By Connie Draycott
Insta @crdraycott
For most women getting your period is just a natural part of life, but how well do you really understand the menstrual cycle and the reproductive hormonal affects on your body?
You might be surprised to find out that 1 in 4 women in the UK do not understand their menstrual cycle, but not surprising is that only six percent of sport and exercise research is done exclusively with female athletes.
Dr Emma Ross is the winner of the 2021 Sunday Times Sport Women of the Year – Change Maker award for her pioneering work in female health and sport. She is the co-founder of The Well HQ. They are on a mission to change how we educate, engage, and train women in sport, health and life.
Dr Emma Ross said: “We really believe in the idea that information is empowering. It’s women’s health meets sport – making sure sport takes into account women’s bodies and allows girls and women to thrive.”
Dr Ross has also joined up with Hormonix at Mint Diagnostics, as the Female Health and Performance Lead. Hormonix is a service that uses regular monitoring of hormone levels combined with data analytics – thee new essential instrument for Human Performance optimisation and we will be learning more about this at the SW/S Conference on Friday 10th June at UWS Hamilton. Tickets available here.
There is a discrepancy in knowledge around a women’s reproductive biology, and it would be helpful to those who get a period, to have a basic understanding of the menstrual cycle and what is happening in their body.
Men have a twenty-four-hour rhythm of hormonal fluctuation that is at its peak in the morning and slowly decreases throughout the day. This happens regularly each day.
For women, the hormonal rhythm of our sex hormones happens over a longer period of time, and we call this the menstrual cycle. Its basic function is to allow a woman to become pregnant. When those hormones are going up and down over the monthly cycle, we can feel the effects physically and emotionally all across the body.
The menstrual cycle has two halves – the first being the follicular phase and the second is the luteal phase. There are four distinct hormonal environments within the body over the course of the menstrual cycle, which is why Dr Ross prefers to break the cycle into four phases.
Phase 1
The first day of the period is day one of the cycle. Oestrogen and progesterone are dormant during this phase and because the last cycle did not result in pregnancy, this is the time women will have a bleed. A period can last between two to seven days.
Over the course of this phase, many follicles are maturing the egg and one becomes the dominant follicle and that one becomes the egg that is released at ovulation.
Phase 2
Oestrogen begins to rise and is at its peak just before the middle of the cycle, while progesterone remains low. The brain then signals to the body to ovulate.
The egg is produced from the dominant follicle and is released into the ovary. That same follicle becomes a hormonal producing gland that begins the production of progesterone.
Oestrogen is a feel-good hormone that energises and increases motivation.
Phase 3
This is sometimes referred to as the “high hormone phase”. There is a slight drop in oestrogen and progesterone becomes the dominant hormone. Progesterone is a calming hormone and can slow things down in the body. It is great at soothing the circuits in the brainassociated with anxiety and overwhelm.
Progesterone’s effects can also cause the digestive system to slow, which can result in bloating and feeling sluggish.
Phase 4
When the cycle has not resulted in pregnancy, the body knows that it is time to start the cycle all over again. The body sheds the lining of the uterus, which is a type of inflammatory process. The body withdraws oestrogen and progesterone, and they will return back to baseline levels.
It is the rapid drop of the calm and feel good reproductive hormones that can cause premenstrual symptoms (PMS). There has been 150 different symptoms reported by women during this phase in the cycle.
922 million women worldwide are using some form of contraceptive (UN Study, 2019). The pill is favoured by athletes, and it is important to understand how they work within the body.
The pill delivers a synthetic dose of both oestrogen and progesterone into the body. This tricks the body into thinking that it has ovulated and that it is in the second half of the cycle.When the body receives regular synthetic hormones the natural production of oestrogen and progesterone flatlines.
Dr Ross explains: “The reason we are having a small bleed at the end of the pill cycle is because we stop taking the synthetic hormones. As a result of the withdrawal of the synthetic hormones you have a little bleed of any lining that is there, but it is not a real period. It is usually much lighter than you would have during a natural hormonal bleed.”
It is important to note research has shown that women on the pill can exhibit physiological markers of stress despite the absence of external stressors. This evidence has been observed in both the general population of women and in female athletes.
There is a widely known misconception in sport that not having a period is normal and even desired and it can even be considered an inconvenience to have a period while training and competing! The reality is the presence of a period is a sign of good health, and the absence of a period is a red flag and signifies that something is not right.
Dr Emma added: “If we lose our cycle and we don’t get that monthly dose of hormones, we can compromise our short- and long-term health.”
Oestrogen is vital for bone health, good immune function and contributes to cardiovascular health, while progesterone is good for breast and brain health – all of which are essential for peak performance.
There are a whole host of lifestyle factors that can either positively or negatively affect the menstrual cycle. The most impactful being diet, sleep, stress, and the amount of fuelling and recovery the body needs.
“Thirty percent of active girls and women lose their periods because they are over exercising and under fuelling.” Dr Ross said.
If the body is not getting enough fuel to accommodate the demands of day-to-day life and a rigorous training schedule, the body knows that the menstrual system can stop and this will have a minimal impact on the body, therefore prioritising major organs.
There is a common misconception that an athlete is at a disadvantage training and performing while on their period. Research shows that performance at any time in the cycle is not compromised by fluctuations in reproductive hormones.
In fact, there are many benefits to oestrogen and progesterone’s natural fluctuations within the body.
Dr Ross describes: “If you want to produce strength, power, aerobic fitness or your running economy, they should not be affected by the hormonal fluctuations on any given day. On the other side of the coin, hormones can change how we feel or our metabolism. So, the work we have to do to get the best out of our body, might be different on any given day,
“We need to have different strategies, different approaches, on different days to get the best out of ourselves.”
Closely tracking the cycle and having a firm understanding of symptoms, can allow for the development of strategies to not only work with the cycle, but to manage symptoms. These strategies could be as simple as altering your warmup or adjusting your diet and hydration.
Recently there has been a lot of attention regarding female athletes being at a higher risk of injury at certain times during the menstrual cycle: “Women in general are up to eight percent more likely to have a noncontact injury, particularly the ACL. One of the risk factors is thought to be the menstrual cycle. But it is important to remember that injury doesn’t just happen because of one thing.”
Because of the lack of research on female athletes, there is not enough data to say with absolute certainty there is a correlation between reproductive hormones and higher risk of injury.
However, there is evidence when looking at joint mobility across the cycle that just before ovulation, when oestrogen is high, joint laxity – which is how much our joints move – is increased. If the joint is less stable, it is more prone to injury.
“We don’t have robust evidence. In my experience with working with active women and athletes, we have athletes who will report a tight hamstring or a back niggle that flares up and once we are having them track their cycle, they see that it is cyclical.”
With this valuable knowledge, athletes can better prepare during this time in the cycle. This might require changing up your warmup or strapping the body differently. Having this knowledge may empower athletes to feel less worried they are going to have a catastrophic injury.
Studies have shown that forty percent of girls will not exercise during their periods and about sixty-four percent of girls will have dropped out of sport by the end of puberty.
There are a variety of reasons for this, but the research shows that girls are struggling with their periods. Particularly with embarrassment around leaking, being in pain and not knowing what to do, and breast development and not knowing how to best support their developing breasts.
Hannah Miley is a three-time Olympian, a World Champion, a European Champion, and a two-time Commonwealth Champion competing in swimming for Team Scotland.
Now that Hannah has retired from competitive swimming, she is championing for more education and understanding around the menstrual cycle for young female athletes as they begin puberty.
She said: “I wish I had this information from the age of fifteen. I should have known what my body was capable of.”
Hannah had an exceedingly tough time with her period when she was young. It was very irregular, and she would have her period for fourteen days at a time. She would experience severe abdominal cramping and was very anaemic. At that time, the only option recommended to ‘fix the problem’, was to go on the pill.
Miley goes on to say: “Being on your period was a problem… loads of negative connotations. It was better not to have [a period] from a performance perspective.”
On the pill, Hannah’s periods became regular, and her symptoms appeared to decrease. Hermenstrual cycle had been “dealt with” and Hannah remained on the pill for fifteen years.
Because of this experience and Hannah’s lack of knowledge in her younger years, she has developed a workshop that delivers an information packed session for not only young female athletes but also for coaches, parents and anyone supporting female athletes.
She is enthusiastic about engaging young athletes and is on a mission to empower girls to confidently manage their periods and lessen feelings of embarrassment and shame. Believing that reframing the period as a “Superpower” can shift girls’ perspectives of the period to one that is positive and empowering.
Hannah is advocating that girls do the research and have a solid foundation of the knowledge about the cycle but also understand how your own body reacts and feels throughout your cycle.
“It is important to do the research and the Me-search.”
A large component of Hannah’s workshop is encouraging girls to regularly track their cycle and menstrual symptoms. Because of this Hannah has teamed up with FitrWoman, a free period tracking app.
FitrWoman states: “It helps to track the menstrual cycle and provides personalized training and nutritional suggestions tailored to the changing hormone levels throughout your cycle.”
Miley explains: “The app is quick and easy. You can log and track what your unique symptoms are. It allows you to look ahead and matchup when your competitions are and to navigate what your training preparations should be.”
There is also an app for Coaches and support staff. FitrCoach connects with the FitrWomanApp so coaches can support athletes during each phase and can maximise every session. Athletes must give permission to share their FitrWoman profiles allowing coaches to monitor their athletes’ status in real-time and plan ahead.
Conversations about puberty and the menstrual cycle need to happen as early as possible with young girls. Puberty can start for girls as young as eight years old and the period can arrive around eight to nine years of age.
Dr Emma Ross says: “lots of people are nervous to have conversations about periods because it feels scary, but if we impose our own biases on periods girls will pick up on them.”
Research shows that if adults have a positive attitude towards periods while girls are going through puberty, girls are more likely to have healthy behaviours the rest of their teenage years. That also includes healthier sexual behaviours and physical behaviours. Parents, schools and sport clubs need to create open, positive, and non-judgmental spaces for girls to explore all the questions they might have.
Dr Ross says: “Educating girls about the menstrual cycle when they are younger, sets them up for dealing with fertility really well because they understand an ovulatory cycle, with pregnancy because after pregnancy those hormones are having a massive impact and through perimenopause and menopause. You set up women for a lifetime of better understanding, which is better health and better happiness.”
It needs to be acknowledged that only ten percent of coaches are women – check out SW/S research – https://www.scottishwomeninsport.co.uk/about-us/women-in-leadership-research/
And despite male coaches trying to do their best to understand and support their female athletes, young women don’t always feel comfortable speaking about their cycle with their middle-aged male coach. There needs to be more women at all levels of sport to help break down barriers for female athletes.
There should be a shift on how everyone in society speaks about the period. The more positively people view the menstrual cycle, the less shame and embarrassment girls and women will experience.
If you are interested in attending one of Hannah Miley’s workshops you can contact her by email at hannahmileyswim@gmail.com.
The Well HQ can be found at thewell-hq.com and on Instgram, Facebook, and Twitter. The Well HQ offers information, and webinars, as well as courses that are open to anyone wanting to learn more about women’s health and sport.
SW/S would advise speaking with your GP if you are having any issues surrounding your period or struggling with premenstrual symptoms.
SW/S would also like to acknowledge that not all women have uteruses and that not all people with uteruses are women.
This is a great topic to think about, I’m only just getting back into being active in my (late) 30s and looking back it was my teens, dealing with hormones, embarrassment with period and painful breasts at times that put me off. Great to know I can help my daughter through that time better with more awareness of this topic.
So glad that this blog can be of help to you and your daughter.