Menstruation and its potential effect on training plans

The menstrual cycle has a massive impact on the training and life of an athlete. Coaches should be aware of issues associated with the menstrual cycle and be able to adapt and personalise their program to suit the needs of their athletes.

Physiology of athletes and menstrual cycle

Until puberty, girls and boys do not differ significantly in most physiological responses to exercise, hence the existence of only a mixed category for under 14s. However, there is an individual variation in their stage of development, with puberty taking place on average two years earlier in girls.

The menstrual cycle, usually lasting between 21 and 35 days, is defined by two distinct main phases, follicular and luteal, which prepare the uterus for ovulation and potential pregnancy. These phases involve fluctuations of sex hormones such as oestrogen and progesterone. The menstrual cycle typically begins around 13 years of age and will continue until menopause around the age of 45 years.

Further reading: Menstrual Cycle - HPG Axis - Stages | TeachMePhysiology

Menstrual cycle-based changes in performance

There are potential negative impacts of hormonal fluctuations on sports performance. A lack of evidence, partly due to low quality and poor methodological practices, favours a personalised approach based on individual responses and needs during the menstrual cycle to help improve performance and minimise injury [1].

Nutritional considerations/metabolic demand: Menstruating athletes may benefit from personalised nutritional recommendations on carbohydrate, protein, and lipid intake. Supplements can also help ensure athletes do not suffer from deficiencies such as anaemia Recovery rates have shown to be reduced due to hormonal fluctuations [3]

Birth control: some types of exogenous hormonal intake could affect performance, which is an important factor to consider. Ligament laxity: it is still debated whether female athletes are more prone to anterior cruciate ligament (ACL) tears, whilst statistical differences are observed between male and female athletes [4,5]. However, preventing lower limb injuries due to sex hormone differences could be significant in planning a personalised program.

To optimise training performance, you could consider your athletes' hormonal cycles and see how this interacts with your training plans. There is growing evidence of the advantage of performing strength training during the first half of the cycle because the body could adapt and recover better. Indeed, during the follicular phase (1st half of the cycle), progesterone levels are at their lowest and oestrogen peaks resulting in greater strength and power outcomes. Moreover, force production could be greater in the late luteal phase. Finally, studies have found that fat or carbohydrate could be utilised differently as fuel due to oestrogen and progesterone fluctuations [6,7].

The use of personal menstrual cycle monitoring is observed in elite sports. Chelsea Football Club uses apps to track each athlete's cycles, pain or changes in sleep and develops individualised nutrition and training-based interventions to improve performance.

Whilst guidelines are still limited to precisely adapting fitness training to one's menstrual cycles in amateur sport, few apps (e.g. Fitr) exist to help the athletes and coaches to understand the functioning of the athlete's body.

Considerations for coaching practice

The menstrual cycle should be discussed, when necessary, with openness and no awkwardness within a team. As a coach, you should educate yourself on the issue of menstruation (See ). It is important to know what the athlete could go through to personalise and adapt the links below training program for individuals. For example, before and during menstrual cycles, athletes can experience premenstrual syndrome (PMS) or symptoms such as:

body composition (fat deposits on hips and thighs and bone growth)
mood swings
feelings of depression, irritability, and stress
fluid retention
breast tenderness
headaches, and fatigue

The coach should anticipate sensitive conversations with the athletes and create a safe environment for any issues to be discussed openly. Following are suggestions on how to handle this situation:

Pick your moment carefully
Be clear about what you want to say
Use correct language, and make sure the athlete understands
Create a buddy system or group sessions for athletes to share and discuss concerns
Treat the athletes you work with as individuals.
Finally, here are some additional examples of what you can do to provide a safe and inclusive environment:
Make sure facilities with toilets are available, and breaks are planned in the training program
Consider the opinion of athletes who menstruate on the colour of the uniform shorts (white is always troubling for some) Keep tampons and pads in the team's bag
Avoid having important events or training in four-week cycles
Until puberty, girls and boys do not differ significantly in most physiological responses to exercise, hence the existence of only a mixed category for under 14s. However, there is an individual variation on their stage of development, with puberty taking place on average two years earlier in girls.

References

[1] McNulty KL, et al., Sports Medicine (2020) 50:1813–1827
[2] Wohlgemuth et al., 2021, Sex differences and considerations for female specific nutritional strategies: a narrative review, Journal of the International Society of Sports Nutrition, 18:27
[3] Hackney AC, Kallman AL, Agön E. Female sex hormones and the recovery from exercise: menstrual cycle phase affects responses. Biomed Hum Kinet. 2019;11(1):87–9.
[4] Shafiei SE et al., Knee laxity variations in the menstrual cycle in female athletes referred to the orthopaedic clinic, Asian Sport Med, 2016
[5] Silvers HJ et al., Prevention of anterior cruciate ligament injury in the female athlete, Br J Sports Med 2007;41
[6] Carmichael MA et al., 2021, Int J Environ Res Public Health, The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review
[7] Oleka CT et al., 2020, J Pediatr Adolesc Gynecol, Use of the Menstrual Cycle to Enhance Female Sports Performance and Decrease Sports-Related Injury

Additional Resources

coachingtraingood-practicespublish