A teammate of one of my athletes asked me to write about the influence of menstruation on training and performance.

Okay, game on.
Admittedly, this article has been difficult for me. Not because of the science on menstruation or on athletic performance (tl;dr: eat more carbs to support energy availability during pre-menstrual and menstrual phases), but because of how I perceive my role in making the topic mainstream. 

Let’s start at the beginning: I’m cis-male, have never experienced a period, and, until my wife’s second pregnancy, had never given any thought to the impact of sex hormones other than testosterone on training performance.

So move to the middle: I have read a lot of books about hormones, a lot of articles about differences between female and male physiology, and a lot of memoirs and biographies from male, female, and transgender athletes…yet, as many before me have noticed, I discovered that almost no scientific literature addresses the unique physiological environment of estrogen-dominant athletes.

And now, on to the end: I’m not at all qualified to talk about this.

But I am qualified to talk about being a male coach to non-male athletes, what I’ve personally missed and misunderstood, and what I’m trying to do to be better.

As a bonus, a few dear friends and long-time athletes and fellow coaches — all high-performing women — shared opinions with me on how women in sport can get their voices heard by oblivious male coaches.

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Nothing I say here applies to the elite level of sport. Broadly speaking, all the worst parts of male-centric culture are manifest in every form of elite sport. I haven’t lived, worked, or competed at that level and I’m obviously not a female athlete thus not a female athlete at that level, so I cannot suggest how to shift elite athletics on this topic – this 51% of the human population topic, this <30% of all research topic, this “WTF is up with Nike?” topic.

Male coaches: empty your mind then read/watch the interviews with the most public women in sport; they are telling us everything we need to know, we just don’t listen. Maybe if things get better at my level, at the middle school and high school level, at the local gym level, at the amateur athletics level, then things can get a little better at the college and professional levels…eventually. Maybe.

Last thing before I actually think aloud for you: athletes referred to as “female” in this piece are athletes born with ovaries and thus assigned female at birth, whose dominant sex hormones are estrogenic rather than androgenic, and who menstruate. I use the term as shorthand to reference an athlete’s endocrine physiology, specifically because the oestrogen-progesterone cycle is relevant to the training and nutrition recommendations. Further, I use “male” in this piece as shorthand for athletes whose dominant sex hormones are androgenic rather than estrogenic and who do not menstruate. I recognize all gender identifications as valid & true.

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On Performance and Perception

As a male coach of female athletes, I have to accept that I don’t know anything about how your response to “how do you feel today?” could impact how you perform today. By starting there, I can begin to guide my athletes toward higher performance.

Male Athletes and Emotional Expression

To be clear, there’s so much unhealthy emotional suppression, peacocking, and “no pain, no gain” nonsense in men’s athletics, that I can’t reliably trust a male athlete’s response to that question either.

But the default narrative for the male athlete is “push through.” Then, when that athlete fails, the coaching culture is to yell, is to berate them publicly, is to glower at them, and then is to turn your back on them. Tragically, there’s enough nonsense in the culture that, instead of that athlete quitting in most cases, it does, in fact, serve to push them to higher heights. At least, it pushes the gifted and fortunate survivors to higher heights, while the “lesser”, the “weaker”, and the “unfit” — often derisively referred to as the “sissies”, the “lazy”, and the “losers” — actually walk away from sport forever.

That’s middle school football in Texas, by the way. Burning a 12-year old out of sports for all of adolescence and young adulthood passes for culture…

So the survivors get praised for being “tough” and being “ready to play the game”, develop a strong sense of self-worth from enduring this culture, maybe even thriving in it, and carry that pride into coaching. Coming into coaching, our mentality is that “what worked for me is going to work for him.” It’s survivor bias and it propagates the virus in the culture. It shouldn’t be surprising that the next generation of coaches, finished in a stew of hostile masculinity and bombastic showmanship, behaves in accordance with all generational trauma: hurt people hurt more people.

How Male Coaches Approach Non-male Athletes

But now imagine the hurt survivor who aspires to be a coach carries that mentality into women’s sports. I hate to acknowledge this, but a lot of male coaches come to female sports because there wasn’t a slot for them in their sport of choice with male athletes. Add in a sense of shame related to your own value as an athlete, as a leader, and as a would-be member of the coaching fraternity…now you have a damaged male attempting to coach female athletes.

It’s a pretty pessimistic view, but it’s how I look at my fundamental position as a coach.

I am a survivor of that system. I carry male traditions from male sporting culture and conclusions about the adaptability of male physiology from male-centric sports science into every interaction I have with athletes. I carry male biases. I carry male presumptions about fatigue, about soreness, about pain, about distress, about arousal, and about performance. I can only see the world from my viewpoint and my viewpoint, because my nature and my nurture are such, is quintessentially male.

So if I’m to have any chance of connecting with, investing in, developing, and being trusted by female athletes, I have to accept that I don’t know anything about how your feelings during a training session will affect your performance.

An Alternative Approach To Coaching

At most, I can arrive to the training session as a scientist with a hypothesis, no more than a testable idea. And what I have to do from there is observe, collect data, and modify my hypothesis.

In nearly 10 years serving female athletes, I now have some hypotheses that I trust. Thankfully, emerging sports science seems to support the conclusions I’ve arrived at. (To be fair, most of my conclusions actually come from mentors and other coaches who have shared their experiences trying to be better partners to their female athletes, too. I’m not smart enough or old enough to reach any conclusions on my own!)

A Male Coach’s Conclusions About Female Athletes

• Female athletes can tolerate more training volume per day and per week
• Female athletes “need” more food and get by on less sleep
• Female athletes can be incredibly strong relative to bodyweight…
• …but grip is a more limiting factor
• Fully expressed emotions seem to enable PRs
• Structural injuries are almost always related to (inadequate) food
• No one is immune to social pressures about body composition
• Female athletes’ (loss of) periods are the last warning before catastrophe

Look! Look at the bias! Everything I have concluded about female athletes, everything that I lean on to better support and coach female athletes, is comparative to male athletes. Except for line 7, you could add “compared to male athletes” to every line, because that’s how the thought emerges in my mind.

I’m ashamed of this, as it makes me feel ego-centric and male-centered in my coaching, but I don’t know any other way to reference my lived and learned experience before applying that experience to female athletes.

But here are the implications which have helped me help more athletes succeed:

• what works for the female athlete, works for every athlete regardless of hormone proportion, especially pre-pubescent, masters, low training age, and post-injury athletes
• benchmarking against my male experience shows me how to help all athletes thrive, rather than letting them struggle against anomalous standards of performance

These implications struck me powerfully when I returned to sport (again) four years ago. Basing our training standards on the outlier survivors of the male sports system permits an approach to training that breaks most athletes and benefits few. You can’t build standards for exceptions.

Where Precedent Training Paradigms Fail Athletes

Female athletes seem to have fewer neural pathways for grip and upper body strength. This would imply that they will not do as well with heavy upper body work, in the modern S&C/bodybuilding tradition. Yet kinesthetics and biomechanics research suggest that upper extremity muscle mass makes little contribution to sports performance in most sports, including the fighting and throwing arts. (Gymnastics is a notable exception…but there’s an exception to this exception that Christopher Sommer has done a brilliant job detailing in Building the Gymnastic Body, so I won’t bother here.)

So what’s the deal with all the upper body work? Why is it important? Because men take pride in developed, muscular upper bodies. We value a particular aesthetic and train accordingly. This is a social factor, not a sports performance factor.

Dan John quips that he can teach a gym class full of 13 year-olds to squat deep and power snatch and jump, doing enough reps to exhaust them, yet the boys still want to do curls after. I don’t have a problem with “look good, feel good, play good” but that’s hardly an adequate criteria for a sports science position. (He added that the girls, by the way, always wanted to do ab work. If they did more comprehensive core work rather than crunches, this would have actually been useful!)

Everything sports science says about strength standards, about acute and chronic fatigue, about anabolism, and about nutrient timing is similarly biased in conception because the studies were all done on men in their peak testosterone years.

How Female Athletes Thrive…

Exercises That Work (for everyone)

Hanging from objects, isometric and slow lunge patterns (aka split squat holds and box step-ups), and postural work do wonders for female athletes. Incidence of ankle and knee injuries decrease, power transfer increases, low back pain diminishes, and training volume can increase when this type of work is done frequently and with appropriate intensity.

Turns out, those same pillars of training make middle school athletes into monsters on the field at the same time they lay a foundation for future performance. Those same pillars of training keep masters athletes in the game. Those pillars of training are the starting point for most physical therapy and for assessments in S&C programs. Those pillars are the basics. If it is true that “the elite are just better at the basics than everyone else”, then the things that make female athletes thrive are the things that make all athletes thrive and, thus, are the things that build elite performance: the basics.

The hinge pattern, as Pavel and Dan John say in Easy Strength about the kettlebell swing, “is a fat burning athlete builder.” The most effective exercises for improving performance in female athletes lean into that hinge pattern:

• barbell or trap bar deadlift
• kettlebell swing (and the Olympic lifts, but I don’t teach them to non-weightlifters anymore)
• hanging leg raise
• ab wheel rollout
• glute bridge / hip thrust
• broad jump
• box jump
• all vertical and horizontal throws

The magic of this pattern is how it builds up the glutes and the counter-glutes (abs+obliques). This pattern develops explosive power, maximal strength, and extraordinary postural strength. The hinge pattern makes you more athletic.

As the glutes become strong and the abs become strong, female athletes jump higher, run faster, throw farther, and bounce back up faster. Developing the glutes and abs with proper strength and power sets up long careers for youth athletes and extends years of performance for masters athletes. Any S&C program worth its salt starts with the hinge and cultivates it every day. The focus of PT for old clients is getting them to have the coordination and strength to hinge — interrupt a fall, stumble and recover, and lift from the floor — without pain or fear. The hinge is the fountain of youth and is the foundation of all athletic movement.

Female athletes thrive on the hinge because all athletes thrive on the hinge. What works for female athletes works for everyone. So what good is the distinction between male and female athletes?

How Menstruation Impacts Performance

The only meaningful distinction to make between male and female athletes is menstruation. Now we finally get to the point: how does an athlete’s period affect performance?

First, an overview of the menstrual cycle, for common context.

• the pre-menstrual phase (luteal phase) is when oestrogen & progesterone levels fall
• the menstrual phase is when those hormone levels are lowest and bleeding occurs
• the follicular phase begins alongside menstruation but continues for a few weeks as oestrogen & progesterone levels rise again
• the ovulation phase is when those hormone levels are highest

And, for simplicity, further reduce the menstrual cycle to a “low-hormone phase” (luteal and menstrual phases) and a “high-hormone phase” (follicular and ovulation phases).

With that language for the menstrual cycle in place, consider that every human’s body has two preferences about energy sources:

• it prefers to save fat for emergencies
• it prefers to burn carbs (glycogen) for activity

Ironically, trying to convince your body to burn fat by starving it of carbs only serves to convince it you are living in an emergency, and thus to store all the fat it can. Intermittent fasting and ketogenic diets seem to only work short-term for field- and power-athletes.

For menstruating athletes, there are two more considerations:

• throughout the low-hormone phase, the body is more averse to sacrificing fat
• throughout the high-hormone phase, the body is more inclined to utilize fat

PERFORMANCE DURING LOW-HORMONE PHASES

When estrogen levels are low or trending downward, adequate glycogen availability is central to performance, both to supply your working muscles and to counteract a physiological inclination to store fat.

What’s more, the decline in estrogen means you are likely to feel hotter and have worse sleep. When body temperature is elevated, muscles increase their glycogen consumption, even at rest, meaning you have less glycogen available during training. When you have poor sleep, less glycogen is replenished in your brain overnight, which sharply increases your fatigue response during the day.

All this resting glycogen consumption – combined with a few other cardiovascular factors – means the menstruating athlete is likely to experience reduced endurance, reduced aerobic power, and reduced aerobic capacity before and during their period.

The solution is to #eatmorecarbs. Seriously, a large body of anecdotal evidence suggests that eating more complex carbohydrates reduces PMS symptoms, enables quality training in the pre-menstrual phase, and maintains time to exhaustion during intense, sustained efforts throughout menstruation. When your body is burning carbs like a coal train and highly resistant to consuming stored fat, your performance solution and your body composition solution is to fuel your work, as Amber Pierce used to say when she presented for TrainerRoad.

You have to eat. A lot. And you have to eat more carbs.

PERFORMING DURING HIGH-HORMONE PHASES

When estrogen levels are high or trending upward, adequate glycogen is still central to performance. The key to training and competing well during this phase is capitalizing on your hormone availability and taking advantage of your body’s willingness to consume fat as fuel.

An increase in estrogen generation means you are likely to feel cooler and have better sleep. Feeling cooler means you need serious effort to maintain thermogenic homeostasis all day, so your pre-training warmup needs to attend to less-ready muscles and joints to minimize injury risk. But feeling cooler also improves the quality of your sleep and sleep is the most anabolic activity there is. Greater anabolic signaling means more thorough muscular and neural recovery from training.

Regardless of the phase of the menstrual cycle, no scientific literature documents any change in peak power or peak force production. Ignoring psychological factors for a moment, no matter how severe the physical symptoms of the low-hormone phase, you can always go to max…once.

But sports performance is rarely defined by a single effort. The body’s preference for consuming fat during aerobic activity throughout the high-hormone phase is lightly correlated to faster recovery both between efforts and between sessions of exercise. So you still need to eat adequate carbohydrates to fuel your work, but, presumably, lipolysis (fat burning) boosts your capacity to recover quickly so you can do work again.

Taken all together, it would be little surprise to run faster, lift heavier, or set a few PRs during your high-hormone phases. That said, an appropriate recovery philosophy is likely the more influential factor.

At this point in the menstrual cycle, you have to eat. A lot. But you “only” have to eat enough carbs.

Is Any Of This Actually Unique To Female Athletes?

Yes – hormone cycles which define menstruation and their physical and emotional effects not covered in this article are unique to the female athlete.

Also, no – optimizing field- and power-sport performance with consumed carbohydrate applies to everyone. Better carbs helps youth athletes have more consistent training capacity. Appropriately timed carbs helps Masters athletes train hard without gaining excess weight from fat. Enough carbs helps male athletes perform at higher percentages of peak capacity more often.

Further, the quality of attention and empathy and support an athlete receives from their coach is highly influential on performance and athletic longevity. The real issue with this for menstruating athletes is how little emphasis the hormone cycle is given in literature or practice.

How Menstruation Actually Affects Performance

The biggest impact that menstruation has on an athlete’s performance actually comes from social factors. The fact that male coaches don’t talk about endocrine physiology and aren’t asking about or listening to your comments about your period means that we’re not building training programs to take advantage of your hormonal and physiological readiness.

The fact that male coaches shun discussion of “lady issues”, often openly dismissing symptoms associated with either hormone phase and with many collegiate and professional programs hiring women as assistant coaches specifically to address so-called issues, is noted by Lauren Fleshman as encouraging a culture of shame around periods, such that candid, objective conversation about performance and nutrition and recovery factors can’t happen but closeted, ignorant or superstitious, self-destructive behaviors can persist.

The fact that even informed, well-meaning parents don’t recognize the role nutrition plays in an athlete’s performance and emotional health means that many athletes struggle with body dysmorphia and dysfunctional eating before they can ever embrace their hormone cycle. This is compounded exponentially when we talk about pubescent female athletes who absolutely must see a temporary performance decrement during puberty so that their mature bodies can demonstrate power and coordination which results only from strong soft tissues and properly developed skeletal structure.

And the fact that sport science and sports broadcasting prefer to highlight males means that females’ experiences as high-performance athletes are not being elevated enough for developing females to realize their own capacity.

One Perspective On Periods and Performance

When I compare my experience in sport to that of my athletes, I notice a key marker of privilege: if scientific literature and media and sports money elevated female athletes the way they do male athletes, no one would have requested this article. The impact of menstruation on performance would have all been as common knowledge as the physiology of aerobic adaptation which gets summarized in every new textbook on sports science.

Let’s return to the beginning:
I wrote this article to lay out why I don’t know anything about how your response to “how do you feel today?” could impact how you perform today.

If I first accept that you could have any response at all to that day’s stimuli and, thus, could have any degree of performance during the training session, then I can accept that you are an individual. The fact that you are a female athlete actually has no bearing whatsoever on how I will coach you long-term.

Because you are an individual, I can compare you today to you yesterday and assess what impact our training intervention had in the context of your life. What you ate, how you slept, how your social interactions were, what your stressors are, and what your hormone status is. I can take that context and my knowledge of the highest-probability response to our last training session to form a hypothesis about what might help you today.

We treat training as an intervention. If you thrive, we check the context first, then we do more of it. If you wilt, we check the context first, then we do something different. Every 30 days or so, a pattern emerges, I take my notes, you share your impressions, and we march forward together.

If I accept that I cannot know what is best for a female athlete, I stop trying to fit you in a box defined by hormones. Instead, I spend all my time looking for what works for you.

Because what works for you – rejecting standards based on survivor bias, observing your needs and your capacity each day, collecting data during your training session, then modifying my hypothesis for the next session – works for everyone.

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More Words On The Topic

The Most Important Impact Of Menstruation

If you lose your period, something is terribly wrong with your nutrition and training schedule.
If you lose your period, you are guaranteed to have a debilitating injury soon if you don’t make a change.
If you lose your period and your coach doesn’t intervene immediately, get a new coach because this one will watch you suffer until you break, then will shame you for it.

Suggested Reading

• Lauren Fleshman’s “Good For A Girl”
• Stacy T. Sims’ “Roar”
• Tracy Reifkind’s “The Swing!”
• Jessie Cameron (J.C.) Herz’s “Learning To Breathe Fire”
• Andrea Hudy’s “Power Positions”
• Cheryl Strayd’s “Wild”
• every Serena Williams, Allyson Felix, Mary Cain, Kara Goucher, and USA Gymnastics team member interview, plus 1,000 more articles worth your time
• the small mountain of literature I climbed to keep myself from making unsubstantiated claims

Most Quotable Quote From Research For This Article

“Men coaching women are so scared of our feelings that they’re easy to manipulate. Just because we look a little sad or we cry or we whine doesn’t mean we can’t – or even that we don’t want to – do the work. It just means we know you’re a sucker, so we can get out of it. Some days, we would work harder if you weren’t there. We know our teammates won’t let that shit fly.”

Michaela (co-founder of a college team, semi-pro player, and elite domestic rugby coach), you’re the best.