Does the menstrual cycle impact athletic performance? This is a question that you should have at least a basic understanding of if you are a coach, medical practitioner, or athlete.
As a coach or practitioner, in what ways do you support the females you work with around the menstrual cycle? Perhaps this is something that you have not considered, or maybe you have but just don’t know where to start. Want my advice? Start with the basics and keep it simple!
Pictured: Dina Asher Smith who pulled up in the 100m at the European Championships 2022 due to cramps in her calves which she perceived were caused by her period.
Let’s start with the basics
For some female athletes, their performance and wellbeing can be negatively impacted by the physical and psychological effects of the menstrual cycle (e.g. bleeding, cramping, bloating, fears of leaking) (1–6).
To provide support to female athletes around the menstrual cycle, coaches and practitioners must have the relevant knowledge and skills. Understanding the processes and effects of the menstrual cycle, and the role it plays in female health is therefore key.
The menstrual cycle is a biological process important for female health and reproduction. The cycle starts with the period (i.e. the bleeding phase) on day one and ends the day before the next period begins. On average, the length of one full cycle is 28 days, but in reality, this can range anywhere between 21-35 days and still be considered as a healthy cycle. For young females, it can take some time for their cycles to regulate after they have had their first period (known as menarche). As a result, they may experience longer cycle lengths of up to 40 days. Note: females should get their first period by the age of 15 years.
As shown in Figure 1 below, there are two main phases of the menstrual cycle; the follicular phase and the luteal phase which are separated by ovulation. Each phase can be distinguished from one another based on the level of fluctuating sex hormones, oestrogen and progesterone.
Figure 1. Overview of the Menstrual Cycle (sourced from SHE Research educational infographic: ‘Back to basics’)
Should we be tailoring training around the menstrual cycle?
Beware of what you read and see on social media about the menstrual cycle, especially when influencers are telling people how they should feel and what activities they should be doing at a certain stage of their cycle. Remember, the menstrual cycle is a unique experience that can vary not only between females but also within females (i.e. from one cycle to the next). It is very difficult to create a set of standardised guidelines for female athletes which indicate what they should or should not be doing at certain stages of their cycle, because what works for one person may not necessarily work for another. Therefore, as current research suggests, training should be adapted based on a female athletes’ personal experience with the menstrual cycle (7).
Keep it simple!
In a way, I feel that we have become so consumed by the idea of tailoring training around the menstrual cycle, that we have overlooked the simple opportunities to support female athletes around the menstrual cycle. Of course, one size does not fit all and this process is very individual, but it doesn’t have to be complicated. Here are some simple and effective ways which you can offer support to female athletes:
1. Communicate
Simply asking an athlete if she would like to be supported and in what ways can be helpful. Given the individuality of the menstrual cycle, it would be naïve to assume that every female athlete is negatively affected. Therefore, having open and honest conversations with athletes is an essential part of understanding how the menstrual cycle impacts them and their performance. At first these conversations can seem awkward, but over time as you build trust with athletes they become a bit easier.
2. Create comfortable environments
Not everyone is comfortable discussing the menstrual cycle, and this can be a challenge for those who wish to receive or offer support. Research shows that coach gender can influence comfort of discussion (2–4), and that some female athletes prefer to speak to medical practitioners or other females about this topic (3,4). With this in mind, if coach gender is an issue and/or the availability of medical staff is limited, it may benefit to have a designated female within the sporting environment whom female athletes can confidently approach with concerns related to their menstrual cycle.
3. Create a period positive environment
Place educational posters or infographics related to the menstrual cycle in changing rooms/toilets. This can help raise awareness and create opportunities for female athletes to learn more about the menstrual cycle. Who knows? It might even be a conversation starter! – SHE Research have FREE educational infographics which you can download here.
Ensure there are a range of period products available in toilets which are easily accessible. This can be helpful for athletes who unexpectedly get their periods, and can also eliminate the discomfort of having to ask for sanitary products if stuck. Toilets should also be equipped with sanitary bins and appropriate handling facilities like a sink that allow for the careful disposal and/or cleaning of period products.
4. Consider training/competition kits
Fears of leaking through training/competitions kits are just one of many psychological impacts of the menstrual cycle reported by female athletes (3,4). To tackle these period concerns, several county and international teams have moved away from wearing white shorts. This is a very simple but effective change that is worth considering for performance, wellbeing and participation of female athletes in sport.
5. Know when to signpost
A regular cycle (i.e. getting a period every 21-35 days) is a sign that the body is healthy and has enough energy to carry out important bodily functions such as reproduction. On many occasions, I have heard people say that it is normal for female athletes to lose their period and that it means they are training hard.
While period loss is common for female athletes, it is NOT normal. The menstrual cycle is an indicator of female health, and changes to its normal function (i.e. irregular cycles/period loss) should be addressed. As a coach or practitioner, you are not expected to know everything, but knowing when to signpost an athlete to a medical expert is important.
Are you interested in learning more about the menstrual cycle and improving your knowledge in this area? Here are some great educational resources and web pages!
Australian Institute of Sport (AIS) Female Health and Performance Initiative offer free online modules and infographics.
SHE Research have educational infographics on the menstrual cycle which are FREE to download from their website (see education).
@periodoftheperiod Instagram page by Dr. Kelly McNulty summarises the latest research on women’s health, including the menstrual cycle and menopause.
England Rugby have developed several toolkits for athletes and coaches in relation to menstrual health, breast health, pelvic health, and menopause.
References
Adam MEK, Bristow A, Neely KC, Erlandson MC. Do women athletes’ experiences of menstrual function and dysfunction vary across competition levels? A mixed methods exploration. Psychol Sport Exerc. 2022 Nov 1;63:102270.
Armour M, Parry KA, Steel K, Smith CA. Australian female athlete perceptions of the challenges associated with training and competing when menstrual symptoms are present. Int J Sports Sci Coach. 2020 Jun 1;15(3):316–23.
Brown N, Knight C, Forrest L. Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance. Scand J Med Sci Sports. 2020 Sep 1;31.
Findlay RJ, Macrae EHR, Whyte IY, Easton C, Whyte) LJF (née. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. Br J Sports Med. 2020 Sep 1;54(18):1108–13.
McHaffie SJ, Langan-Evans C, Morehen JC, Strauss JA, Areta JL, Rosimus C, et al. Normalising the conversation: A qualitative analysis of player and stakeholder perceptions of menstrual health support within elite female soccer. Sci Med Footb. 2022 Nov 7;0(ja):null.
McNamara A, Harris R, Minahan C. ‘That time of the month’ … for the biggest event of your career! Perception of menstrual cycle on performance of Australian athletes training for the 2020 Olympic and Paralympic Games. BMJ Open Sport Exerc Med. 2022 Apr;8(2):e001300.
McNulty KL, Elliott-Sale KJ, Dolan E, Swinton PA, Ansdell P, Goodall S, et al. The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis. Sports Med Auckl Nz. 2020;50(10):1813–27.