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If you’re a female athlete, premenstrual syndrome (PMS) may well be something that has scuppered your performance in the past. Whether It has inhibited your preparation when it matters most or carried the blame for succeeding sub-optimal showing, either way, an alarming percentage of female athletes claim to have been negatively impacted by the seemingly unavoidable stranglehold of their biology.
But is it unavoidable? Or are there things that we can be implemented to minimize the negative impact of PMS, and setting ourselves up to ensure that we optimize all aspects of our training, our preparation, our sleep, and our mood, when nature's rhythm may have something else planned – this article hopes to shine a light on exactly that.
It’s important to note that both the symptoms and the severity of symptoms vary drastically between people, with some athletes finding themselves and their training largely unaffected, spanning to others who are unable to train at all. Commonly reported symptoms however include:
It is easy to see then how many of these symptoms can have a detrimental effect on training routines as well as training outcomes, particularly if experiencing severe variations of any of the aforementioned, or sometimes equally as debilitating, multiple symptoms simultaneously.
Track and Trace
Not that kind, don’t worry. What I mean by track and trace is the importance of monitoring the trends and symptoms associated with your menstrual cycle over a long period. There are several apps available that offer this kind of tracking (Clu, Flo, Ovia, Fit Woman to name a few), or a diary of your own with a pen and paper would suffice. There are also questionnaires available that are implemented in many team sport settings, and that have an ever-growing presence in the research literature – LEAF-Q for example. Assuming that our nutritional habits and exercise routines are structured, then there should be trends over time and on a cycle-to-cycle basis that allow us to join the dots. Again, it’s important to note that very few people will have the same experience as others, and not only will there be differences in symptomatic response, but also in cycle frequency, cycle duration and so it is important that your log is for you, and needs not to be compared to team-mates, colleagues, or anyone else for that matter. Once you have this information, talk about it with an appropriate professional, be it someone at your sports club or within the governing body if such a person exists, or your GP or relevant health practitioner. If you have any questions or concerns, please don’t suffer in silence as there is always help out there.
Once we have a handle on the symptoms, we can start to make meaningful and well-intended interventions to try and counteract the negative impact. Each of the aforementioned symptoms does have a corresponding anecdote that at the very least, can help alleviate (if not eliminate) some of the symptoms themselves. This may not be a silver bullet approach and may require some time, trial, and error. For example, if you know that your cycle length is typically 26 days and that in the final 2-3 days of your cycle, plus the first day, you tend to have trouble sleeping – then we can make sure we are giving ourselves the best opportunity to optimize our sleep hygiene throughout that period. Paying even more attention to our pre-sleep routines; ensuring we sleep in a cool, dark, quiet room at an appropriate time; shaping our nutritional strategies to ensure we are not opening ourselves up to vitamin and mineral deficiencies that may affect our sleep (iron, magnesium, zinc etc); eliminating our blue light exposure and caffeine intake from the mid-afternoon daily etc.
Likewise, if we frequently note nausea around eating times or generally throughout the day through days 1-3 of the cycle, we can prioritize the optimal structure of our plate design. Thus, ensuring we continue to uptake all we need from a nutrient and performance fuelling standpoint, but actively choosing foods to minimize gut discomfort. This could be in the form of manipulating our lactose and/or dietary fibre intake and carefully selecting our carbohydrate sources and volumes. We can then hopefully offset the severity and subsequent negative impact on our training and performance.
The take-home here is that there is something to be done, whether it be through tweaking and adjusting our routines, or making subtle adjustments to our dietary intake, or utilizing supplements, or just simply being more conscious of what may be coming in the days that lie ahead. We can make sensible and informed changes to minimize the impact of PMS, especially when it matters most in terms of training, competition, and performance.
It is important to note that although the associated symptoms may sometimes seem like a chore, a lot of them come as part of a healthy menstrual cycle, which is something all female athletes should aspire to ascertain. Although there are multiple reasons for disruption to menstrual health, the most common in my experience is as a consequence of sub-optimal nutritional practices. What was formally the Female Athlete Triad (relationship between disordered eating, bone health/bone mineral density, and menstrual disturbances/onset of amenorrhea (the absence of menstruation through infrequent or repeated cycles) is now classified under RED-S (relative energy deficiency in sport) syndrome and highlights the relationship between poor nutritional practice, in particular failing to meet minimum energy requirements for active athletes, and disturbances to menstrual health? You can find the RED-S CAT (clinical assessment tool) online and is something that I would generally recommend as a first port of call if you’re worried about your menstrual health.
Research into female athletes is still scarce, unfortunately, certainly in comparison to the overwhelming amount of research into male equivalents. It is important to remember that women are not just ‘smaller men’ when it comes to biology and performance physiology, and thankfully, some superb academics and practitioners are doing outstanding work and research all over the world to try and level out the playing field. There are inclinations that the fluctuations in a woman’s endocrinology throughout a healthy menstrual cycle, may open doors as something of a biological ‘superpower’, with susceptibility to enhanced adaptation to certain exercise modalities a very real possibility if aligned to certain phases of the menstrual cycle – so it isn’t all bad news!
The menstrual cycle and the female athlete as a whole still occupy a fairly new and relatively small space in the evidence literature, but thankfully, as mentioned earlier, that is gradually changing. There are some outstanding practitioners and academics that are continuing to probe and analyze to better understand the relationship between the menstrual cycle and performance. Equally as important, is that conversations around periods and the menstrual cycle are becoming more and more commonplace – and the more we can continue that trend, the more we can surpass any previous taboo associated with the subject, and aid women in understanding their bodies better and how best to manage them.
This article merely scratches the surface when it comes to the care and attention that is so often lacking for many female athletes, and if it has sparked any thoughts, I would wholeheartedly recommend that you reach out to an appropriate professional to discuss further.