How can coaches best understand and approach the entire menstrual cycle?

In recent years, there has been much-needed attention and attempts to understand the menstrual cycle and its interaction with performance for female athletes.

Original study

Bruinvels, G., Hackney, A. C., & Pedlar, C. R. (2022). Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance. Sports Medicine, 1-4.

Click here for abstract

Background & Objective

In recent years, there has been much-needed attention and attempts to understand the menstrual cycle and its interaction with performance for female athletes (see HERE). Most importantly, a topic that was once avoided is now appreciated by coaches, and female athletes hopefully feel they too can speak up regarding symptoms (e.g. cramping, headaches, nausea) or simply changes in mood that no doubt impact their performance.

Secondly, the menstrual cycle is not something to be generalised across females. Everyone responds differently, as their body is going through drastic changes in hormones across the month. Oftentimes, these changes happen overnight, creating daily fluctuations in preparedness and adaptability.

Further, although much of the research supports a personalised approach (see HERE), there are still some who aim to over-simplify the menstrual cycle into two or three distinct phases and that seems far from appropriate as we continue to learn more through research and application.

Ultimately, the goal of this review paper was to help coaches appreciate the impact the menstrual cycle can have on females’ daily psychophysiological readiness, paying special attention to the individual nature and fluctuations across the entire process, and how it interacts with athlete preparation and performance.

What They Did

The authors outlined and addressed the topic of understanding the menstrual cycle by first highlighting the gaps in an overly basic, ‘two phase’ model (follicular and luteal phases) or even the commonly researched ‘three phase’ model (menstruation, pre-ovulation, and luteal) – both ignore hormonal shifts between phases, leaving practical application for athletes incomplete.

The authors encouraged a more complex focus – recognising menstruation, the early and late follicular phase, ovulation, as well as the early and late luteal phases – that appreciates the transitions and fluctuations in hormone levels and the psychophysiological impact it has on a female athlete on a daily basis. That said, symptoms associated with these hormone fluctuations vary between individuals and even between cycles in the same individual. Regardless, at some point, interference with psychophysiological readiness is very likely, and identifying ways to navigate them are important.

Therefore, learning and discussion need to be constant between coach and athlete regarding a female’s menstrual cycle and symptoms. This hinges on the appropriate concern (e.g. language, empathy, and respect), as well as actions, identifying sustainable interventions or modifications. Not to mention, research into various means and methods that allow females to continue to train or compete at a maximal level throughout the month without sacrificing long-term health.

What They Found

Practitioners should not oversimplify the menstrual cycle into 2-3 phases, but rather appreciate the hormonal fluctuations that occur throughout and the impact those changes can have on training and performance.

For the exercising population, 80% of regularly menstruating (eumenorrheic) females report symptoms that negatively impact performance every menstrual cycle (see HERE), and as much as 67% in elite athletes (see HERE).

Extensive research is needed for females attempting to manage and perform consistently throughout their menstrual cycle, as well as individual monitoring and proactive interventions to optimise an individual’s performance when negative symptoms of premenstrual syndrome are masking performance potential.

Practical Takeaways

Menstrual cycle symptoms are individual (e.g. in the overall amount, intensity, and duration) and can vary based on a combination of factors (e.g. sleep, nutrition, other stressors, etc.). Coaches should inquire about all of these areas related to recovery and readiness (e.g. sleep quality, fatigue, soreness, mood) on a daily basis with a wellness questionnaire prior to training in order to make sure loads are dosed appropriately.

Coaches, especially males, should first educate themselves about the menstrual cycle. Likewise, female coaches should learn about the individualised response versus only their anecdotal experiences. From there, coaches can either lead education or bring in another professional to help normalise conversations and build a knowledgeable, open, and comfortable conversation around the topic.

The days during pre-menstruation appear to have the most symptoms that would interfere with athlete readiness. It may be most productive during this time period to forego high-intensity activity and prescribe additional recovery or low-intensive activity (see HERE). Coaches should be understanding, flexible, and willing to give up a day for more productive training when readiness is more optimal.

Progesterone increases post-ovulation, negatively impacting nerve activity, metabolism (making and burning energy from food), regulating body temperature, and protein synthesis (see HERE). Managing training volume and intensity during the rise and fall of progesterone can help limit excess fatigue and poor performance.

Encouraging athletes to monitor (e.g. cycle tracking, symptom logging) either by simply journaling (paper-based) or mobile applications (e.g. FitrWoman) can help them better understand symptoms to be prepared throughout the menstrual cycle and promote open conversations between coach and athlete about the menstrual cycle. Coaches can write out training prescription with exercise options, volume ranges (e.g. two to five sets), and intensity windows (e.g. one to three repetitions in reserve, a velocity window, or 70-80%-1RM) to allow females flexibility in optimising training based on mood, energy, as well as known hormone levels or physiological function they are knowingly experiencing through tracking. This provides the athlete with autonomy and supports a trusting coach-athlete relationship.

If resources allow for measurement of hormone levels (see HERE), this can help provide objective physiological feedback to best identify where in the cycle the athlete is at that time. However, the subjective report of symptoms is likely the greatest driver to adapt to with regards to training prescription.

Most importantly, competition dates are not negotiable like training days/activities and the negative symptoms associated with premenstrual syndrome can be reduced without the use of drugs (e.g. analgesics, anti-inflammatories, hormonal contraception). Instead, symptoms can be managed in a more natural way, through changes in nutrition (e.g. curcumin or omega-3 supplementation), low intensity aerobic exercise (e.g. walking at 60-70% of heart rate reserve), yoga, or even simply sleep extension to reduce inflammation associated with changes in hormone levels. These approaches are much less invasive and potentially deleterious, providing a sustainable, long-term approach for female athletes seeking consistency in their ability to compete and perform.

The best way to find what works best for the individual is to monitor symptoms and be strategic with one intervention at a time to find what works best. More often than not, the approach that is most effective is the one the athlete believes in and is willing to commit to on a monthly basis.

Cody Roberts’ Comments

“The research and practice around menstrual cycle education, research, and openness is changing for the better for female athletes.  Most importantly, it should not be dismissed, and cannot be generalised. It is not a binary cycle of menstruating (having a period) and not. For coaches and athletes alike to be most successful in optimising training, they need to make an effort to learn, understand, and adapt to the psychophysiological state of the athlete.

“The menstrual cycle is a very real, constant, and ever-changing physiological state that is difficult for a male to understand. Therefore, the best thing that any coach can do (male or female) is to create a safe space for the athlete to be honest and open (transparent) about their mental and physical state. The menstrual cycle is not everything, but it is a component that at times, regardless of sleep, nutrition, or recovery, is going to interfere with performance.

“A coach should aim to build a trusting relationship with every athlete, be educated so you can shed light on what is happening inside their body, but most importantly, be ready and willing to simply listen. If you do that, performance and productivity are limitless.”

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