Menstruation in Sport
Learn how the menstrual cycle can impact performance and some tips to help.
Menstruation in sport is a growing area of interest. In 2020, the BBC’s Elite British Sportswomen’s survey found that 60% of athletes considered their athletic performance to be impacted by their periods, and more recently, research has found that 100% of sampled athletes report performance decrements during menstruation.
Athletes have also spoken out in the media, using their platform to highlight the difficulties of training and competing through unsupported menstruation. For example, Dina Asher-Smith discussed how she was unable to retain her 100m European Championship title in 2022 because of calf cramps caused by her period.
Now this isn’t to say that performance is doomed in the face of menstruation – Paula Ratcliffe broke the marathon world record in 2002 on day 1 of her period.
But what this does show is that menstruation is a key factor in athletic performance and wellbeing.
Don’t be phased by the phases
It’s a very common experience going into the gym one week and smashing through the programme, and then coming in the next week and your warmup weights feel like your final set. Fluctuations in things like performance, appetite, weight, and mood can be really frustrating and often feel like they’re coming out of nowhere.
While the primary role of oestrogen and progesterone is concerned with the reproductive system, the changing levels of these hormones throughout the menstrual cycle can impact multiple systems in the body, such as the cardiovascular and metabolic systems.
This means fluctuating levels of oestrogen and progesterone are often behind these changes. By learning how they work, things can stop seeming to come out of nowhere, and you can use them to your advantage.
The Follicular Phase
With the move into the late follicular phase after menstruation comes an increase in oestrogen levels in the body. Oestrogen is often called a feel-good hormone because as levels of oestrogen increase, so do the levels of serotonin. Increased levels of these feel-good hormones can lead to improvements in confidence, mood, wellbeing, and motivation to train.
Physiologically, high levels of oestrogen can also lead to greater protection from muscle damage, reduced inflammation, and quicker recovery. This often results in a greater capacity to carry out high-intensity training and can be why you might suddenly increase your performance or energy levels after your period.
The Luteal Phase
As the menstrual cycle moves into the luteal phase after ovulation, levels of oestrogen and serotonin decrease, and progesterone levels rise. This can lead to mood changes due to this reduction in feel-good hormones. Progesterone is a catabolic hormone which means it breaks down muscle and makes it harder for athletes to build muscle and strength during this stage.
High-intensity training can also be more difficult during this phase, as the body is less able to metabolise carbohydrates as fuel and instead favours fats as a source of energy. During the luteal phase, body core temperature can rise by half a degree, which can lead to athletes feeling hotter during exercise.
With reduced serotonin comes increased brain fog and reduced spatial awareness that can negatively impact athletes’ coordination.
On the flip side, progesterone can also lead to lower levels of anxiety and better sleep, so you may experience better recovery during this phase.
Menstruation, injury, and recovery
While oestrogen can positively influence our mood, motivation, and training intensity, it also plays a key role in influencing injury risk throughout the menstrual cycle. While research is limited, studies describe how oestrogen can interfere with joint collagen and create joint laxity, such as joint looseness.
Ultimately, this means that during the follicular phase, when oestrogen levels are at their highest, joints can be looser, less stable, and, therefore, more susceptible to injury.
Empirical research: The current state of play
At the moment, we’re still playing catch-up in terms of research into menstruation and sports performance. Research findings are currently pretty limited and sometimes mixed. Some performance measures, such as joint laxity and injury risk, have been reported as impacted by the menstrual cycle, while other measures, such as VO2 max, strength, and power, don’t seem to change significantly.
However, research looking into experiences and perceptions of menstruation in sport has found that both athletes and support staff report performance impacts throughout the menstrual cycle. This suggests that while an athlete may have the same physical capacity to perform, the symptoms of hormonal changes, such as severe pain and reduced spatial awareness, can influence athletes’ capability to fulfil this capacity.
Actionable steps
While tracking your cycle, start to track how you’re thinking and feeling.
For example, note down what days you feel you have lots of energy vs the days you don’t, when you start feeling pain, whether you get food cravings, and whether your sleep patterns change.
By beginning to pay attention to our bodies, we can start to map out how our body reacts to its own individual cycle. For example, you may notice that every time you’re on your period, you have very heavy bleeding and can feel faint during training, or at a specific time point every month, you experience niggles in an old shoulder injury.
Once you have a better understanding of any physical and psychological changes that occur throughout the cycle, you can start to pre-empt them and put strategies in place to manage them.
You can use the expertise of your support team or the experts from The Athlete Place to help you do this.
If we take the previous example of heavy menstrual bleeding to feel faint, you could discuss this with your nutritionist and see how you could get more iron into your diet during the menstrual phase to support you through these experiences.
Take Home Points
Peaks in oestrogen lead to increased motivation, confidence, and physical capabilities and can influence injury susceptibility.
Peaks in progesterone can impact mood, metabolism, coordination and sleep.
Research is still trying to understand the impact of the menstrual cycle on physical and mental performance.
To create this content, The Athlete Place has teamed up with...
Emma Quinn
BSc, MSc, PhD (ongoing)
Hello! My name is Emma, and I’m a doctoral researcher in menstruation.
Following my experiences of battling difficult menstruation and the performance expectations of competitive sport, I developed an interest in the topic of menstruation in sport. During my BSc and MSc in sport psychology I researched athletes’ experiences of menstruating in the culture of elite sport, and IDT practitioners’ experiences of menstrual support provision.
Alongside my PhD that focuses on menstruation, mental health, and stigma, I work with support staff and athletes to improve awareness and understanding of the menstrual cycle and develop discussions about menstrual support in sport.
If you’ve had difficult experiences of menstruation in sport, want to learn more, or have any questions please reach out and we can start a conversation.
Chat with Emma
Evidence-Based Research
Brown, N., Knight, C. J., & Forrest, L. J. (2021). Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance. Scandinavian Journal of Medicine & Science in Sports, 31(1), 52-69. (View Paper)
Herzberg, S. D., Motu’apuaka, M. L., Lambert, W., Fu, R., Brady, J., & Guise, J.M. (2017). The effect of menstrual cycle and contraceptives on ACL injuries and laxity: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 5(7), 232596711771878. https://doi.org/10.1177/2325967117718781 (View Paper)
McNulty, K. L., Elliott-Sale, K. J., Dolan, E., Swinton, P. A., Ansdell, P., Goodall, S., Thomas, K., & Hicks, K. M. (2020). The effects of menstrual cycle phase on exercise performance in eumenorrheic women: A systematic review and meta-analysis. Sports Medicine, 50(10), 1813–1827. https://doi.org/10.1007/s40279-020-01319-3 (View Paper)
