by Alice Hunter, Specialist MSK & Sports Physiotherapist
Do you exercise and want to perform better? Feel fitter? Prevent injury?
If so, then I want to talk to you about periods.
Why!? You ask…
Well, let’s just set the scene with… 1.8 billion of the world’s population menstruate:
(THAT IS 21% OF THE WHOLE ENTIRE WORLD BY THE WAY).
Of those 1.8 billion people, many of them exercise. And for those that do… research has (finally) started noticing and recording the effect that menstruation has on sport, exercise and performance!
Here’s just a few stats to start:
- 78% of female athletes report pre-menstrual symptoms
- 74% of female athletes also report pain when on their period
- 77% of women report pre-menstrual low mood or irritability
- Many women report a reduction in exercise performance whilst menstruating
- They also report a perceived longer recovery time after training
- Athletes have identified that cycle related symptoms affect their perception of fitness, strength, mental sharpness, balance and sleep quality
So, we’ve established that having a monthly cycle can have a MASSIVE effect on exercise, training and performance – HOWEVER barely any people, understand HOW our periods affect us and WHAT we can to optimise the effects…
That’s why I am writing this blog. To empower us to understand, communicate and act upon our symptoms - so we can start WINNING this hormonal game.
A little side note: this blog refers to ANYONE that has a menstrual cycle – we will mainly be discussing the “natural cycle” (for people who don’t take hormonal contraceptives) however research shows that both non-hormonal contraceptive users and pill-users report symptoms throughout their cycle – so everyone can benefit from tracking potential trends (as discussed in this guide).
THE TEAMSHEET:
(Let’s say hello to the players)…
OESTROGEN:
The hormonal superhero, big, strong, super-energetic (but throws the occasional spotty tantrum)…
· Anabolic – increasing muscle mass and speed
· Maintains bone density and supports collagen synthesis
· Anti-inflammatory properties
· Regulates metabolism and body weight (can suppress hunger)
· Regulates blood sugar and cholesterol levels
Improves sleep quality (keeps body temperature at night low)
· Grows the lining of the uterus – controls production of hormones FSH and LH.
PROGESTERONE:
The Yin to Oestrogen’s Yang, the antagonist, the contender… equally as powerful but stays in the shadows (covertly making your bones stronger, your brain better – but also making you break wind more than you’d like).
Catabolic - breaks down protein metabolism (increases hunger levels)
Stimulates bone growth
Increases body temperature
Increases grey matter in your brain (helps information processing)
Can act as a muscle relaxant - reducing bowel contractions (and making you constipated)
Increases fluid retention (can make you bloated)
Anti anxiety and sedative affects
Reduces oestrogen production and maintains the uterine lining
TESTOSTERONE:
TThe weird mate that floats in temporarily to the party for a few hours and then disappears again – brings additional drinks, great chat (and we all appreciate them being there). But you then realise they’re seriously hard work if they stick around for too long…
· Sexual desire – you might notice this increases around ovulation
· Regulates bone-mineral density
· Promotes muscle development (which is why it can be mis-used in sport)
· Stimulates the production of red blood cells
Not to forget THE ESSENTIAL (but kind of boring) FAMILY MEMBERS:
FOLLICLE STIMULATING HORMONE (FSH)
Causes ovaries to ripen the egg and produce oestrogen
LUTENISING HORMONE (LH)
Triggers the release of the egg from the ovaries (ovulation)
THE RULES OF THE GAME:
We were taught it in school – but please put your hand up if you can remember ANYTHING about what a period actually is…
…
Don’t worry, I’ve got you…
(If you’re that A* biological genius with all the answers, please skip ahead…)
A quick run down:
There is 3 Phases of the menstrual cycle… it is 28 days (roughly) of hormone fluctuations. (Note anything between 21 and 40 days is considered normal and everyone’s cycle is different).
Follicular (split into early and late): Days 0 - 14
(The first half – laying the groundwork)
Ovulation: Days 14 - 17
(HALF TIME BABY)
Luteal (also split into early and late): Days 17 - 28
(The second half – it’s heating up)
Early Follicular
Oestrogen and Progesterone are low. If pregnancy hasn’t taken place the lining of the womb sheds (this is the period) which normally last between 4-7 days.
Late Follicular
After your period finishes, Oestrogen starts to increase. Follicles are produced (each containing an immature egg), the lining of your uterus thickens.
Ovulation
This is where your ovaries release a mature egg, which travels via the fallopian tubes towards the uterus. Ovulation occurs right in the middle of your cycle (normally around day 14) and lasts for 24-72 hours. Short, snappy… sexy?!
Early Luteal
Oestrogen levels have dropped and progesterone levels rise (preparing the lining of the womb for pregnancy).
Late Luteal
Progesterone and oestrogen are high initially, however if pregnancy doesn’t occur, the hormones fall – the lining of the womb sheds, and back to the beginning we go! (You spin me right round baby right round… )
THE GAME PLAN:
Everyone’s cycle is different – tracking your symptoms is the best way to learn how your cycle affects you… use an app! Your notes page! A paper diary! your physio’s printed exercise sheets!! – track it, record it and learn from it.
EARLY FOLLICULAR (During your period)
Low oestrogen and progesterone can mean reduced strength and endurance
Symptoms around this time may include; pain, fatigue, cramping, low mood and motivation
This is the time to optimise the GOOD SELF CARE - listen to your body and your symptoms.
Do what feels good – if you’re feeling particularly rubbish, take this as an additional rest day, or try some chilled low intensity exercise (lots of evidence recommends chilled exercise to help support those symptoms).
LATE FOLLICULAR
· Oestrogen is on the increase!
· You might feel stronger with more energy and better capacity to build muscle
· Reduced delayed onset muscle soreness and a quicker recovery time
TIME FOR PUSHING THOSE PB’s – look for opportunities to get some extra gains in the gym – maybe push yourself extra hard in your workouts, or try and get an extra session in… your recovery time has the potential to be quicker and your performance better!
OVULATION
Oestrogen remains high and with a sprinkle of testosterone this is a good time to continue training hard and pushing those PB’s.
The anti-inflammatory components of oestrogen allows your muscles to recover more quickly between sessions.
BUT think STRONG + STABLE… limited evidence suggests ligament laxity is high here – leading to increase risk of injuries such as ACL tears
On the note of ligament laxity and injuries - the research is inconclusive, but it is a consideration that this might not be the ideal time to be pushing and testing your stability (ensure thorough warm ups and be mindful in cutting / impact sports).
However it is still prime time to optimise your strength and performance - so lets maximise that extra energy!
EARLY - MID LUTEAL
· Progesterone levels increase inhibit oestrogen.
· Symptoms may include mood changes, bloating, constipation and increased hunger
Oestrogen remains at a moderate level alongside progesterone – with reduction in strength levels this may be a good time to focus on endurance sports or training.
Think about increasing aerobic fitness rather than pushing PB’s and strengthening (always be mindful of recovery).
LATE LUTEAL
· Oestrogen and progesterone start to decline (goodbye fair friends), IT’S PRE-MENSTRUAL TIME!
· Poorer sleep, with low mood, higher levels of anxiety and irritability (fun right!?)
· Some people may find concentration levels and alertness are also reduced
Therefore this is a great time to focus on how you are feeling - do exercise that feels good, and take time for recovery. If this is one of those days that you come home with minimal energy – prioritise sleep, comfort and good vibes.
Side note, when progesterone is high in the luteal stage, metabolism is increased and you can burn up to 300 calories more a day – so if you need a little bit of sweet, sweet goodness (Cadburys is my personal choice) then Honey, YOU’VE EARNT IT.
THE POST MATCH DEBRIEF:
Cool, so we’ve learnt the rules, met the players and executed the game plan.
However, not everyone is the same, some people get THE WORST pre menstrual symptoms – and some get none.
Therefore the key take a way message is to try and understand the changes that effect you.
Track your symptoms and talk about them; with friends, partners, healthcare professionals, coaches. Not only because you may be getting symptoms that impact injuries, training and recovery – but also because it may give an opportunity to make the best of you!
So, the next time I see you in clinic – let’s talk about it!
Oh... and also - this wouldn't be a women's world cup edit without a good old GO LIONESSES!
References:
Bernstein, C. Behringer, M (2023). Mechanisms underlying Menstrual Cycle Effects on Exercise Performance: A Scoping Review. Women in Sport and Physical Activity Journal. 1, 1-18.
Ekenros L, von Rosen P, Solli GS, Sandbakk Ø, Holmberg HC, Hirschberg AL, Fridén C. Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports. Front Physiol. 2022 Aug.
Maruyama S, Yamazaki T, Sato Y, Suzuki Y, Shimizu S, Ikezu M, Kaneko F, Matsuzawa K, Hirabayashi R, Edama M. Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle. Orthop J Sports Med. 2021 Mar 29;9(3)
McNulty, K. L. et al (2023). The symptoms experienced by naturally menstruating women and oral contraceptive pill users and their perceived effects on exercise performance and recovery time post training. WSPAJ.
Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019 Jun;220(6).
Unicef. (2023). Menstrual Hygiene. [Online]. Unicef. Available at: https://www.unicef.org/wash/menstrual-hygiene. [Accessed 19 August 2023].
Wallace, H. (2022). The Female Factor. London: Hodder and Stoughton. pp.11 - 65.