At the recent World Aquatics Swimming Championships in Budapest, Olympic champions Pernille Blume, Caroline Jouisse, and Ranomi Kromowidjojo joined sport scientist Dr. Marine Dupuit in leading open, practical workshops on an often-overlooked topic in elite sport: the menstrual cycle.
This article builds upon the insights shared during the recent World Aquatics Swimming Championships in Budapest, where Olympians Pernille Blume, Caroline Jouisse, and Ranomi Kromowidjojo, alongside esteemed sport scientist Marine Dupuit hosted interactive and educational workshops on the menstrual cycle for both athletes and coaches. We aim to continue this important conversation—empowering athletes and coaches with few tools to optimize performance and well-being throughout the menstrual cycle.
This post was written in cooperation with Marine Dupuit, PhD, Sport Scientist on EMPOW’HER Program, France’s National Institute of Sport, Expertise, and Performance (INSEP) and with the World Aquatics Sports Medicine Committee.
Introduction - Understanding the phases of the Menstrual cycle
The menstrual cycle typically lasts around 28 days.
However, every woman is different, and the duration of a cycle may vary (from 21 to 35 days), and therefore the duration of each phase should be approached with caution.
Menstrual Phase (Day 1-5): Physical and mental energy may be lower, and symptoms like abdominal cramps are common.
Follicular Phase (Day 6-14): Estrogen level begin to rise and peaks just before ovulation day. (Day 14), which can boost energy. This phase may be ideal for incorporating higher-intensity training, as it can maximize strength gains and enhance muscle recovery.
Luteal Phase (Day 15-28): Both progesterone and estrogen increase with higher progesterone levels. The drop of hormonal concentration at the end of this phase can lead to various symptoms.
Breaking Taboo – Communication and Knowledge Barriers
Menstrual Cycle is a topic that is not much discussed within the athletic community. Over 81% of athletes2 considered menstrual cycle as a taboo.
There is often a lack of open communication between athletes, coaches, and medical staff regarding menstrual health. Only 11% of athletes2 openly talked about menstrual cycle with their coaches.
The lack of open communication between athletes, coaches, and medical teams can prevent the early detection of issues such as irregular cycles or menstrual-related pain.
The perception of the athletes is that their coaches have limited or no knowledge about the Menstrual Cycle. In general, athletes feel more comfortable talking with female coaches.
53% of the athletes2 perceived the knowledge acquired of their coaches as poor/very poor.
Why should you talk about your Menstrual Cycle?
Menstrual cycle affects energy levels, strength, and endurance. Addressing menstrual cycle-related symptoms and planning around the cycle can make a notable difference in training, competition results, and injury prevention.
Identifying Symptoms of the Menstrual Cycle
The most common menstrual cycle symptoms reported by elite female athletes include:
- Mood changes
- Fatigue
- Abdominal cramps (reported by up to 80% of athletes)
- Bloating
- Changes in appetite
- Breast tenderness
- Headaches
- Lower back pain
- Acne
- Disturbed sleep
Some athletes report heightened emotional sensitivity during certain phases, which can affect focus and mental resilience in competition.
These symptoms tend to be most prevalent during the premenstrual (late luteal) and menstruation (early follicular) phases of the cycle (see Figure A). Some athletes may experience Premenstrual syndrome (PMS), while others report heightened pain during menstruation or mid-cycle ovulation.
Period pains and symptoms are not normal. Don’t hesitate to consult if your symptoms are intense and the pain high.
Measures to support athletes through the menstrual cycle
Every woman, every athlete is different.
Athletes should know about their menstrual cycle and should be encouraged to keep a menstrual health journal, logging symptoms, moods, and performance impacts during each cycle, to help in understanding personal patterns and planning around potential disruptions.
Swimming often involves an early specialization, coupled with intense training regimens and high energy expenditure, especially at a young age. Due to these demanding conditions, athletes are at a heightened risk of experiencing menstrual cycle irregularities. The combination of rigorous physical activity, high training volumes, and the pressure to maintain peak performance can disrupt hormonal balance, leading to a higher prevalence of cycle disorders (primary amenorrhea, secondary amenorrhea, and oligomenorrhea) among athletes in aquatic sports. These menstrual cycle disturbances can be partly due to a Low Energy Availability (LEA)/Relative Energy Deficiency in Sport (REDs).
- Primary amenorrhea = no period before 15 years old
- Secondary amenorrhea = missing 3 cycles and more (over 90 days)
- Oligo-menorrhea = cycle > 35 days / 6-8 cycles per year
Extended/irregular cycle length or missing period should be investigated. Being an elite athlete and training hard does not mean that a Menstrual cycle disorder is normal.
Adjust the Athlete’s Life: Training and Competition
Individual Variability: Each athlete is unique, and the impact of the menstrual cycle on performance is highly individual. While some perceive significant effects, others may notice little to no impact.
Scientific Considerations: The relationship between menstrual cycle and performance requires further research. Athletes may also have conditions like Polycystic Ovary Syndrome (PCOS) or use hormonal contraceptives, which influence hormonal profiles and cycle patterns.
Adaptation Recommendations: Athletes not using hormonal contraceptives might consider modifying training intensity during certain phases of their cycle. However, these adjustments should be personalized and approached cautiously until more conclusive evidence emerges.
Athletes may adjust training intensity based on the menstrual phase (e.g., lighter loads and/or higher recovery during menstruation or premenstrual phase if necessary).
Nutritional Support
Adapted nutrition strategies can help to reduce the symptoms of physiological stress. For instance, encourage a balanced diet rich in whole foods, omega-3 fatty acids, and hydration, which can reduce discomfort and menstrual pain. Minimize caffeine, additive sugar, salty and processed foods, as they can exacerbate symptoms like cramps and bloating.
Psychological and Stress Management Techniques
Provide access to mental health resources, as psychological symptoms can impact motivation and focus. Chronic stress worsens menstrual symptoms, so implementing relaxation techniques like deep breathing, meditation, and yoga can be beneficial. Journaling can be therapeutic, helping to reduce stress, and improve overall mental well-being by providing an outlet for expressing thoughts and emotions.
Pain Management Plans
Encourage athletes to consult with healthcare providers on safe and effective options, which may include non-steroidal anti-inflammatory drugs (NSAIDs), heat therapy, or prescribed hormonal therapies, to manage painful symptoms without compromising health or performance.
Key points
Open conversations: Discussing your menstrual cycle and contraceptive use with coaches, staff, and teammates should be normalized—it's not a taboo topic.
Seek Knowledge: Don't hesitate to ask for additional education and resources to deepen your understanding.
Individual Variability: Menstrual cycles and their symptoms are unique to each athlete and woman.
Red Flags: Irregular cycles may signal Low Energy Availability (LEA)/Relative Energy Deficiency in Sport (REDs). Monitor your cycle to catch early warning signs.
Tracking is Key: Use tools (e.g., app for smartphone) to track your menstrual health for better performance and well-being.
Strategies & training adaptations
- Nutritional strategies to reduce symptoms (inflammation)
- Therapeutic strategies to reduce pain
- Stretching to gain in mobility
- Specific preparation/warm-up to prepare the body and reduce injury risk
- Training load adaptation (easier in individual sports)
References