Periods – a neglected issue in sport and sport research?
Approximately 50% of the adult population are women. At some point in their lives, most of us menstruate. For some women, menstrual cycles and periods are just a simple fact of life. They are lucky to be able to just ‘go with the flow,’ so to speak. For others, the physical and emotional symptoms of their menstrual cycles and periods can be debilitating and can impact negatively on their lives. Yet, the subject is rarely discussed openly—much less studied.
The scientific community has historically neglected or has been reluctant to study females in relation to exercise physiology. On this issue, I was as guilty as anyone: the research for my postgraduate doctoral degree (PhD) between 2007 and 2010 only included male participants! Ten years on, and women continue to be under-represented within sport and exercise science research…
Menstruation – a complicating issue in sport and sport research?
It has been reported that only 36% of participants in studies from three major sport-science journals were women. The gender disparity can be even wider with one well-known sport science journal publishing work in which a paltry 4% of research participants were exclusively female athletes. Why is this significant under-representation of women in scientific studies still the case?
The blame does not necessarily sit only with the teams behind the journals. The reason is likely to be multi-factorial, with potential social (e.g. gender imbalance among people working within sport and exercise science) and practical factors.
In practical terms, it is sometimes indeed difficult to study females. Difficult in the sense that those of us who are ‘naturally cycling’ females (i.e. those that are not taking hormonal contraception) will have hormonal fluctuations throughout our menstrual cycles. Those fluctuations have the potential to affect many psychological and physiological facets of health and sporting performance. This makes study design and interpretation in women more complex. To put it bluntly, studying females is often more costly and time-consuming than studying males due to the number of variables that need to be considered and controlled.
Why should you be interested in knowing about the menstrual cycle in sport?
I strongly believe that we should be looking initially at the menstrual cycle from a health perspective, even among sportswomen like you. Then we need to understand better how your menstrual cycle impacts on training and competition. Eventually, this will help you to plan and cope better with any ups and downs.
One thing should be made clear here – having a menstrual cycle is a good thing! It might not seem like it for some of us as we can struggle with our symptoms. They can be anything from mildly to hugely inconvenient. But, not having a cycle can be much worse. Athletes often train long and hard. While most of you will eat well, you might unknowingly not eat enough to fuel your training and lifestyle demands. We know that the lack of menstrual cycles can occur when your body does not receive sufficient energy from your diet, and we also know that this can have a devastating effect on bone health (amongst other things).
It’s time to talk about menstruation
Whilst working as an applied practitioner, I saw at first-hand the different challenges female athletes faced, especially in relation to their menstrual cycles. A number of high profile athletes have recently shared their menstrual cycle experiences on social media platforms. These have included Scotland’s Eilish McColgan and the USA women’s national soccer team.
They have opened up a dialogue that has been much needed. It is now being recognised among athletes and their entourage that more must be done. We must have a greater understanding about the psychology and physiology of female athletes in training, competition, travel, nutrition, and recovery in order to optimise their health, wellbeing, and performance.
Listening to athletes becoming more vocal and doing their bit to break down long-standing taboos and stigmas associated with discussing their periods, it became apparent to us that there was a large gap in the research on this area. So, we set out to understand the current and historical menstrual cycle status of elite female athletes, in this case, rugby players. More importantly, we wanted to gain an understanding of their experiences and perceptions of their menstrual cycle in relation to their athletic performance.
First in-depth insight into athlete’s experiences of their menstrual cycle
To this end, we interviewed female rugby players and asked them about their cycle-related symptoms, how these affected them, how they dealt with them, and what kind of support they received in that. Our research highlighted that symptoms related to menstruation (e.g. cramps, heavy bleeding) were highly prevalent and very individual in female athletes. However, what was more significant, was that two-thirds of athletes felt that these symptoms negatively impacted upon their performances.
Athletes would often accept their symptoms and try to manage them without seeking advice or support. Moreover, athletes’ comfort to discuss their menstrual cycle concerns and issues varied. Many said that they wouldn’t feel comfortable discussing any of these problems with male staff members.
From the research we have conducted at the University of West of Scotland and from my previous experience of profiling many female athletes, I feel that it is fair to say that athletes are generally happy to discuss their periods. However, there is one condition: the right environment needs to be created in order for athletes to feel comfortable to open up.
Similarly, we found that coaches and athlete support teams are happy to discuss periods and associated symptoms and, importantly, are keen to understand more. However, in some environments, particularly in male-dominated ones, conversations generally need to be initiated in order for them to become normal.
Based on our findings, we made a number of recommendations. Indeed, the governing body with whom we were working alongside responded very positively to these recommendations, and changes in practice were made almost immediately. We need more sporting organisations to follow this lead, be proactive and committed in continuing to support the health, well-being, and performance of their female athletes at every stage within the performance pathway.
Some of our recommendations are more focused towards elite athletes who have the associated support teams around them. However, others encompass all levels of female participation. I am a firm believer of empowering women in sport and beyond to achieve their optimal performance.
Play your part
You can empower yourself by:
- Education, education, education: Invest some time to learn about the menstrual cycle and menstruation. Knowledge is power. I encourage you and any girls and women in sport to educate yourselves about what is normal—and what is not normal.
- Monitor your cycles: Become more aware and understanding of your menstrual cycle and your experiences. In doing so, you can track when you feel mentally and physically good or bad. Use the good times to your advantage and focus on strategies to optimise other times.
- Seek support when required: Know how to manage your symptoms, but also how, when, and from whom you should seek help if and when necessary.
As more research emerges around the menstrual cycle and sport, and athletes continue to speak out, more coaches, support teams, and governing bodies of sport will listen and respond. Consequently, we will be able to help further improve female performances.
We can all do our bit for the next generation of females coming through sporting systems by starting to talk about menstrual cycles. Periods have long been a subject that the sports environment did not encourage us to talk about. Let’s change that. Period.
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Joseph T. Costello, Francois Bieuzen, Chris M. Bleakley. Where are all the female participants in Sports and Exercise Medicine research? European Journal of Sport Science. 2014;14:8,847-851. DOI: 10.1080/17461391.2014.911354
Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine. 2014;48:491-497.
Findlay RJ, Macrae EHR, Whyte IY, Eaton C, Forrest LJ. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. British Journal of Sports Medicine. Published Online First: 29 April 2020. doi: 10.1136/bjsports-2019-101486
Bruinvels G, Burden RJ, McGregor AJ, Ackerman KE, Dooley M, Richards T, et al. Sport, exercise and the menstrual cycle: where is the research? British Journal of Sports Medicine. 2017;51:487-488.