Written by Coach Bert Abbott, Summary Graphic by Coach Kira Morin
For people who menstruate, This article is written for ultimate players across the gender spectrum who menstruate and/or have menstrual cycles as defined by cycling concentrations of estradiol, progesterone, and other hormones. it’s a common (and possibly dreaded) experience to realize your period will fall over a tournament. This poses logistical problems you need to manage throughout the day on top of drinking water, eating food, being present for your teammates, and playing your best on the field! Those with cycling hormones think about the impact of menstruation on tournament play, but changes in hormone levels also affect fueling, mental health, warmup and recovery considerations throughout the whole cycle.
You could fill books on what we know about how the menstrual cycle impacts the lives of athletes, and whole libraries with what is yet to be discovered; after a centuries-long drought of meaningful scientific research on people with menstrual cycles, scientists are increasingly analyzing the beautifully complex ways that cycling hormones impact health and performance. This means the scientific community is just scratching the surface of the interplaying dynamics between these hormones and all the different facets of life they interact with. I’ve done my best to dig through what research there is, but as with any topic in science, studies vary widely in their quality and conclusions. As such, the information presented here is based on our understanding at the moment and is subject to change as more research is done. This article will cover how to prepare for optimal tournament performance during any part of the menstrual cycle, including for folx on varying forms of birth control. The content is complex and interweaving because that’s the truth of cycling hormones. Take the time to dig through and digest the article, and move forward with the summary image at the end as a handy resource!
Menstrual Cycle Phases
Menstrual processes are governed by four hormones: progesterone, luteinizing hormone (LH), estradiol (the most active form of estrogen), and follicular stimulating hormone (FSH). The concentrations of these hormones in the body vary cyclically in a feedback loop governed partly by the pituitary gland. Although there are many ways to divide the menstrual cycle, for the purposes of optimizing athletic performance, we’ll divide the cycle into four phases, focused around the changes in concentrations of estradiol and progesterone.
Phase I is the “first” 5 days of the average cycle (meaning when you average data on different people’s cycles, with a total cycle length of 28 days) when both estradiol and progesterone are low. Phase II occurs over the next 5-6 days, as estradiol rises rapidly and progesterone stays low. Phase III begins with a quick decline in estradiol followed by a gradual rise in both estradiol and progesterone. This phase lasts about 10-12 days, and includes ovulation a few days into it after the drop in estradiol, usually around day 14 of the cycle. Finally, over the next 7-8 days, Phase IV is characterized by a gradual decline in estradiol and progesterone.
The chart below shows the general concentration of relevant hormones and the four aforementioned phases over the course of an idealized menstrual cycle:
The chart shows an unregulated menstrual cycle. For folx using an IUD, whether hormonal or copper, the impact of the device is mostly local. People with IUDs still experience hormone cycling and ovulation, and therefore everything in this article is still relevant! For those using an IUD who no longer menstruate, it may be worth tracking other symptoms related to the cycle such as cravings, muscle cramps, concentration, energy, and body temperature. That way, you can shift your preparation for performance according to the “silent cycle” that is still occurring. Oral contraceptives generally have a steady concentration of synthetic forms of progesterone and estradiol in all of the “active” pills, then no hormones in the placebo pills where bleeding usually occurs. These synthetic hormones override the natural production of progesterone and estradiol in your body.Pletzer, B. A., & Kerschbaum, H. H. (2014). 50 years of hormonal contraception-time to find out, what it does to our brain. Frontiers in neuroscience, 8, 256. doi:10.3389/fnins.2014.00256 More research needs to be done on the effects of synthetic hormones on the body. For the purposes of reading this article, you can assume that the placebo pill phase correlates to Phase I and the active pill phase correlates to Phase III. It’s possible, however, that the synthetic hormones in oral contraceptives and other methods like birth control implants are inactive enough in cellular processes that the body acts more like it’s in Phase I throughout the whole time you’re using that medication. Truthfully, the full impacts of hormonal contraceptives of all types are highly individualized and dependent on the dosage of your medication and the specific synthetic hormones used.Godsland, I. F., Crook, D., Simpson, R., Proudler, T., Felton, C., Lees, B., Anyaoku, V., Devenport, M., and Wynn, V. (1990). The effects of different formulations of oral contraceptive agents on … Continue reading
In this article, we’ll examine each of these phases and how the shifts in hormone concentrations impact the body and mind. We’ll also address how you can adjust your physical and mental preparation to optimize performance, maintain good nutrition, and reduce the risk of injury. If you’re not already tracking your menstrual cycle, there are several apps out there that help you do so. The US Women’s National Soccer Team has gotten some press lately about their use of cycle data for performance; the FitrWoman app they use is available for free and offers many recommendations for training and performance inside the app itself. These apps are particularly helpful to track symptoms beyond bleeding to get a better picture of the impacts of hormones throughout the cycle, including for those using IUDs who no longer get a period. Please note that variation in menstrual cycles is normal, with some folx experiencing cycles of very different lengths month to month. Using tracking apps to understand your cycle might be beneficial for understanding your cycle’s variations, especially if it comes time to talk to a health professional about any concerns.
Phase I – Menstrual
During this phase, the levels of all cycling hormones are low. It is generally characterized by menstruation, which for some folx comes with cramping and other symptoms. Despite it being painful to do so at times, exercise can often help relieve some of the symptoms associated with menstruation.
Your body is predominantly using carbohydrates to fuel exercise during this phase.Oosthuyse, T. & Bosch, A.N. (2010) The Effect of the Menstrual Cycle on Exercise Metabolism: Implications for Exercise Performance in Eumenorrhoeic Women Sports Med 40: 207. … Continue reading As such, when getting your field food ready and preparing meals leading into the tournament, it’s important to have a lot of complex carbs on-hand. Additionally, some of the symptoms of menstruation are connected to an increased inflammatory response while hormones are low.Bouman, A., Heineman, M. J., and Faas, M. M. (2005). Sex hormones and the immune response in humans. Human Reproduction Update, 11(4):411–423. Look for foods that are naturally anti-inflammatory, such as fish, berries, nuts, and clichéd as it might be, dark chocolate. Berries are doubly great because they’re an easily digestible source of carbohydrates that you can snack on throughout the day.
One consideration when warming up is that there is some evidence that lowered hormones negatively impact your neuromuscular control, especially if you experience PMS symptoms.Dedrick GS, et al. (2008). Effect of sex hormones on neuromuscular control patterns during landing. Journal of electromyography and kinesiology,18(1):68-78.Fridén, C. (2004). Neuromuscular … Continue reading This means it might take some extra time to get your muscles firing properly and fully, and they might need extra reminders throughout the day. Bring along a mini bandThe company that produces the linked bands, NeeBooFit, is run by an ultimate player and Strive & Uplift member! If you’re in need of bands, use the code SNUNBF15 for 15% off to add a little resistance to your glute and core activation. Run through multidirectional movement patterns using this lunge matrix. Try waking up your stabilizers through a progression of double and single-leg jumps, paying attention to knee stability. Take any extra time you need to feel ready during the warm-up and revisit some of those activation exercises before you start playing again after a break between games.
Take into account the potential increased inflammation when you’re recovering or traveling. Simply walking helps clear out inflammation, especially in the lower limbs. If you’re driving to and from the tournament, take frequent stops and get out of the car to walk around. If you’re flying, you can try wearing compression socks and tights, but most importantly, stand up and walk at regular intervals. Between days of play, use your favorite inflammation management strategy, whether that’s ice baths, contrast baths, putting on compression tights, or finding a teammate willing to trade massages.The research on recovery techniques is deep and fascinating, and will likely warrant another article devoted to these techniques alone. Much of the research points to these different recovery methods … Continue reading You may find that places with old, recovered injuries hold onto extra inflammation or stiffness; try using a tissue flossing band on those spots.There is currently a small amount of evidence in support of properly utilized tissue flossing’s positive impacts for recovery and for performance when used during warm ups:Driller, M., Overmayer, … Continue reading We have a video detailing how to use floss bands available to our virtual members.
Phase II – Follicular
This phase is all about the build-up to ovulation for those with naturally cycling hormones. Although not fully in line with the medically drawn phases, we’re going to consider this phase as the time span where estradiol is increasing rapidly while progesterone stays relatively low. This will give us the clearest picture of the athletic impacts of the hormones.
As an athlete, this is one of the most confusing phases to be in. Here, you’ll generally feel an increase in energy, alertness, and positivity, as well as your pain threshold. Your muscles recover better from exercise, and peak power is at its highest. However, high estradiol has been associated with ligament laxity, and this phase has been correlated with an increased incidence of ACL tears.Balachandar, V., Marciniak, J. L., Wall, O., & Balachandar, C. (2017). Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury … Continue reading There are, fortunately, lots of studies on this, but they’re of wildly different quality; the most consistent conclusion is that the risk of ACL tears is generally higher during Phases I & II than III & IV. This could be due to lower neuromuscular control during Phase I and increased ligament laxity and subsequent mechanics breakdowns in Phase II. You may be tempted to think that smoothing out hormone profiles using oral contraceptives would help, as one study looked at.Slauterbeck, J. R., Fuzie, S. F., Smith, M. P., Clark, R. J., Xu, K., Starch, D. W., & Hardy, D. M. (2002). The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury. Journal of … Continue reading While they found a splashy 20% reduction in ACL surgery correlated with birth control use, the strength of evidence is so lowCan Birth Control Pills Prevent Knee Injuries?. (2019). Retrieved from http://depts.washington.edu/shsi/article/can-birth-control-pills-prevent-knee-injuries/ it’s not worth jumping on the pill for that reason alone. In the end, warming up properly and a robust strength and movement quality training program are the best injury reduction strategies. Because of the potential increase in the incidence of soft tissue injury, it’s important to get ready for competition deliberately during this phase.
The best way to prepare for performance while protecting your ligaments in this stage is through an extensive warm-up that gradually moves into changes of direction. The FIFA 11+ Warm Up has been used beyond just soccer to reduce the incidence of injuries, especially severe knee injuries, by up to 50%. A few iterations have been made on this team warm-up for ultimate, including one that I’m trying out with my own team that adds in activation exercises (see Phase I). Once it’s fine-tuned, we’ll share it with our virtual members!
Since your ligaments need a little extra support, include collagen and vitamin C in your fueling strategy; think high-quality protein, eggs, avocado, citrus fruits, peppers, and green veggies. A $20 jug of artisanal bone broth also works – or, do what I do and demolish a rotisserie chicken, then boil the bones for a day or so with some veggie scraps and salt. During this phase, your blood sugar tends to be relatively stable as your body shifts towards using an increasing amount of fat for fuel. You may notice that you have fewer cravings for sugar throughout the day of playing, though getting carbs from fruits and veggies are great choices to keep your quick energy systems going. Make sure you eat a solid breakfast and go for small, balanced meals when you have longer breaks (30 minutes or more) to digest.
Phase III – Luteal
During this phase and the next, the focus is all about the change in your hormone levels as opposed to their absolute values. After an initial drop in estradiol, both progesterone and estradiol gradually rise, and these increases in hormone concentrations lead to wide-ranging shifts in the body. The hormone systems at this time are focused on providing a home to a potential fertilized egg (whether one exists or not). This is potentially the time when folx with cycling hormones are least attuned to the impacts of their cycle since it’s so far in time from the menstrual phase, but the impacts are very real!
As you go through this phase, you might notice that you are increasingly hungry as your rising hormone concentrations increase your basal metabolic rate. Your blood sugar is also less stable during this time and fat is your primary fuel source for exercise; it’s essential that you get balanced meals with protein, fats, and complex carbohydrates before playing, during any long breaks in the day, and afterward for recovery.A number of studies have looked at how to make it so folx with estradiol-dominant hormones get the same kind of performance increase from carbohydrate loading as those with testosterone-dominant … Continue reading Ultimate is a game of repeated high-intensity sprints, which are primarily powered by carbohydrates. Snack on complex carbs throughout the day to keep your energy levels more stable throughout play. Veggies and hummus, a bagel with peanut butter, and popcorn all work well here. During this phase, you’re more susceptible to illness because high progesterone suppresses the immune system. It’s another great time to eat antioxidant-rich foods, as well as drink beverages with some carbohydrates in them while playing like in this homemade recipe from Aimee Gallo of VIBRANCE Nutrition.A study looked at the impacts of higher intensity exercise on leukocyte mobilization across menstrual cycle phases and found a significant increase during the luteal phase when folx drank a placebo … Continue reading
Especially important during this phase is fueling for recovery after playing since there’s an increase in muscle breakdown paired with a higher demand for amino acids. This might be due to the redirection of amino acids toward building the endometrial lining since the whole phase, hormonally, is about caring for a potentially fertilized egg.Draper, C. F., Duisters, K., Weger, B., Chakrabarti, A., Harms, A. C., Brennan, L., Hankemeier, T., Goulet, L., Konz, T., Martin, F. P., Moco, S., and van der Greef, J. (2018). Menstrual cycle … Continue reading It’s really important to get high-quality proteins immediately after playing (within 30 minutes) alongside some carbohydrates to help with protein absorption. In particular, getting sources of protein with a sufficient amount of branched-chain amino acids (BCAAs) alongside other essential amino acids will stimulate the most complete muscle recovery. Proteins are made up of amino acids, which can be further classified into groups. Essential amino acids are those that humans cannot produce ourselves and have to get from dietary sources. Branched-chain amino acids are a subgroup of essential amino acids that stimulate the creation of muscle proteins in our body. If you guzzled down pure leucine (one of the BCAAs and the primary driver of muscle protein synthesis), you would trigger the pathways for muscle building, but you still would need the other required amino acids to complete your muscle masterpiece. So BCAAs are a good way to stimulate muscle building and stave off muscle tissue damage during exercise, but they need to be consumed alongside the rest of the essential amino acids to provide the most complete recovery.Fouré, A., & Bendahan, D. (2017). Is Branched-Chain Amino Acids Supplementation an Efficient Nutritional Strategy to Alleviate Skeletal Muscle Damage? A Systematic Review. Nutrients, 9(10), … Continue reading If you’re looking at the nutrition facts on supplementary protein powder, you need at least 2 grams of leucine at the end of the day. Food sources of the essential amino acids, especially BCAAs, are lean meats, milk and yogurt, eggs, peas, and beans. In addition to deliberate fueling, you may also want to allow yourself more recovery before the tournament so you go into the weekend fresh!
Your body temperature tends to be higher during this phase, which might mean you feel like your muscles get warm more quickly at the beginning of the day. When playing in hotter temperatures, be especially ready and proactive about cooling strategies – finding shade or using cooling towels or a sun hoodie to keep from overheating.
One of the mental health impacts of this phase is that you’re primed for increased emotional connection and empathy. Look for ways to structure positive communication with your support network on the team. Reach out to your teammates and be a resource if you feel like you have an increased capacity to be there for them!
Phase IV – Pre-Menstrual
During this phase, hormone levels decline as the body realizes there’s not a fertilized egg to care for, and it’s time to go in for another cycle. During this phase, especially toward the end of it, most folx experience premenstrual syndrome (PMS) symptoms to varying degrees and intensities. As with phase I, it’s important to remember that exercise helps relieve these symptoms, even if it’s hard to motivate through the discomfort. Please note that PMS and periods should not be excessively painful to the point where you’re unable to play. If discomfort from PMS is getting in the way of normal activities, please seek medical advice.
As hormones decline, your body starts shifting back to using carbohydrates for fuel. Additionally, there’s a potential increase in the inflammatory response. Because of these two factors, try to decrease the amount of saturated fats in your diet and opt instead for foods rich in fish oils, walnuts, or seeds. Up your intake of fruits and vegetables, aiming for 7-8 servings a day. When you grab breakfast in the morning, think lox and veggies on a bagel rather than the bacon, egg, and avocado sandwich that was optimal only a week ago. Bring along fruit and veggies to consume throughout the day to keep your energy reserves up.
For some, managing the symptoms of PMS becomes the highest priority during this phase so you can focus on your play. In particular, yoga and Pilates have both been found to reduce symptoms. Strive & Uplift incorporates mat Pilates exercises and gentle mobility as a part of all our warm-ups; consider taking a little extra time on core activation and deep breathing before you play and doing extended mobility work for your cooldown at the end of the day. A potential symptom that you may have experienced during this phase is sleep disruption. As you approach bedtime, try adding in some melatonin-rich foods like tart cherry juice, vegetables, and nuts, and limit your screen time. At the very least, use built-in settings or apps on your phone that shift the color spectrum of the screen during the evening. Bring along earplugs and cover up your eyes while you sleep to reduce night-time disturbances, especially if you’re traveling for the tournament. Finally, stress management is important during this time to reduce overall PMS symptoms. A tournament is an inherently stressful situation, so using de-escalation techniques, deep breathing, and other mindfulness practices can help reduce the impact of stress on your body. A favorite at Strive & Uplift is a self-reflection process that Coach Kira Morin brought to our coaches; it’s so great she shared it with our virtual members as a clinic!
For easy reference, feel free to download the following chart (available as an image below or as a pdf here):
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|↑ 1||This article is written for ultimate players across the gender spectrum who menstruate and/or have menstrual cycles as defined by cycling concentrations of estradiol, progesterone, and other hormones.|
|↑ 2||Pletzer, B. A., & Kerschbaum, H. H. (2014). 50 years of hormonal contraception-time to find out, what it does to our brain. Frontiers in neuroscience, 8, 256. doi:10.3389/fnins.2014.00256|
|↑ 3||Godsland, I. F., Crook, D., Simpson, R., Proudler, T., Felton, C., Lees, B., Anyaoku, V., Devenport, M., and Wynn, V. (1990). The effects of different formulations of oral contraceptive agents on lipid and carbohydrate metabolism. New England Journal of Medicine, 323(20):1375–1381. PMID: 2146499.|
|↑ 4||Oosthuyse, T. & Bosch, A.N. (2010) The Effect of the Menstrual Cycle on Exercise Metabolism: Implications for Exercise Performance in Eumenorrhoeic Women Sports Med 40: 207. doi:10.2165/11317090-000000000-00000|
|↑ 5||Bouman, A., Heineman, M. J., and Faas, M. M. (2005). Sex hormones and the immune response in humans. Human Reproduction Update, 11(4):411–423.|
|↑ 6||Dedrick GS, et al. (2008). Effect of sex hormones on neuromuscular control patterns during landing. Journal of electromyography and kinesiology,18(1):68-78.|
Fridén, C. (2004). Neuromuscular performance and balance during the menstrual cycle and the influence of premenstrual symptoms. Retrieved from https://pdfs.semanticscholar.org/5eff/d10c44cff10ca7760c9c29b51371ba908001.pdf
|↑ 7||The company that produces the linked bands, NeeBooFit, is run by an ultimate player and Strive & Uplift member! If you’re in need of bands, use the code SNUNBF15 for 15% off|
|↑ 8||The research on recovery techniques is deep and fascinating, and will likely warrant another article devoted to these techniques alone. Much of the research points to these different recovery methods leading primarily to a reduced perception of fatigue the next day:|
Dupuy, O., Douzi, W., Theurot, D., Bosquet, L., & Dugué, B. (2018). An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in physiology, 9, 403. doi:10.3389/fphys.2018.00403
|↑ 9||There is currently a small amount of evidence in support of properly utilized tissue flossing’s positive impacts for recovery and for performance when used during warm ups:|
Driller, M., Overmayer, R. (2017). The effects of tissue flossing on ankle range of motion and jump performance. Physical therapy in sport 25:20-24. doi: 10.1016/j.ptsp.2016.12.004.
|↑ 10||Balachandar, V., Marciniak, J. L., Wall, O., & Balachandar, C. (2017). Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review. Muscles, ligaments and tendons journal, 7(1), 136–146. doi:10.11138/mltj/2017.7.1.136|
Beynnon, B. D., & Shultz, S. J. (2008). Anatomic alignment, menstrual cycle phase, and the risk of anterior cruciate ligament injury. Journal of athletic training, 43(5), 541–542. doi:10.4085/1062-6050-43.5.541
|↑ 11||Slauterbeck, J. R., Fuzie, S. F., Smith, M. P., Clark, R. J., Xu, K., Starch, D. W., & Hardy, D. M. (2002). The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury. Journal of athletic training, 37(3), 275–278.|
|↑ 12||Can Birth Control Pills Prevent Knee Injuries?. (2019). Retrieved from http://depts.washington.edu/shsi/article/can-birth-control-pills-prevent-knee-injuries/|
|↑ 13||A number of studies have looked at how to make it so folx with estradiol-dominant hormones get the same kind of performance increase from carbohydrate loading as those with testosterone-dominant hormones, and it takes a lot of extra fueling to get there (we’re talking a 30% increase in calories). Most importantly, though, none have shown a significant performance benefit from forcing estradiol-dominant bodies to utilize carbohydrates more during exercise, especially during the luteal phase.|
Wismann, J., & Willoughby, D. (2006). Gender differences in carbohydrate metabolism and carbohydrate loading. Journal of the International Society of Sports Nutrition, 3(1), 28–34. doi:10.1186/1550-2783-3-1-28McLay, R., Thomson, C., Williams, S., and Rehrer, N. (2007). Carbohydrate Loading and Female Endurance Athletes: Effect of Menstrual-Cycle Phase. International Journal of Sport Nutrition and Exercise Metabolism, 17:189-205.
|↑ 14||A study looked at the impacts of higher intensity exercise on leukocyte mobilization across menstrual cycle phases and found a significant increase during the luteal phase when folx drank a placebo drink. This change was negated when they drank a beverage with carbohydrates during exercise as opposed to an otherwise identical one that used artificial sweeteners. Yet another reason real sugars are good for athletes:|
Hashimoto, H., Ishijima, T., Hayashida, H., Suzuki, K., and Higuchi, M. (2014). Menstrual cycle phase and carbohydrate ingestion alter immune response following endurance exercise and high intensity time trial performance test under hot conditions. Journal of the International Society of Sports Nutrition, 11(1):39.
|↑ 15||Draper, C. F., Duisters, K., Weger, B., Chakrabarti, A., Harms, A. C., Brennan, L., Hankemeier, T., Goulet, L., Konz, T., Martin, F. P., Moco, S., and van der Greef, J. (2018). Menstrual cycle rhythmicity: metabolic patterns in healthy women. Scientific Reports, 8(1):14568.|
|↑ 16||Fouré, A., & Bendahan, D. (2017). Is Branched-Chain Amino Acids Supplementation an Efficient Nutritional Strategy to Alleviate Skeletal Muscle Damage? A Systematic Review. Nutrients, 9(10), 1047. doi:10.3390/nu9101047|
Wolfe R. R. (2017). Branched-chain amino acids and muscle protein synthesis in humans: myth or reality?. Journal of the International Society of Sports Nutrition, 14, 30. doi:10.1186/s12970-017-0184-9
Jackman, S. R., Witard, O. C., Philp, A., Wallis, G. A., Baar, K., & Tipton, K. D. (2017). Branched-Chain Amino Acid Ingestion Stimulates Muscle Myofibrillar Protein Synthesis following Resistance Exercise in Humans. Frontiers in physiology, 8, 390. doi:10.3389/fphys.2017.00390