The Menstrual Cycle and Athletic Performance
Many male coaches have acknowledged that they feel ill equipped and ill at ease when it comes to assessing and accommodating the effects of the menstrual cycle on female athletes. Very often the subject is not raised at all. The reasons may be:
- Concern that the athlete(s) might be embarrassed
- Concern that his motives might be questioned if he tries to raise the topic
- Concern about different cultural attitudes
- Concern about own lack of information
- Thinks the athlete would mention it if it were a problem
- Questions appropriateness
- Questions necessity
- Lacks confidence
- He never thought about it
It is important to remember that many women report no noticeable difference in performance as a result of their menstrual cycle. Indeed, Olympic medals have been won and world records set by women at all stages of the cycle.
So, although it is clearly important to raise awareness and assist coaches to deal with any problems athletes may have, both appropriately and sensitively, it is equally important not to encourage either athletes, parents or coaches to see menstruation as problematic per se.
There are three major stages to the 28 day average menstrual cycle:-
Although about 50% of women notice pre-menstrual and early flow stage symptoms, no general pattern of effects of specific stages has emerged from the research. There has been much investigation on the effects of exercise on menstruation (perhaps reflecting society’s generalised anxiety about keeping women in line) but much less about the effects of the cycle on exercise and athletic performance. But, although specific sport studies have often come to conflicting conclusions it has been proved that these cyclic hormonal changes can affect the physical and psychological potentials, which, in turn, influence sport performance. However, as has been stressed, women’s experiences are highly individual, varied and subjectively reported. They also change over time, pre-menstrual pain being more common in younger girls.
Committed, mature athletes will need to chart their own detailed responses to the phases of their cycle in order to make personal use of the research. Fig 9 provides a simple chart (From Hormones and Female Athletic Performance, Judy Daly and Wendy Ey, 1996. ISBN 0 9586477 7 1)
The following pre-menstrual (late luteal phase) symptoms are most consistently reported:
- Mood changes – irritability and anxiety
- Fluid retention and a feeling of bloatedness
- Breast tenderness
- Abdominal pain
(See figure 10, summary of common menstrual cycle disorders and their treatment. Hormones and Female Athletic Performance, Daly and Ey)
Additionally, several studies demonstrate reduced reaction time, neuromuscular co-ordination and manual dexterity during the pre-menstrual and menstrual phases. There is also evidence that blood-sugar levels, breathing rates and thermoregulation vary, which may well account for the slight decreases in aerobic capacity and strength which some women have observed. Obviously a woman’s performance is likely to be diminished to some extent if she is experiencing any or all of these symptoms, but it is worth remembering that personality, state of mind and attitude can negate or exaggerate this effect.
Some women have reported improved performance in the immediate post-menstrual days, whilst a minority report improvements during menstruation.
A mature, socially confident athlete who has a healthy, mutually respectful, adult to adult relationship with her coach may find no difficulty in raising the issue. However, if this is difficult for either party (emotional responses are a good guide, i.e. embarrassment, discomfort or inappropriate closeness displayed in language, expression or body language), bringing in a third party such as a female team manager or advisor could be a better bet
For younger or club athletes, the menstrual cycle is perhaps best seen as an issue of social and physical comfort and health – part of the club's athlete centred care strategy, rather than a performance issue. A female coach or team manager could take charge of setting up group discussions, giving girls basic information and giving them a chance to talk about any problems or worries. If the coaching is not club based, or if no suitable adult female is available, an athlete’s mother could be drawn in to undertake this task, provided she shows a degree of objectivity and is able to forge relaxed and responsible relationships with young people, especially her own daughter. With the athlete’s permission, the woman could then liaise with the coach on behalf of the athlete about anything he needs to be aware of. Other relevant information, such as on the female triad, (see below) could also be dispensed in this way. A buddy system (a younger athlete paired with a older athlete for support) could operate to back this up. This could also be a good anti-drop out strategy.
Buddy System: Young athletes are paired with an older athlete for friendship and support. The older athlete needs to be able to establish warm and supportive relationships, be able to manage her own athletics’ life reasonably well and have good inter-personal skills. With proper training and development, this could be linked to a coach recruitment programme.
Guidelines for discussing sensitive issues:
- Pick your moment carefully
- Be clear about what you want to say and its relevance to athletics
- What would be most comfortable for you and the athlete – to speak individually or ina small group?
- Be sensitive about others overhearing the conversation – even if you don’t find it difficult to discuss, the athlete might
- Is it appropriate to talk on the trackside, or would it be better in an office space?
- There should be a clear purpose to the conversation. Do you want to achieve an outcome, raise an issue, and gain some information? Know what this is and how you will achieve your purpose
- Use correct language e.g., period, menstrual cycle, and be sure the athlete understands
- Be honest – if you are finding it difficult to talk, share those feelings. Acknowledge that it isn’t easy, this will relax the situation
- Use empathy where appropriate – past experience of other athletes’ (keep names and biographical details confidential).
- Humour is helpful when used sensitively and appropriately
The female networks of the sport abound with stories, some of which may be apocryphal, about women athletes who, whilst warming up for major competition, find that competition anxiety has brought on a period for which they are unprepared. Frantic searches for tampons ensue, in the process of which various male coaches, team managers or medical support are highly embarrassed by the request or show themselves insensitive to the needs of women by not carrying tampons along with the crepe bandages, ice packs and packets of pins. One highly respected female coach relates how, when competing in an international meeting in the 70s, she found herself is such a situation, but was relieved to find that the then National Coach Dennis Watts produced a tampon from the packet he habitually carried with him with a relaxed smile. The same coach recently acted as team manager for a travelling junior team and asked the team doctor if he carried that essential equipment. He did not. The female network rolls its collective eyes heavenwards.
Moral – Young athletes need to be warned about this possibility by team management and encouraged to get into the habit of carrying tampons with them always. Coaches and team support staff should also do so.
Prevention of negative effects of menstrual cycle
For some mature, elite athletes, menstruation may indeed be a serious performance issue. Although it is essential not to build up the perception of a problem or exaggerate the difficulties, debilitating menstrual symptoms do need to be addressed. As thorough as possible an understanding of the athlete’s individual responses at different stages of the cycle is required. Athletes should therefore log their cycle and associated physical and emotional states, plus their exercise and athletic performance, to establish any patterns.
Clearly the prevention of very troublesome PMS is a problem that needs individual medical attention and is beyond the scope of this publication. However some general observations can be gathered from the literature.
The use of low dose oral contraceptives can be used to control pre-menstrual symptoms very effectively. However, individual and family cultural and religious sensitivities need to be born in mind and accommodated. This could be a very appropriate topic for discussion in clubs’ women and girl groups and within buddy networks. Another problem has been that some athletes have reported significant increases in fluid retention and, therefore, weight gain. However there are now some new, extremely low dose pills available which are unlikely to cause this problem in the medium to long term. If the do cause weight gain, this usually settles down and returns to normal after the first month or two.
It has been shown that the majority of women in the general population suffering pre-menstrual symptoms “have a poor nutritional intake compared to those who have no PMT.” (Dr. Guy Abraham, specialist in nutrition and PMT). Sufferers are frequently found to have low magnesium levels which affects blood sugar control and hormonal metabolism. A high intake of salt and fat can aggravate fluid retention and breast tenderness.
Dietary advice for athletes suffering from PreMenstrual Symptoms
- Reduce intake of refined sugar, salt, red meat and alcohol
- Eat fish, poultry, whole grains and legumes
- Reduce intake of coffee, tea, chocolate and cola drinks
- Reduce in take of fats, particularly animal fats, fried foods and hydrogenated margarines
- Increase intake of fibre in the form of green leafy vegetables, legumes and fruits
Frank Horwill, Peak performance On Line
Nutritional supplements have been recommended from the same source (Frank Horwill):Take a multivitamin supplement together with the B vitamins, vitamin C, plus minerals. 500mg capsules of Evening Primrose Oil, 4-8 per day, taken 2 weeks before the period is due. Vitamin E, 300-500 International Units per day may be helpful with pre-menstrual breast swelling and tenderness.
200-300mg of elemental magnesium per day.
Note: The above supplements should be taken for three months to test effectiveness. ONLY PHARMACUTICAL GRADE SUPPLEMENTS SHOULD BE TAKEN I.E., THOSE MADE BY THE LARGE DRUG COMPANIES. FOOD ADDITIVES MAY PUT THE ATHLETE AT RISK OF BEING IN CONTRAVENTION OF THE RULES ON DOPING.
Some hormonal or gynaecological problems can have symptoms similar to those of PMS. If the symptoms do not improve or are very severe, a doctor must be consulted.