle. A histogram-like scatter plot is shown grouping health domain occurrence by bins of two days hence half day values given
3 Summary
Female health domains are prevalent in women’s rugby.
Pelvic health domain problems are ongoing and can lead to modifying training activities. Strategies to screen and manage these problems should be prioritised.
Menstrual health domain problems are common and, unsurprisingly, cyclical in nature. Proactive strategies to minimise or manage these problems should be prioritised.
Breast health domain problems were also cyclical in nature indicating menstrual-related pain rather than exercise-induced breast pain.
These pilot findings underscore the need for robust, prospective data collection to better understand the prevalence and impact of female health problems in women’s rugby. Ongoing work to enhance and implement the surveillance system will lead to more inclusive and responsive female athlete health screening and management strategies.
4 Next steps
Improve the health surveillance system through incorporating clinical experience and feedback
Explore how chronic female health conditions can be captured in the system
Roll-out version two of the system in future international women’s rugby tournaments (pending funding)
Look to integrate the system into a traditional, time-loss injury surveillance system to minimise burden on clinicians and optimise data analysis possibilities
5 Methods
Ethical approval was obtained from the University’s Ethics Committee (ref: sta-11247).
Female athlete health domain focused reporting system co-created with clinicians (1).
Medical attention definition of a health problem was used. Data from two national teams (n=62 players consented) was collected during the World Cup 2025 pre-tournament camp and the World Cup itself.
The Orchard Sports Injury and Illness Classification System version 16, which includes new female athlete codes, was embedded within the system to code health problems (6).
Data were anonymised at the point of data entry. A GDPR compliant data management and storage system was used. Ethical decisions regarding data presentation were undertaken due to the sensitivity of data reported.
Prevalence was calculated using different numerators and denominators based on the measure. The following definitions were used:
Cohort (n): total number of players in the cohort
Prevalence of players with health problems (% of cohort): number of different players with health problems relative to the total number of players in the cohort
Modified training prevalence (% of health problems): number of health problems that led to modified training relative to the total (or domain specific total) number of health problems sustained
Ongoing health problem prevalence (% of health problems): number of ongoing health problems relative to the total (or domain specific total) number of health problems sustained
Recurrent health problem prevalence (% of health problems): number of recurrent health problems relative to the total (or domain specific total) number of health problems sustained
95% confidence intervals (CIs): To compute 95% CIs for prevalence measures Jeffreys (Bayesian) confidence intervals for binomial proportions were used
Acknowledgements: Thank you to the National Governing Bodies that supported the HER World Cup 2025 pilot project and to the clinicians (Jo Perkins, Flo Laing and Morag Robertson) who helped co-create the surveillance system and record the data.