Menstrual cycles and athletic performance - changing the narrative is the only hope of progress

Almost half the planet goes through it, once a month, for an average of 40 years. Women will have on average 480 periods in their lifetime. Yet for such a frequent occurrence, why is so little known about their conflicts, nuances and continuously varying symptoms?

Existing information on how monthly visits from Mother Nature can affect athletic performance is even scarcer - so how we are then able to protect, strengthen and train our bodies to still excel during the typical 28-day cycle? 

In 2022, Dina Asher-Smith pulled up with cramp at the 100m finals of the European Championships in Munich and when asked about the reason for the issue, the fastest British woman on record cited ‘girl stuff’, before going on to call for more funding and research in period sports science.  

Speaking to the press, the World Champion said: “Sometimes you see girls who have been so consistent have a random dip, and behind the scenes they have been really struggling. It could do with more funding, because if it was a men’s issue, we would have a million different ways to combat it.”

Asher-Smith has been far from the only voice in calling for increased attention in this area, with fellow British Olympian Eilish McColgan and British long jumper Jazmin Sawyers also speaking out.

But how much research is out there already and when are we expected to see more?  

NationalWorld sat down with British Gymnastics Female Athlete Support Lead and Senior Performance Nutritionist Mhairi Keil to discuss how menstrual cycles can affect athletic performance, and the necessity to remove the stigma surrounding talking about ‘girls’ stuff’.  

As any female who has experience with periods will tell you, however, the answers are never going to be straightforward.

“This is a complex one!,” said Mhairi, when asked to give her verdict on how menstrual cycles affect performance.

Mhairi went on to explain that while some research confirms the menstrual cycle does not affect someone’s capacity to do strength training, and added: “Menstrual cycles can come in naturally as the hormones are ebbing and flowing, there are certain times where we might feel more motivated and we have a greater capacity to do the training because we feel more energised.

“Or, there’s times where we might feel it’s harder to do that training but that doesn't mean we can't adapt and respond to that training.

“It’s important to understand that everyone can adapt to the training they are doing throughout their cycle. The challenge is, it may feel harder to complete certain sessions and/or we may feel less motivated to train at certain times of our cycle. It is therefore important to have strategies in place to help us overcome these challenges specific to the symptoms we experience, which will vary from person to person. Some women do experience symptoms that can be debilitating, for these athletes, adjustments to their training programme may be essential.”

Another exceptionally grey area surrounding significant lack of research in the menstrual cycle pertains to how they can affect injuries, notably Anterior Cruciate Ligament issues which have become overwhelmingly prevalent in women’s football.  

Between 25 and 30 players - enough for an entire football squad - missed the Women’s World Cup last summer due to the ACL pandemic and women are reportedly two-to-six times more likely to sustain the injury than their male counterparts.  

How much of this, then, has been hindered by our menstrual cycle and is there anything we can do to help? 

Mhairi claims there is no clear cut yes or no answer, but finding that answer has not been helped by ‘flaws’ in past research methodology. What is known, though, is that for all the positives that oestrogen can bring, one of the negative aspects is joint laxity and at certain points in the month our joints are definitely going to be more laxed.  

Discussing this finding, Mhairi states: “We’re never going to get rid of the menstrual cycle - we don’t want to! (So) we’ve got to work with our body. Injuries, particularly ACL injuries, are multifactorial. We must mitigate the risks by ensuring (female athletes) we are well fuelled, we’ve got healthy menstrual cycles, good quality warm-ups, optimal strength training programmes, good recovery strategies, to name a few.  

“If someone doesn’t have a “healthy menstrual cycle”; regular and manageable cycle, which includes ovulation, a bleed, with manageable symptoms and not excessive bleeding, then this can be a contributing factor towards injury risk.

“We’ve got to work with our bodies, maximise their potential, use our hormones to our advantage, and have strategies in place to overcome the challenges. It’s looking at the whole holistic approach as to what we can do to get the best out of bodies, training and performance, because we have to be prepared to train and compete at all time points in our menstrual cycle, therefore we have to mitigate against any potential risks.”  

Food, however, is not the immediate answer when it comes to mitigation tactics with Mhairi once again citing a lack of research on the topic.  

When asked if there are particular food groups we should have more at certain times of the month, she answered: “There is some research to show that magnesium can reduce pelvic pain during our periods, and those who experience heavy blood loss should be more aware of their iron status and nutritional intake of this important mineral. 

“(But) everyone has got different dietary requirements/preferences but around the menstrual cycle, it’s more (a question of) ‘are you eating enough to support your training demands?’ and ‘are you optimising your training plan?’

“There might be a few nuances that you discuss with someone depending on the symptoms they experience and their nutritional preferences, but getting the fundamentals correct such as total energy intake and availability, good fuelling and recovery strategies, eating a good quality diet and ensuring your nutrition is supporting the demands your training is placing on you is of particular importance”  

A huge advocate for changing how we interpret and characterise our menstrual cycles, Mhairi believes that the catalyst to understanding them further is to ‘change the narrative’. 

An important part of this is not just changing this pessimistic attitude we are all complicit in having at some point when it comes to the menstrual cycle, but also by bringing men more affirmatively into the conversation - we can then hope that male coaches can have a far broader knowledge and appreciation of how their female athletes can respond at certain points in the month.

On this point, Mhairi continued: “It’s fundamentally hugely important (to have men in the conversation) because girls have dads/male guardians, and male coaches and support teams who have to navigate this too.

“Our cycle is a sign of health. The big thing for me is trying to change the narrative around menstrual cycles. Our menstrual cycle is another amazing feature of our body but all we ever do is focus on the negative aspects of it. Looking at what our hormones do for us, such as building strong bones, supporting cardiovascular health, making us feel energised at certain times, and of course, enabling us to be able to have children as and when the time is right. 

“The barrier is that people just don’t know enough about it,” continued Mhairi. “That’s not just men, women don't know enough about their cycles, the benefits of our hormones and how they impact us individually. Until we understand this - men and women - it’s really hard to truly support what’s going on and be able to have those conversations with people.”  

As openly discussing menstrual cycles becomes more commonplace, the hope is of course that the necessary research regarding ‘girls stuff’ is given sufficient funding and we can be permitted to deepen our understanding of our bodies, learning to work with them rather than fighting against the hormones keeping us afloat.  

For, as Mhairi points out, no matter how much we might protest the monthly visits, they’re certainly not going anywhere any time soon!