Menstrual myth busting
Issue: Volume 28 Number 2
If it is talked about at all, it is often referred to by a euphemism: ‘the curse’, ‘the crimson tide’ or ‘that time of the month’. In the historically male-dominated sports sector, matters related to menstruation have largely been sidestepped or put in the ‘too-hard’ basket.
In fact, even well into the last century, women were warned against taking part in sports during menstruation because of concerns it would harm their health.
That picture has changed over time, with more and more research addressing the effects of exercise on menstruation, including the associated effects on bone health.
The same, however, cannot be said for how menstruation affects women’s performance in sport.
Hormonal changes during the course of a woman’s menstrual cycle may affect physiological and psychological potential and impact on sports performance, but the reality is that researchers and experts cannot speak in certainties, or even in generalities. A lack of quality and widespread research means that they can only talk in terms of possibilities. About the only thing that is clear is that it varies markedly from woman to woman.
Menstruation is the term given to the periodic discharge of blood, tissue, fluid and mucus from a woman’s reproductive organs. Menstruation is part of a menstrual cycle that takes place over the course of 28 days (although a normal cycle can vary from 23 to 35 days). The first part of the cycle is called the follicular phase, when the egg (or follicle) is being stimulated by hormones prior to its release around the middle of the cycle (this release is called ovulation). During the follicular phase and the luteal phase (second half of cycle that occurs after ovulation) the uterus is prepared for a possible pregnancy by causing the lining to thicken. If the egg is not fertilised, it does not attach to the uterine wall. It is the sudden reduction in the hormones when the egg dies, particularly progesterone, that cause the uterus to shed its extra lining.
Hormones govern this process, and it is the balance and interplay between these hormones that regulate the specific events that make up the menstrual cycle.
Melbourne-based sports physician and Chief Medical Officer for Netball Australia, Dr Susan White says research has yet to conclusively prove a consistent relationship between menstrual cycle and sport performance or outcomes.
‘It’s a difficult area to research. The things that some women associate with the menstrual cycle, like fatigue or bloating or general lethargy, are hard to measure. And even if we could measure them, it’s then difficult to say that it’s just one or a combination of those symptoms and other internal or external factors that may affect performance.
‘World’s best performances have been recorded at all stages of the menstrual cycle, including the pre-menstrual and menstrual phases,’ Dr White said. ‘However there is one study in Italy that indicates female soccer players may have a greater injury risk before and during their menstrual periods. It is unclear whether it was because of physiological or psychological factors or a combination of them. There are no other studies at this stage that support this research.’
Other studies have documented variations in plasma, electrolytes, sodium levels, potassium, chloride, bicarbonate, blood sugar levels, breathing rates and thermoregulation, but whether they ultimately effect performance is unclear.
In fact, in 1993 American MD Constance Lebrun published a comprehensive review of literature examining the effect of menstrual cycle phase on athletic performance. She concluded that there were inconsistencies in the information available due to variables of the women studied (such as nutritional status, fitness level, degree of exercise, mood state), different methods used in studies and the small numbers of women studied.
In her view, there did not seem to be any conclusive evidence of effects of the menstrual cycle on actual athletic performance. She did, however, add that at the elite level even a ‘statistically non-significant change may mean the difference between first and second place’.
For Jackie Fairweather, once an elite triathlete and now head coach of the Australian Institute of Sport Triathlon program, menstruation was seldom discussed during her time climbing the ranks of triathlon. ‘I’ve never really discussed it with a coach, but then I’ve never been in a position to worry about it.’
‘I distinctly remember winning a silver medal at the World Championship when I had my period, because things were difficult when I had to then go into the toilets to give a sample for the drugs test.’
She says that, as a coach, her first rule is to ‘treat every woman as an individual’.
‘For some women it’s an issue whether physiological or psychological, but for others it’s not.
‘I don’t formally go out of my way to bring up the subject with my athletes, but if a girl has a concern I hope that she feels our relationship is open enough to discuss it with me.
‘Generally it is talked about in the girls’ medical screenings once a year and a girl might come to me if they’re feeling discomfort or if they’ve got a really important race coming up.
‘In that case I’ll manage it with a doctor, but personally I believe that on the whole girls need the confidence to see that they can go out and perform even with their period. Winning major competitions is about having the mental ability to adapt to anything and to deal with anything that’s thrown at them.
‘I think what’s of more concern is when girls don’t talk about not menstruating because they’re happy because they’ve reached their body weight or they don’t have to deal with it. Amenorrhea is the silent problem’, Fairweather said.
For national netball coach Norma Plummer, engendering a team environment of honesty and trust is the key to dealing with any concerns that individual team members may have.
‘If a girl comes to me I don’t pretend that I’m the expert. We have a doctor who is with us and I encourage the girls to see her and talk to her if they’re having any issues.
‘I’ve been around netball for a long time. There were times years ago when there were players who had chronic migraines or pain or excessive flows. It’s different these days with medication. Never in all my 30 years involved with netball have I ever come across someone who couldn’t play. We’re females, we know our bodies, and particularly when women get to this elite level, they’ve been playing and managing their periods for many, many years’, Plummer said.
Dr White believes that women are able to manipulate their cycles with the help of the oral contraceptive pill. ‘This is not for everyone, but it is a reasonable option in situations when an athlete may not wish to have their period for a certain event or competition,’ she says. ‘It can be done using the standard oral contraceptive pill to effect regular, ongoing manipulation of the menstrual cycle [for example, only have a period every three months]. Alternatively, the use of a short course of a milder form of the hormones can allow an athlete not usually taking the oral contraceptive pill to miss their period for a single event.’
She says she often acts as a mediator for male (and female) coaches and their female athletes to allow discussion of menstrual issues in a structured environment.
‘Communication is important and so is the need to recognise that everyone is different. Considering all the factors in an athlete’s life (including menstruation) can assist the coach in helping an athlete to achieve their potential’, White said.
Daly, W and Ey, W 1996, Hormones and Female Athletic Performance, Australian Sports Commission, Canberra.
Sports Medicine Australia, Premenstrual Syndrome and the Sportswoman, www.sma.org.au/information/women_in_sport.asp.
Volk, E, Planet Estrogen Part III: the menstrual cycle and athletic performance, www.thinkmuscle.com/articles/volk/planet-estrogen-03.htm.