Menstruation in women’s sport and the ‘taboo’ in it

Menstruation in women’s sport and the ‘taboo’ in it

Imagine if Kuany Kuany, South Sudan national basketball team captain have to play through painful stomach cramps. That she suffers fatigue and dehydration ahead of a crucial game. The pain so severe that it clouded his decision-making, violent mood swings and bloating.

These are the many challenges that thousands of female athletes go during menstruation circle, and yet it remains woefully under-discussed – a bizarre situation, given the physical toll it can exert on female players.

The City Review sought the views of various known female figures in South Sudan sports but none was willing to be quoted on such a near ‘taboo’ discussion.

“This is a burden we must gracefully carry. At one sporting event my menses symptoms became so severe I had to leave a match midway. But you are not quoting me on this, right?” posed a female footballer.

The menstrual cycle is a repeating pattern of hormones, designed to allow pregnancy to occur. Each phase produces different concentrations of the hormones oestrogen and progesterone. These hormonal differences, between women with and without a menstrual cycle mean that not all female athletes are the same.

As oestrogen and progesterone have the potential to affect many aspects of health and sports performance, it’s important to know the hormonal profile of each athlete, so that training and performance can be optimised.

Multiple studies have provided in-depth insights into athletes’ experiences of the menstrual cycle and its perceived impact on training and competition. They highlight individual responses to menstrual “issues” and emphasize the need for clinicians and support staff to undertake menstrual cycle profiling, and monitoring and continue to develop awareness, openness, knowledge, and understanding of the menstrual cycle.

In recent years, a number of top sportswomen have talked about the impact of their menstrual cycle on their training and performance.

British tennis player, Heather Watson attributed her first-round loss at the 2015 Australian Open to period symptoms, including dizziness and nausea, while British Olympic athlete Eilish McColgan believes her period contributed to a hamstring injury in 2017, BBC reported.

Research from 2016 shows that more than half of elite female athletes say that hormonal fluctuations during their menstrual cycle hampered their training and performances.

Yet much women-whether elite or recreational athletes – are loath to talk about their periods to their coaches and performance teams due to embarrassment.

Mobile apps to the rescue

FitBit launched a “female health tracking” feature last year, enabling users to log their periods and record their symptoms.

“By having all your health and fitness information in one place and looking at your cycle trends and data over time, you can better understand the connections between your activity, sleep and cycle symptoms,” Jennifer Mellor, engineering manager at Fitbit told BBC in an interview.

“When it comes to working out, everybody is different. Energy levels may vary at different points in a woman’s cycle, or they might feel strong all month long. By using the female health tracking feature, users can see clear, personalised signals to either slow down or ramp things up.”

The female health app Clue also enables users to track exercise and energy levels throughout their cycle.

“By consistently inputting this data into the app, users can gain a better understanding of how their training can differ at various points in the cycle, and adjust accordingly,” says Clue boss Ida Tin.

“For example, they might find that some days are better for strength training as energy levels are higher, whereas on others, energy is lower than usual, so stretching and light exercise might be better options.”

One app takes this a step further by using insights from elite athletes and making them available to others. FitrWoman is owned by sport technology company Orreco, and was co-founded by elite runner and research scientist Dr Georgie Bruinvels and product development manager Grainne Conefrey.

The training app enables users to track their periods, report symptoms, log training activity, and access nutrition and physiology support during each phase of their cycle.

Nottingham Trent University Senior Lecturer Kirsty Elliott-Sale writes in The Conversation that the menstrual cycle is part of a much bigger health issue for female athletes.

“A concept called the “female athlete triad” describes the link between menstrual function, energy availability and bone health. If an athlete does not have a healthy menstrual cycle – which can be caused by low energy availability – then this can cause problems for her bone health. Another concept, known as “relative energy deficiency in sport” expands upon this by adding other aspects of health and performance. This research suggests that bone health may not be the only aspect of health or performance affected by poor menstrual function,” she says.

Taken together, these two concepts teach us that having a menstrual cycle is better than not having one. While some athletes told us that they experienced a small number of negative side effects during their period, the long-term benefits of having a period clearly beat the possible short-term issues. Athletes need to be supported with these issues, which can be achieved by athletes talking openly about their periods and menstrual cycles with their coaches and medical professionals. This way, we can ensure that their hormonal profile is the best it can be for their health and sporting performance.

Breaking taboo

Until a few years ago, female athletes were wary of speaking about their ‘periods’ on a public platform. Although the situation has improved, there’s still a long way to go. In 2016, Chinese swimmer Fu Yuanhui had spoken of having her period during the 2016 Summer Olympics, after she won the bronze medal. She had also gone on to clarify that she wasn’t using her period as an excuse! 

“My period started last night,” Fu told reporters after the race, “so I’m feeling pretty weak and really tired. But this isn’t an excuse. At the end of the day, I just didn’t swim very well.”

Ayesha Billimoria, a three-time 200-metre national champion, Olympic aspirant, and sports trainer, shares her experience: “Most women have a hard time training during their periods, but as a young teenager and even in my 20s, I used it to my benefit (mentally), and told myself that it charges me up to run faster. It didn’t affect me so much. Although when I stepped into my 30’s, it was a completely different story. It was a sign my body was telling me to relax, breathe and do light movements on those first three days.”

Some female athletes also use birth control pills to manipulate their periods, but it is advised not to pop these pills right before an event, since it could lead to decreased performance levels.

In a study with her colleagues, Kirsty Elliott-Sale sampled 430 sportswomen who were using contraceptives to manage periods.

“Out of 430 sportswomen, 213 (49.5%) used some type of contraceptive and 217 (50.5%) did not. The oral contraceptive pill was the most popular type of hormonal contraceptive – used by 78.4% of contraceptive users. Contraceptive users reported 19 negative side effects, with weight gain, irregular periods and poor skin being the most common.

“In contrast to the negative side effects reported, 12.7% of contraceptive users told us they liked the regularity of the pill and knowing when they would experience their withdrawal bleed – not the same as a period – which happens during the seven pill-free days of an oral contraceptive pill cycle. In addition, 12.2% of the athletes using a hormonal contraceptive said they liked having a reduced number of bleeds per year, which can be achieved by skipping the pill-free days. Knowing when the withdrawal bleed would occur allows athletes to avoid bleeding during an important competition, such as the Olympics,” she wrote in The Conversation.

Athletes not using any type of hormonal contraceptive had menstrual cycles of different lengths, usually between 21 and 35 days. Just over three-quarters of these athletes reported negative side effects that usually occurred during the first day or two of the cycle when they were having their period. The most common side effects were cramps, back pain, headaches and bloating.