Menstruation
This page highlights some of the latest research that relates to menstruation and the possible impact on the female athlete. While there is limited research within this area, some recent findings aim to give females guidance on both how to train more effectively and also managing the risk of injury through the cycle.
Key takeaways
- No universal approach to training exists as each individual will have different experiences.
- Monitoring and tracking symptoms allows athletes to plan more effective training programmes.
- High quality research on menstruation is sparse with contradictory research findings on whether
different phases are linked to optimum different training strategies.
- Athletes may need to consider adjustment of carbohydrate and protein intake during different phases.
Training
A currently much debated question surrounding female athletes is how and if they should adapt their training during the menstrual cycle, as evidence suggests that exercise capacity can vary during different phases. However findings at present do not support a one size fits all approach to training when considering the menstrual cycle. There appears to be a significant variation in how physical capacities impact individuals during the cycle. Most evidence agrees that the monitoring and symptom tracking of the cycle can enable athletes to individualise their training approach, making it more effective in developing different aspects of their physical fitness.
While all types of training can be completed throughout each phase, some management of the volume and intensity of training may aid individuals in gaining more effective adaptations. While high quality research is limited within this area, some research suggests that the follicular phase is more suited to higher intensity workouts and development of strength and endurance. With the luteal phase maybe where workouts could feel harder and where a reduction in training volume and or intensity may be appropriate. However it must be stressed that research is inconclusive and individuals should monitor their own well-being as their guide to training.
Current debate
Specifically, some studies suggest that muscle strength and muscle diameter increase more during follicular phase-based strength training compared to luteal phase-based strength training. The highest level of motor abilities in female athletes is characteristic of the postmenstrual and ovulatory phase which allows for the planning of maximum physical activity during these phases. During menstrual and premenstrual phases (luteal), training modifications may be switched to focus on recovery and lower intensity work as these appear to be the phases of least physical efficiency.
Following such a phase based approach to training requires the planned and effective individual tracking and monitoring of symptoms by individuals and therefore may only be relevant at the elite level. Evidence points to the use of tracking apps and wellness questionnaires, including a performance measurement such as RPE, as being efficient at picking out trends and allowing athletes to modify their training schedules appropriately.
INJury prevention
Some recent evidence has linked different phases of the the menstrual cycle to an increased risk of injury. However there is not currently a full understanding of this area with research in its infancy. Whether this is causal due to the direct impact of hormonal changes or a result of ineffective management of training during different phases of the menstrual cycle is currently not clear. During periods of increased risk, historical training development of correct movement mechanics including balance and stability training may be equally relevant in understanding why female injury rates can be above those of male athletes.
Summary
When correct training loads, techniques and progression are combined with monitoring and appropriate nutrition this may mitigate the impact of hormones as a factor in female injuries. In this scenario, tracking an individual's menstrual cycle and using appropriate training loads could reduce the risk of injury. It is difficult to draw a firm conclusion on training during the menstruation cycle at present due to the limited research and complex and multi-dimensional nature of injuries amongst female athletes.
A note on Concussion
A pattern of increased vulnerability of concussion during the late luteal phase and first 2 days of menstruation has been found in recent studies on college students with a 9-day window of increased risk identified which accounted for 2/3rds of the sustained concussions in the study. The mechanism suggested is the reduction in oestrogen and progesterone reducing neuroprotection and increasing recovery time from symptoms. Once again it must be stressed that research in this area is recent with no firm conclusion being drawn from the available evidence.
A note on Nutrition
Nutrition also plays a significant role for an athlete with the need for carbohydrate (CHO) to be strategically adjusted as females appear to benefit from higher CHO intake during the follicular phase. Increased high quality protein intake during the catabolic luteal phase should be consumed every 3 - 4 hours with some evidence linking the need for its consumption before and directly after training or competition.
Resources
Reference list
Research: 2022 Commonwealth games (Birmingham) The most common coping strategies were ignoring pain (83.3%), maintaining hydration (66.67%), additional sleeping (66.7%) and painkillers (66.7%). Hot-cold pack use (50%), stretching (41.6%), taking a day off (20%), and modifying training (16.6%) were less common. https://bjsm.bmj.com/content/58/Suppl_2/A203.2
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