KYMIRA – Managing PMS as an athlete
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 own biology.
But is it really unavoidable? Or are there things that we can be implementing to minimise the negative impact of PMS, and setting ourselves up to ensure that we optimise all aspects of our training, our preparation, our sleep, and our mood, when natures 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 varies drastically between people, with some athletes finding themselves and their training largely unaffected, spanning to others whom are unable to train at all. Common reported symptoms however include
- Muscle Aches & Pains
- Sleep Disruption
- Skin irritation
- Breast tenderness
- Increase in feelings of anxiety, irritability and/or sadness
- Drastic fluctuations to libido
It is easy to see then how many of these symptoms can have a detrimental effect to training routines as well as training outcomes, particular if experiencing severe variations of any of the aforementioned, or sometimes equally as debilitating, multiple symptoms simultaneously.
In terms of the direct cause of PMS, there are still questions that need to be asked and clarity that needs to be gained. For the most part, it is assumed that the outbreak of the aforementioned symptoms derive as a change to the persons homeostasis (their biological/physiological "norm") that occurs due to the changes to hormonal status that come with the menstrual cycle (we'll discuss this further later).
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 of time. There are several apps available that offer this kind of tracking (Clu, Flo, Ovia, FitrWoman to name a few), or alternatively, 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 length/duration and so it is important that your log is for you, and needs not 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 person exists, or your GP or relevant health practitioner if you have any questions or concerns – one thing is for sure though, don't just suffer in silence and assume there's nothing that can be done.
Once we have a handle on the symptoms, we can start to make meaningful and well-intended interventions to try and counter-act the negative impact. Each of the aforementioned symptoms does have a corresponding anecdote that at the very least, can help alleviate some (if not eliminate) the symptom itself. This may not be a silver bullet approach, and may require some time, trial, and error, but as an 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 optimise 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 effect our sleep (iron, magnesium, zinc etc); eliminating our blue light exposure and caffeine intake from the mid-afternoon on a daily basis etc.
Likewise if we frequently note nausea around eating times or generally throughout the day through days 1-3 of the cycle, we can prioritise the optimal structure of our plate design – ensuring we continue to uptake all we need from a nutrient and performance fuelling standpoint, but actively choosing our foods to minimise gut discomfort – whether that be from manipulating our lactose and/or dietary fibre intake and carefully selecting our carbohydrate sources and volumes, we can 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 utilising 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 minimise the impact of PMS, especially when it matters most in terms of training, competing, and performance.
It is important to note that although sometimes the associated symptoms may seem like a chore, a lot of them come as part of a healthy menstrual cycle, which is something all athletes and women should aspire to ascertain. Although there are multiple reasons for disruption to menstrual health, the most common in my experience is as a consequence to 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) 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 futile unfortunately, certainly in comparison to the overwhelming amount of research into the male equivalents. It is important to remember that women are not just ‘smaller men' when it comes to biology and performance physiology, and thankfully, there are some superb academics and practitioners 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 over the course of a healthy menstrual cycle, may in fact 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 occupies 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 analyse in order 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 common place – 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 own 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 whole-heartedly recommend that you reach out to an appropriate professional to discuss further.