Female athletes are calling for more research into periods. Here’s why

At the 2022 European Championships, sprinter Dina Asher-Smith – the fastest British woman on record – made headlines when she spoke about being unable to complete a race due to period pain.
“More people need to actually research it from a sports science perspective, because it’s absolutely huge,” she told the BBC.

“It could do with more funding … I feel like if it was a men’s issue, we’d have a be a million different ways to combat things, but with women, there just needs to be more funding in that area.”

Her sentiments have been echoed by female athletes all around the world.

So how much research has actually been done in this field, why don’t we know more about it, and will things change in the future?

How do periods impact athletes?

Chloe Dalton, GWS Giants AFLW player and founder of media platform The Female Athlete Project, says she suffers a significant amount of nausea and pain every month due to her period.
“It feels like I’m getting stabbed a lot of the time, which is really horrible, so to couple that with high-intensity training on a regular basis is something that’s very difficult,” she told SBS News.

“A lot of the time I probably haven’t felt comfortable … to put my hand up and say ‘I can’t train today because of this’.”

AFLW player Chloe Dalton says she struggles with a significant amount of pain during her period each month. Source: Getty / Ian Hitchcock

“If you had a sore back or a sore hamstring it’s a similar level of pain, but it’s probably not something that’s widely acknowledged … I don’t think a lot of staff have had enough education about it.”

Dr Brianna Larsen, lecturer of sport and exercise at the University of Southern Queensland, told SBS News elite athletes often have higher rates of menstrual dysfunction, and can be more likely to experience issues such as amenorrhoea (the absence of periods) or polycystic ovarian syndrome (PCOS).
“Even though these topics are really relevant and they are a group that, in general, is very controlled around what they eat, and they report their sleep and mood and training load and all these things, this area just hasn’t gotten the same level of attention even though it is affecting a lot of athletes,” she said.

“That can mean things like experiencing cramps that will affect their ability to perform … some people have really heavy periods and they actually become anaemic over the course of their menstruation period, so feeling fatigued and weak and those sorts of things … there can be mood changes as well.”

“The majority of athletes do say these things negatively affect their ability to train and perform at different times of the month.”
Dr Larsen said roughly 50 per cent of female athletes in Australia are likely to be on a form of hormonal contraception, with many using the pill to regulate their periods.
In turn, though, hormonal contraceptives can also have mental and physical impacts.
Dr Kathleen Casto, a researcher in the field of behavioural neuroendocrinology and a former high-level student-athlete, says premenstrual dysphoric disorder (PMDD), a condition with both physiological and psychological effects, can also add complications.
“People who have PMDD or premenstrual exacerbation will perhaps have heightened injury risk, motivational complications, and just general psychological and physiological symptoms that make poor performance particularly challenging in the days leading up to the period and may put them at an injury risk,” she said.

“For those people, it’s important to know (about the condition), but the science of how to mitigate those effects is still far behind.”

What research has been done in this space?

Lindsie Arthur is a PhD candidate at the University of Melbourne conducting research into competitiveness and motivation across the menstrual cycle, and how this can be impacted by the contraceptive pill.

“One of the things that I find the most frustrating in this literature is that there’s just so little (of it),” she said.

“There is some research out there, but there’s not a lot of it, and what there is … has some pretty significant methodological limitations.”
Dr Casto agreed, noting that female athletes have been historically underrepresented in the area of sports medicine and sports science.
Additionally, she said conducting this type of research is somewhat difficult, and has been flawed in the past.
“There are a lot of methodological challenges about the accuracy of determining the menstrual cycle phase and measuring hormone levels,” she said.

“There are some studies that have … potential methodological problems with low sample sizes or inaccurate or invalid methods for determining menstrual cycle phase.”

Australian Institute of Sport launches landmark project

The Australian Institute of Sport (AIS) is currently conducting a landmark camp focused on the impacts of periods and hormonal contraceptives on female athletes.

The project is a collaboration between the AIS, the National Women’s Rugby League (NRLW), the Australian Catholic University (ACU), and Boston Children’s Hospital’s Wu Tsai Human Performance‘s Female Athlete Innovation Hub.

Turby league player standing on indoor track

The Female Athlete Research Camp will see 26 members of the NRL Indigenous Women’s Academy train full-time at the AIS in Canberra for a camp focused on the impacts of periods and hormonal contraceptives on female athletes. Source: Supplied / AIS

The Female Athlete Research Camp will see 26 members of the NRL Indigenous Women’s Academy train full-time at the AIS in Canberra, while being monitored and supported daily by 12 female researchers conducting 10 different studies.

Project Lead Dr Rachel Harris said the camp will study correlations between sport performance and female health, including the influence of the menstrual cycle and hormonal contraceptives on injury prevention, energy levels, recovery and sleep.

“We have seen an incredible growth in women’s sport over the past decade and it’s imperative that we commit to research and innovation to support the health and performance of our female athletes,” Dr Harris said.

Periods ‘shouldn’t be perceived as weakness’

Dr Casto said while this research is incredibly important and in need of funding, it is vital for messaging not to be misconstrued.
“We need to be careful about how we communicate this science, and make sure we’re careful in carrying out that science application-wise in protecting women in sports (and their) data and bodies,” she said.
“There is a tension in the history of how the menstrual cycle has been weaponised as a way to say that women can’t or shouldn’t be able to do the things that men do … I don’t want science to be used to say women are less capable of doing things.”
Dalton also said periods should not be seen as a weakness, but as an important element of the female body and physiology.
“Women’s bodies are incredible, the fact that we can carry babies and give birth, it’s quite amazing what our bodies have the capacity to do,” she said.
“It’s this really fine balance where we want to have equal access, we want to have equal pay, we want to have equal resources for women’s sport … but we don’t need our bodies to be compared to men’s.”

“I don’t think it’s something that should be perceived as a weakness simply because we can be impacted by periods, I think it’s really important that we don’t shy away from talking about that.”

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