Blood, sweat and fears: the P word

Research into female athletes’ health raises awareness and questions concerning the often unacknowledged and ‘taboo’ topic in women’s sport – the menstrual cycle

Health and Wellbeing

“We conducted a survey and we found that 55% of elite level athletes say that their menstrual cycle affects their training and performance,” explains Georgie Bruinvels, PhD student at St Mary’s and UCL. Bruinvels is currently researching iron metabolism in endurance athletes, particularly focusing on female health and the menstrual cycle. Her studies with UCL are among the first to investigate the many ways in which menstruation might affect competition and training for female athletes.

“A third of all elite level athletes have heavy menstrual bleeding which is really significant because in research, everything is dominated by the female athlete triad, [a syndrome of three interrelated conditions including; energy deficiency, amenorrhea (absence of menstruation), and decreased bone mineral density].”

While conducting the research, Bruinvels realised that the menstrual cycle just isn’t spoken about in relation to athletes. As a result, the ‘taboo’ subject was either left unacknowledged by researchers, or the research conducted only targeted women at specific phases during their cycle. Some research trials were only conducted on men as the massive complexities and varieties in women’s individual hormone levels made trials complex and expensive.

“The easiest, [and cheapest] situation is to either; test women who are on the pill – which is very common, or to only test women who are in certain stages of their menstrual cycle. So, it’s effectively preventing showing that variation which is anticipated.”

“It’s become a big passion of mine,” says Bruinvels. “I am fascinated by the whole thing and I want to delve deeper and understand better what’s going on and advance female physiology research in a male dominated world.”

Research into female physiology

“Around the time of the First and Second World War, it was perceived that they shouldn’t test women due to potential harm to unborn foetuses and also that women and men were the same and that they should categorise them as the same.”

Sports science has advanced hugely since then, accompanied by the acknowledgment that there can be gender-specific influences on an athlete’s performance. “However, by then it was too late and people always want to progress research forward and not go back and repeat everything and now we are kind of stuck in this situation,” says Bruinvels.

Bruinvels’ plan for her research is to develop it further and gain a better understanding of the menstrual cycle, it’s effects on performance and how to negate them. “Strength varies through the menstrual cycle, typically it’s suggested that what you should eat varies through the menstrual cycle, injury risk varies through the menstrual cycle, so many different things vary and it’s a question of manipulating them, potentially, to optimise performance.”

Athletes and their experiences

Speaking to some female athletes first hand about how their cycle affects them, confirmed what Bruinvels and her research were saying. “It one hundred percent affects my training,” said one athlete. “Without a doubt one day a month, at least, my legs get very heavy. I’ve heard that from a few other girls that their legs get really heavy and you just don’t feel good.”

“I’m training 60 miles a week, that’s about 8-10 miles a day and that’s very testing on your body as it is without having that on top. I dread it, to be honest.”

Another athlete echoed her statement. “I do, definitely notice an effect coming up to my period and the days I’m on my period. I’m bloated, my legs feel tired and I just want to eat chocolate which is not great before races!”

“I just don’t feel great. It definitely has an effect on how I run, because if you’re not feeling good, you don’t run very well.”

Alongside the physical effects of the menstrual cycle, athletes found the psychological side of their sport affected by menstruation or PMS. “I would find that PMS affects me. My mood is down on the first or second day of menstruation and I just don’t feel in the mood for my training schedule. Although, I would never not train if I’m on my period. You don’t give yourself the excuse of it but I still feel sorry for myself after a bad session.”

A common concern between athletes is the gear worn while competing being incompatible with menstruation. “A lot of people don’t consider that when you’re racing you usually have to wear short shorts and if you have heavy bleeding you would be worried you might leak. That was a problem that affected me because my periods used to be quite heavy.

“It’s just an extra stress on your mind,” reiterated a second athlete. “I definitely find my confidence would drop a lot when I have my period when running or racing because I’m really anxious about what I’m wearing and getting to the bathroom. I usually wear these small blue racing shorts but I won’t wear them if I’m on my period.”

The contraceptive pill can be used by athletes who wish to track their cycle and strategically plan to avoid menstruation on competition days. “A lot of female athletes go on the pill to regulate their period,” says one athlete. “I was on the pill for my skin, but as an athlete I was also able to track when my period was due. If I had a race, I knew what to expect and could take precautions.”

But while it accommodates practicalities, for an athlete who is training at top level, all of the time, the days of menstruation will still inevitably have an effect on their training.

“They say there’s a lot of things you can do to regulate it, help it, and that but I don’t know if I would necessarily agree with that. Yes, you can go on the pill. Yes, you can try working your training or races around it but at the end of the day when you’re on the pill, you still get a period, you still get cramps, and you still feel worse,” says one track and field athlete. “It’s very unpredictable, every month is different, sometimes it affects you, sometimes it doesn’t.”

The pill can regulate menstruation, but that’s just one aspect of the menstrual cycle. For an athlete, hormone levels, mood and it’s dreaded unpredictability can all have an effect on performance.

Wrestling with language – the taboo of the word ‘taboo’

“It’s not something that’s regularly discussed,” says Bruinvels, “In doing my research, I’ve realised that actually, the menstrual cycle isn’t spoken about, there’s very little research in it.”

And when the result of speaking about it is enough to make you go viral, it’s little wonder why it’s not regularly spoken about. When a Chinese swimmer, Fu Yuanhui, produced a less-than-best performance in the 4x100m relay in the Rio Olympics, the resulting post-race interview caught the world’s attention, all for the love of the word ‘period’. The New York Times headline read: ‘Uninhibited Chinese Swimmer, Discussing Her Period, Shatters Another Barrier.’

They were right, it is considered one of the last taboos in sport. But when it comes to athletes dissecting their performances, leg cramps, injuries, sleep patterns etc. are all discussed in great detail both on and off screen. A period cramp, although exclusive to female athletes, should be no less abnormal to discuss than a leg cramp due to lactic acid if both hinder good performance.

“I think that’s a massive issue because – almost by saying the word ‘taboo,’ creates a taboo,” says Bruinvels, addressing the heart of the issue.

“It’s getting people to feel that it’s a healthy thing. It is the most natural thing. We need to perpetuate that that is the case and not to overdramatize it.”

On a personal level for an athlete, it’s even more complex than a social ‘taboo’ that deters athletes from discussing it. An athlete’s attitude is crucial to success in their sport, they are used to pain and pushing through tough sessions. That’s the nature of sport. And part of this attitude is an unwillingness for excuses, including menstruation.

“I train with a lot of boys so it’s never really spoken about,” says one athlete. “I don’t like to set men and women apart and because I am training with the lads I want to believe that I can train with them, no excuses.”

“I don’t want to make excuses for myself or put myself in a mindset where I say, I’m not going to do well today because I have this. But then sometimes you do end up feeling sorry for yourself.”

This leaves female athletes in no-man’s land. Talk about it and ‘break the taboo’ and go viral. Or talk about it and risk bad performance by stepping out of the psychological ‘zone.’ And so, it remains a largely unacknowledged aspect of sport. But even if they were to talk about it, athletes are unsure how to address it.

It should be normalized but I don’t know how we go about talking about it, though? Maybe we should just be targeting female athletes,” suggests one athlete.

“You could take a well-known female sports figure, like Jessica Ennis-Hill, for example, a real athlete who girls look up to and for her to speak out and say it’s normal, and how it affects her. That could encourage more open conversation.”

For Bruinvels, it is important to get people talking about it in order to drive research forward and find solutions to gender-specific athlete concerns. “We need to get people to understand that it’s normal and to also, drive research forward. It’s all very well acknowledging that there are different variations and people suffer but we’ve actually got to do something about it.”

Research, or lack thereof, seems to be the crux of this issue. Sport is about winning, and performing to the best of your ability. “As an athlete, it affects your life more than it does a normal person,” acknowledges one athlete. “Most people don’t have to address it. Whereas, as an athlete you probably do have to address it but you don’t want to feel that you’re different.”

This is the paradox presented to female athletes. Until research is advanced enough to offer solutions to the effects the menstrual cycle has on an athlete’s performance, open discussion on this topic will be considered ‘taboo’ and female athletes will, understandably, refrain from talking about it.

“It’s all well and good me saying, ‘Yes, it should be spoken about,’ but when I bring that back to my daily life as an athlete I don’t like the idea of being excused in comparison to the men. But that’s a lose-lose situation, because it can and does affect my training.”