ACTIVE FEMALES AND THE MENSTRUAL CYCLE

It is widely recognised that the menstrual cycle can affect a womans* ability to participate in sport and exercise. At The Injury Clinic, our physios recognise that:

• 41% of 14-16yo say their periods stop them from taking part in sport altogether
• 81% of women and girls have never discussed their menstrual cycle with their coach
• 72% of women and girls report not receiving any education about their menstrual cycle in relation to sporting performance

While we know that women will often need to compete in their sport while they have their menstrual cycle, it is still important to consider – if training should be modified, what aspects of training can be modified and when these modifications should be implemented.

*We recognise not all people with a menstrual cycle identify as being female or a woman. For the purpose of this page, please recognise we consider all menstruating people and those with female sex hormones to be female or women.

 

CONSIDERATIONS FOR MENSTRUATING ATHLETES

One of the key differences between men and women are the fluctuations in hormones that occur with the menstrual cycle. We know that at some stages of the cycle women can have a higher risk of injury, and there are some women who find that their menstrual cycles affect their performance. It is now recognised that women should be discussing their menstrual cycle with their coaches, particularly if they feel it affects their ability to train and perform. In the absence of having a coach, we recommend that female athletes track and take note of performance at different stages of their cycle to determine if patterns in performance, motivation or recovery are present. 

Due to this fluctuation in hormones, active females may notice they have a different response to training loads, fluctuating motivation for training and altered recovery to training at different stages of their cycle. In a typical menstrual cycle, women may see symptoms associated with hormones at the different stages of their cycle as described below. 

Please note, these are common changes that may be seen. Some women will notice large fluctuations and some won’t notice any changes at all. It is important that if any of these symptom changes are extreme (ie. affect your ability to complete normal daily activities) a consultation with a doctor who has an interest in women’s health is arranged. 

 

PHASES OF THE MENSTRUAL CYCLE AND ASSOCIATED EXPERIENCES

Menstruation is a normal, physiological response to a coordinated fluctuation in hormones. It is cyclic in nature, and a normal menstrual cycle lasts on average 28 days. It can be broken up into two main phases, the follicular and luteal phase, and further divided into six subphases. Each of these subphases occur alongside and in response to hormonal changes. While there are multiple hormones involved in the menstrual cycle, the two main hormones involved are oestrogen and progesterone. 

Early Follicular Phase (Menstruation)

This is typically the first 3-7 days of the menstrual cycle. 

• Exercise may help as it improves mood and can help manage symptoms. 
• You may need more recovery time. It is hypothesized that there is an increase in inflammation during menstruation which may affect recovery timeframes. 
• There may be a greater requirement for iron.
• You may need to consider managing the physical aspect of menstruation (i.e. if you need to change their sanitary product during training).
• While menstrual symptoms can be difficult to manage, due to lower levels of oestrogen and progesterone it can also be a time of peak performance.

Follicular Phase

The follicular phase is the phase following menstruation and before ovulation. This can be further split into the mid- and late- follicular phase. 

During mid follicular phase there are lower levels of oestrogen and progesterone and athletes may: 

• Experience higher perceived pain tolerance and higher perceived energy levels. 
• Have an increased ability to utilise muscle glycogen. 
• Feel more motivated and experience high moods. 
• Find it is a time to focus on high-intensity endurance and strength efforts. 
• Find it may be an optimal time for peak performance.

During the late follicular/ovulatory phase active females should consider that due to a surge of oestrogen:

• There may be decreased stiffness of tendons and ligaments. 
• There is an increased risk of some musculoskeletal injuries. 

Luteal Phase

After ovulation, we have the luteal phase (day 16-28 of the cycle). Due to high levels of oestrogen and progesterone in the early luteal phase:

• Women often experience improved mood and reduced anxiety secondary to higher levels of progesterone. This also helps achieve good quality sleep.

As we progress through the luteal phase, there is a rapid decrease in oestrogen and progesterone. This contributes to:

• A rise in body temp which may change perceived difficulty of tasks, especially endurance tasks.
• An increase in pre-menstrual symptoms which can reduce motivation to train and perform.
• Potentially disturbed sleep which may further affect performance, motivation and recovery. 
• A potential for a reduction in skills/coordination
• Stored carbohydrates may not be as readily available, which means an increased appetite may be experienced. 
• For these reasons, it is suggested that during the luteal phase:
  • There is a focus on lower-intensity workouts and more recovery time. 
  • The athlete should also pay more attention to fuelling their body and hydrating. 

 

While these aspects of the menstrual period often can’t be changed, there may be ways athletes can manage and structure their training to ensure these monthly fluctuations have the smallest possible impact on training blocks. An example of this would be a runner training for a marathon who times their deload week with the week they feel most poorly during their cycle. This is something which is significantly easier to do in individual sports. 

As an athlete, it is important to identify if there are certain times during your cycle that you find symptoms associated with your menstrual cycle affect your performance. This means tracking the menstrual cycle and any associated symptoms that are experienced. If there are consistencies month-to-month, these are worth discussing with the coach and a doctor if the symptoms are affecting you significantly.

 

TRACKING THE MENSTRUAL CYCLE

When we are discussing tracking of the menstrual cycle, it is important to take note of what information we need to monitor and be aware of when we need to seek advice from a doctor specialising in women’s health. It is also important to make sure we don’t over emphasize changes or fluctuations that aren’t having any effect on training or daily activities. The important cyclic changes to track and monitor include (but are not limited to): 

• Menstrual period start/end and flow (heavy, moderate, light)
• Ovulation 
• Symptoms ie. pain
• Physical changes ie. sleep, energy
• Emotional changes ie. mood, sociability, motivation
• Performance changes 

It is important to seek further advice from a health professional if you notice: 

• An absence of periods:
  • Primary – your menstrual period hasn’t started by 15 years old.
  • Secondary – your menstrual periods started and then stopped. 
• Irregular periods – 10-12 menstrual periods a year is considered normal. If you have less than that (4-9), further investigations should be done.
• Pain – menstrual pain is experienced by 20-94% of women. While some pain may be manageable, anything that limits your ability to complete normal, daily activities needs to be investigated.
• Bleeding between cycles.
• Premenstrual syndrome (PMS) – while PMS is often dismissed, it is important to have your symptoms affected if it is affecting your ability to participate in your normal activities.
  • PMS will commonly affect energy (more fatigued), mood, bloating, appetite, and breast tissue. 
• Heavy bleeding – this affects up to 30% of women and does require further investigation. 
  • It is also important to seek further assistance if you have large and/or multiple blood clots.
  • Heavy bleeding has been defined as bleeding that affects a woman’s physical, emotional or social wellbeing and quality of life.

 

PERFORMANCE EFFECTS AND THE MENSTRUAL CYCLE

While it is important to have awareness of the menstrual cycle and how it affects women’s performance, it is also important to consider how an athlete will manage this. 80% of women report at least one menstrual symptom ‘often’ and this was associated with missed training/competition or a disruption in or change to daily activities. When female olympic athletes were surveyed on their menstrual cycle and their athletic performance, it was found 66% of athletes reported their menstrual cycle affected their performance. However, athletes also stated they felt confident to race or compete with their period as they knew they had trained with their period previously and performed well in those sessions.

 

IN SUMMARY

Physios at The Injury Clinic recognise the importance of monitoring the menstrual cycle. If there are consistent symptoms or concerns, discussing management options with appropriate health professionals may be appropriate. We encourage active females to openly discuss any menstrual cycle or athletic performance concerns with their physiotherapist and/or strength and conditioning coach. They will either be able to help you tailor a program to suit your cycle or guide you in the right direction to find someone who is able to help address any concerns you have with your menstrual cycle.

 

 

 

 

THE INJURY CLINIC OFFERS SERVICES INCLUSIVE OF: 

PHYSIOTHERAPY: Sports Physiotherapy; Musculoskeletal Physiotherapy; Women’s Health Physiotherapy; Running Analysis; Return to Run Programs

STRENGTH TRAINING: Injury Management; Performance Enhancement; Online Coaching; Return to Sprint Programs

DIETETICS: Sports Dietetics; Race Nutrition and Hydration plans

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