In our supposedly “modern” society, there remains a significant taboo surrounding the subject of menstruation and reproductive health, particularly in the world of sports.

Women often feel compelled to conceal their periods and act as though they are not menstruating, resulting in the overlooking of hormonal cycles altogether. It is especially true when it comes to sports where periods are not taken into account, whether it be in terms of performance, clothing or health.

Despite the fact that menstruation has an undeniable impact on women's physical and athletic abilities, it is frequently ignored or even stigmatized. Conversely, the practice of sports can also have consequences on women's hormonal and menstrual cycles.

This article seeks to provide an overview of the challenges faced by women athletes whether professional or amateur, in relation to menstruation.

The impact of menstruations and hormones on the practice of sport

• Impact on women’s comfort when practicing sport

Federations’ rules have historically been created based on men’s standards, leading to many rules unfit for women, especially during their period (we will dig deeper into the clothing subject from a more general standpoint in a future article).

For example, when it comes to Tennis, Wimbledon required women to wear white skirts until the end of 2022[1]. Similarly, the English national football team attire includes white shorts[2]. 

The implications are not neutral: women on their periods wearing white clothes are often stressed out. They do not move as efficiently as they could, fearing that something may show. Their head cannot be fully in the game.

These issues are not given much thought. For instance, very few people have given a thought about: 

• marathon runners: how can you run 42km with the same tampon? Kiran Gandhi, a marathon runner ran the London 2015 edition without any menstrual protection to raise awareness about the “stigma around menstruation”[3]; 
• or paragliders: Laurie Genovese a world champion - has testified to the Newspaper “Le Monde” that she has no choice but to use adult diapers and, even that does not entirely solve the issue (she must shorten her flights). 

These issues can be addressed with simple or uncostly changes, but it requires a shift in mentality, which remain male-oriented, that is still slow to come. 

That being said, steps are being taken: 

• The English national football team has asked for a change in their shorts. The English Federation of Football indicated to the press in August 2022 that players "will be taken into consideration" for future kit designs. The sponsor still has to present a new short – at least a new color; 
• Wimbledon organizers have declared to the press in November 2022 that, as of 2023, women could wear to wear dark-colored undershorts if they want to[4]. 

Things are changing but there is still a long way to go. 

• Impact on performance

Menstruation does not only affect women’s comfort but also their performance.

The menstrual cycle has four phases, each with its own specificities that impact physical condition and morale: 

• Menstrual phase: very low level of estrogen and progesterone, leading to a degradation of the general state (stomach aches, fatigue, mood). 
• Follicular phase: the levels of estrogen start increasing, which increases muscular force and endurance capacity. 
• Ovulatory phase: the level of estrogen is at its peak, which can improve performance, but the body temperature is higher, thus making it more difficult to recover after training. 
• Luteal phase: the level of progesterone increases, which can lead to fatigue.

Studies have shown periods may, for some women, be as painful as a heart attack – especially for the ones suffering from endometriosis (10% according to the WHO[5]). 

Pain medication is often unavailable due to being banned as a performance-enhancing drug. Even when pain medication is possible, it often has side effects. The same goes with the pill or hormonal IUD that women sometimes take to get control of their hormonal cycle and, therefore, periods.

This is, therefore, a quite delicate subject to tackle. The difficulty is heightened by the taboo around periods and menstrual cycles. Even though more and more women speak about the impact of their periods on their training and performance this is scarcely taken into account, especially by a coach.

Menstruations and hormones should be considered tools for maximizing performance, rather than hindrances. Taking this cycle into account is critical to maximize training and avoiding injuries. 

Mentalities are slowly changing, but there is still much work to be done. 

Abuses to circumvent the impact of women’s hormones on performance

• Third parties’ abuse 

Even though hormonal cycles are not often taken into consideration when training, some coaches and federations have soon realized their impact on athletic performances. They seek to circumvent these effects, resulting in numerous and serious abuses. For example, athletes from the Soviet Union in the 80s/90s have spoken out about pregnancies and forced intercourses as doping techniques. 

Testimonies of these abuses are quite recent. No doubt there are others that will eventually (or not) come to light. 

• Self-abuse or self-negligence 

As we explained above, menstruations and hormonal cycles, especially their effect on training, performance, and comfort, are complex. Therefore, when some women see their periods disappear (or when do not get them during puberty), they do not try to fix the situation and are fine with the change. 

However, when a woman stops menstruating, this may be a sign of a health issue. The stress, high level of training and food restrictions sometimes lead to primary and/or secondary amenorrhea. This subject is scarcely discussed by athletes as it removes a constraint from their training and performance.

Yet, research has shown that prolonged amenorrhea may have an impact on bone density, creating risks of osteoporosis[6]. On a more immediate horizon, this results from a low level of estrogen, which creates a higher risk of injury.

This subject has started being taken into consideration by the Olympics, more especially with the “ICO Consensus Statement” from 2005 and 2014[7]. However, no concrete step has been taken yet. Sports organizations must prioritize the health of their athletes and provide adequate support to address any health issues related to menstrual cycles and hormonal changes. 

* 

To conclude, menstrual cycles and hormones are an integral part of women’s lives and sports are no exception. These are not disabilities, but leverage to maximize women’s performance and, more generally comfort, when doing sports, whether at a professional or amateur level. 

While progress has been made, there is still a long way to go to create a more inclusive and supportive environment for women athletes.

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[1]     Clothing and Equipment - The Championships, Wimbledon - Official Site by IBM: the regulation provides in article 1) “Competitors must be dressed in suitable tennis attire that is almost entirely white and this applies from the point at which the player enters the court surround”

[2]     Euro 2022: FA acknowledges England squad's period concerns over white shorts (espn.co.uk)

[3]     Here's why I ran the London Marathon on the first day of my period – and chose not to wear a tampon | The Independent | The Independent

[4]     This has been reflected in the regulation, where article 1) specifies “Exception provided for female players who are allowed to wear solid, mid/dark-coloured undershorts provided they are no longer than their shorts or skirt.”

 [5]     https://www.who.int/fr/news-room/fact-sheets/detail/endometriosis#:~:text=L%27endom%C3%A9triose%20touche%20pr%C3%A8s%20de,millions%20de%20personnes%20(2).

[6]     Amenorrheic Bone Loss1 | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic (oup.com)

[7]     IOC Consensus Statement on the Female Athlete Triad - Olympic News (olympics.com)