Women, hormones, sport and performance

Shark Week. Monthlies. Painters are in. Girl stuff. These are a few of the hundreds of euphemisms used to describe the female menstrual cycle, or “got my period”. As a female teenager growing up in the ’80s, I do not recall talking to anyone about my period, except maybe mum when it first started. Dad would occasionally make a reference that would have me shrinking in embarrassment or shame. I certainly would not have said anything to my running coach, a middle aged white male. As I got older I might have described it as feeling ‘sluggish’ or that I had a ‘stomach ache’ but seldom directly named or talked about the issue. You just turned up, trained, raced, and hoped your time of the month wouldn’t.

While the taboo of talking about menstruation and hormones still pervades our culture, there are some glimmers of hope that the conversation is changing. When the US Women’s Soccer team won the recent World Cup, they shone a light on a number of issues, such as equal pay for sports women, but also the role of menstrual cycle tracking in their training and performance. The team had a sport science advise them on tracking cycles and tailoring training loads and nutritional intake based on the phase of their cycle and fluctuations in two key hormones – oestrogen and progesterone. 

For most women, these hormones fluctuate across four key phases, and depending on the combination, can affect energy, mood, pain, recovery and ultimately performance. With higher levels of oestrogen in the first half of the cycle, women are more likely to benefit from strength or high intensity training as muscle tissue repairs better in this phase, and energy and strength tend to be at their peak. 

Other stages are of the cycle are associated with greater risk of injury. Anterior Cruciate ligament (ACL) injuries, more common in female AFL players, are more likely to occur when oestrogen levels peak just prior to ovulation. The issue seems to be a change in joint laxity that impacts neuromuscular control and joint stability. Injury risk can be lowered by adapting training and nutrition in this phase. The answer to peak performance is not to train harder, but to train smarter. To understand your own body, its fluctuations, strengths and vulnerabilities and adapt accordingly.

At The Mind Room, we are particularly interested in the impact of hormones on mental health, as well as performance in sport or life. We know that pre-menstrual symptoms (PMS) affects the majority of Australian women, they experience a range of symptoms from abdominal pain, breast tenderness and fluid retention to food cravings, irritability and sadness. For 3-8% of women these symptoms are so severe that they cause significant distress and dysfunction in everyday life, and are classified as a mental health disorder called Premenstrual dysphoric disorder (PMDD).

The treatment for PMDD (different diagnosis to depression), can include herbal supplements, antidepressants (SSRIs), hormone therapies, surgery (in severe cases) and psychological strategies including CBT, mindfulness and stress management. Your medical team will help you navigate the best treatment approach for your circumstances.

Outside of the menstrual cycle, hormonal changes experienced at childbirth and menopause are also implicated in a range of mental health conditions such as postnatal depression, and re-occurrence of previously managed mental health conditions, such as depression, anxiety and bi-polar disorder. 

I previously worked with a female endurance athlete who was diagnosed with post-natal depression following the birth of her first child. She responded well to therapy and within a year she was recovered and managing her mental health with a combination of medication and psychological strategies. She went the next 14 years without any major relapse, until she hit menopause. If you thought “shark week” was a taboo topic, try the word “menopause” at your next office party. The hormone changes, along with a number of life stressors, triggered another episode of major depression. Part of the issue in this case was a lack of awareness that she was entering the peri menopausal phase of life and the impact that it could have on mental health.  

Whether you are an elite athlete, a woman preparing for motherhood or approaching menopause, knowing your own body and understanding your hormones is key to good mental health, wellbeing and performance. 

Finally, when it comes to hormones, let’s talk about it. No more painters are in or shark week. Let’s call a period, a period.