Menstrual Health
Creating a supportive training environment for female athletes requires a comprehensive approach that considers their physiological needs. By understanding the menstrual cycle and its impact on performance, providing education, designating a point of contact, and utilising tools like regular monitoring, coaches can better support their athletes. Additionally, ensuring appropriate facilities and promoting open communication further contributes to a positive and inclusive environment. This holistic approach not only helps female athletes perform at their best but also supports their overall health and well-being.
Phases of the menstrual cycle
During each menstrual cycle, an egg develops and is released by the ovaries. The lining of the uterus builds up, and if a pregnancy doesn’t occur, the uterine lining sheds and the cycle starts again. Each menstrual cycle typically lasts 28 days and consists of four different phases, with the length of these phases varying and changing over time. The use of oral contraceptives influences hormonal changes in the body, which can alter the menstrual cycle.
The menstrual cycle consists of four phases:
- Period
- Follicular Phase
- Luteal Phase
- Pre-menstrual Phase.
1. Period
The period marks the beginning of the menstrual cycle. During this phase, the endometrial lining of the uterus is shed and expelled from the body, a process that includes the discharge of blood and tissue. This phase is characterised by a decrease in the levels of the hormones estrogen and progesterone. Individuals may experience a variety of symptoms, including:
- Cramps
- Breast tenderness
- Bloating
- Irritability
- Headaches
- Fatigue/low energy levels
- Lower back pain.
As a coach, it is important to be aware of these potential symptoms and understand how they might impact an athlete’s performance. Creating an open, supportive environment can help athletes feel comfortable discussing how they feel, allowing you to adapt training sessions as needed to support their well-being and performance.
2. Follicular Phase
During the follicular phase of the menstrual cycle, the hypothalamus signals the pituitary gland to release follicle-stimulating hormone (FSH). This hormone encourages the ovaries to produce multiple follicles, each containing an egg. Typically, only one follicle will mature, housing the healthiest egg, while the others are reabsorbed by the body. As the mature follicle develops, it produces higher levels of estrogen, which helps thicken the uterine lining in preparation for a potential pregnancy.
Ovulation occurs when there is a surge in luteinising hormone (LH) released by the pituitary gland in response to rising estrogen levels during the follicular phase. This LH surge triggers the mature egg to be released from the ovary, after which it travels through the fallopian tube towards the uterus.
Understanding these processes can help coaches appreciate the physiological changes female athletes experience and how different phases of the cycle may impact their performance, energy levels, and training response.
3. Luteal Phase
The luteal phase follows ovulation and is characterised by rising levels of progesterone, which prepares the uterine lining for a potential pregnancy. If the egg is fertilised by sperm and successfully implants in the uterine wall, pregnancy begins.
During this phase, athletes may experience a few common symptoms, including:
- Feeling warmer
- Having an increased appetite
- Experiencing slight weight gain.
As a coach, being aware of these changes can help you better support female athletes during the luteal phase. Adjusting training intensity and nutrition strategies can be beneficial, as understanding these fluctuations can enhance both performance and well-being.
4. Pre-menstrual Phase
If fertilisation does not occur, the levels of estrogen and progesterone decline. During this phase, the individual may experience:
- Headaches
- Breast swelling and tenderness
- Irritability and anxiety
- Constipation.
Impact on training
Menstrual-related symptoms vary significantly among individuals, with nearly all female athletes reporting that these symptoms negatively affect their athletic performance (Findlay et al., 2020). Despite this perceived impact, studies have shown relatively low rates of absenteeism among female athletes, possibly due to the pressure to perform or an increased ability to manage physical discomfort (Findlay et al., 2020). Additionally, female athletes have noted that psychological symptoms associated with the menstrual cycle, such as reduced attentional focus, can further influence their performance (Findlay et al., 2020). Figure 2 below displays the psychological and physiological changes during the menstrual cycle in addition to the effect of training.
Figure 2- Psychological, Physiological and Effect on Training during Menstrual Cycle (Beatriz, 2020)
As a coach, understanding the impact of these symptoms can help you create a supportive environment for female athletes. Each phase of the cycle has a main need, main change, and main impact on sports performance that, if properly addressed, can enhance athletes’ performance. World Rugby’s Player Welfare Resource on the Menstrual Cycle contains a wide range of information and recommendations.
World Rugby Women's Health Resources - Period Health