Menstrual cycle considerations for female fighters
By Esther Goldsmith
We know that the menstrual cycle has the potential to affect how women feel especially in relation to their exercise performance.(1) From our applied work with elite athletes and from our research, symptoms such as fatigue, cramps, pain and cravings are particularly prevalent, and undoubtedly these can impact how you feel in a workout. There is also research to suggest that things like recovery may be altered at different times in the menstrual cycle, (2) but there is little literature on ways to intervene so that female athletes can perform to their best on any one day.
Unfortunately, female fighters are extremely under-represented in any sport science research, despite the fact that they have such unique requirements. However, we have put together some particular menstrual cycle considerations that may help you navigate fighting and hormonal health:
Firstly, it would be remiss not to address the possibility of menstrual dysfunction amongst female fighters. A study in 2017 (3) showed that continual body weight changes, that are often seen in fighters around competition (for the need to ‘make weight’), are associated with menstrual irregularities. One study also found that 55% of participants who were boxers were oligomenorrheic (4) having extended cycles lasting more than 35 days). Fluctuating between weights, particularly in an extreme way and often including dramatic calorific deficits, will put your body at an increased amount of stress. This stress can cause disturbances too, and often ‘shut down’, your menstrual cycle. Trying to maintain a healthy weight for your body, rather than yo-yoing between extremes, and fuelling adequately for your exercise and lifestyle with a healthy, balanced diet should support your menstrual health. And remember: skipping periods is not a ‘normal’ or ‘good’ thing, so please seek medical professional advice if it’s your experience.
Keeping on the topic of ‘making weight’, bloating and weight gain during the menstrual cycle (particularly pre-menstrually) can be a huge problem for fighters. Just this week, UFC fighter Jessica Eye attributed the fact that she recently missed the flyweight limit to her menstrual cycle. But what can be done about this? Some nutrients, such as potassium and calcium, are thought to help water retention and bloating, and decreasing intake of highly processed, sugary and salty foods as well as fizzy drinks could help. Make sure you are fuelling regularly (every 3 hours or so), hydrating with water (+ electrolytes if you are training), and eating enough fibre (the RDA is 30g) is important. If you struggle with gastrointestinal problems a lot, you could consider a probiotic, but we’d advise that you seek professional advice about this first.
One note more on water retention – certain combined oral contraceptive pills are associated with increased water retention. So, if you are on the pill and feel this is a particular problem that you deal with then please seek advice from your GP or relevant medical professional.
There is a lot of talk in the media about the correlation between certain injuries and the menstrual cycle – with the majority of the conversation centering around ACL injuries, which disproportionally affect women compared with men.(5) Emerging research suggests that the increase in oestrogen, independent of progesterone, just prior to ovulation could affect ligament laxity or the stiffness of myotendinous units, and alter some muscle stretch reflexes.(6) This may mean that muscle activation and the way you land from anything plyometric may alter throughout the cycle, altering your risk of injury.(7) We would never want this to stop you training/exercising, so it’s about being proactive around the potential physiological changes. Ensuring that you warm up sufficiently before a workout, and include lots of muscle activation (particularly of the posterior chain; glutes + hamstrings) could help reduce injury risk.(8)
Research also suggests that females may be more at risk of sustaining a concussion compared with males, and it is finally being acknowledged that they may respond to concussion differently, presenting with different symptoms.(9) Whilst concussion is hard to prevent against, if you are experiencing any symptoms and think you might be concussed then please seek medical advice (for more info, check out: https://www.pinkconcussions.com ). It is also important to note that concussion may affect your menstrual cycle. One research study found that, participants with concussion were more likely to have abnormal/irregular menstrual cycles than participants with non-brain injuries.(10)
The final point – whilst research tries to make blanket statements, it is vital to understand that each individual is unique and therefore will respond differently, especially when it comes to hormones in the menstrual cycle. As a female who exercises, one of the best things that you can do is understand your own menstrual cycle, and what the hormonal changes that occur throughout it mean for you. Logging and tracking your period and any symptoms you experience can help with this, which is why we developed FitrWoman – aiming to empower you with the tools and information that you need to be able to perform to your best (in exercise but also in life) on any one day.
Bruinvels, G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2015). The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 London Marathon. British Journal of Sports Medicine, 50(9), 566–566.doi:10.1136/bjsports-2015-095505
Hackney AC, Kallman AL, Ağgön E. Female sex hormones and the recovery from exercise: Menstrual cycle phase affects responses. Biomed Hum Kinet. 2019;11(1):87‐89. doi:10.2478/bhk-2019-0011
Ko KM, Han K, Chung YJ, Yoon KH, Park YG, Lee SH. Association between Body Weight Changes and Menstrual Irregularity: The Korea National Health and Nutrition Examination Survey 2010 to 2012. Endocrinol Metab (Seoul). 2017;32(2):248‐256. doi:10.3803/EnM.2017.32.2.248
Trutschnigg B, Chong C, Habermayerova L, Karelis AD, Komorowski J. Female boxers have high bone mineral density despite low body fat mass, high energy expenditure, and a high incidence of oligomenorrhea. Appl Physiol Nutr Metab. 2008;33(5):863‐869. doi:10.1139/H08-071
Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995;23:694–701
Casey E, Hameed F, Dhaher YY. The muscle stretch reflex throughout the menstrual cycle. Med Sci Sports Exerc. 2014;46(3):600‐609. doi:10.1249/MSS.0000000000000134
Balachandar V, Marciniak JL, Wall O, Balachandar C. Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review. Muscles Ligaments Tendons J. 2017;7(1):136‐146. Published 2017 May 10. doi:10.11138/mltj/2017.7.1.136
LaBella CR, Huxford MR, Grissom J, Kim KY, Peng J, Christoffel KK. Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial [published correction appears in Arch Pediatr Adolesc Med. 2012 Jan;166(1):73]. Arch Pediatr Adolesc Med. 2011;165(11):1033‐1040. doi:10.1001/archpediatrics.2011.168
Covassin T, Savage JL, Bretzin AC, Fox ME. Sex differences in sport-related concussion long-term outcomes. Int J Psychophysiol. 2018;132(Pt A):9‐13. doi:10.1016/j.ijpsycho.2017.09.010
Snook ML, Henry LC, Sanfilippo JS, Zeleznik AJ, Kontos AP. Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women. JAMA Pediatr. 2017;171(9):879‐886. doi:10.1001/jamapediatrics.2017.1140