Olympics weight lifter Mirabai Chanu says she lost as she was on the third day of periods: How do menstrual cycles affect athletes?

Can menstrual cycles impact athlete performance?

So far there’s no research that shows conclusive proof that normal menstrual cycles impact performance. “However having an abnormal menstrual cycle leads to hormonal imbalances which can impact performance of the athlete,” says Dr Manit Arora, orthopaedics and sports medicine specialist at Fortis Hospital, Mohali.

How can heavy periods affect athlete performance?

Heavy periods, or menorrhagia, can decrease an athlete’s endurance and increase fatigue. It can even affect their mental state, leading to decreased motivation, concentration and confidence.

“Within the first days of periods, levels of oxytocin, a hormone which keeps you positive and in peak condition, dip. Accompanying blood loss results in extreme tiredness, called period fatigue,” says Dr Priyanka Sharma, gynaecologist at Fortis, Mohali. Excessive blood loss can lead to anaemia.

“This condition is associated with low oxygen, which can result in lactic acid accumulation and lead to muscle fatigue, in turn affecting the athlete’s performance,” she adds.

“The first five days of blood flow can be disruptive and put athletes at a higher risk of tissue injuries. Some athletes also lose the ability to have periods, a condition called amenorrhea. Extreme physical activity means the production of oestrogen and progesterone in the body goes down,” says Dr Geetu Gaba, gynaecologist at Manipal Hospital, Dwarka.

Can women athletes take hormone pills?

Hormonal contraceptives, such as birth control pills, can be used to suppress menstruation. “But these have side effects like nausea, weight gain, mood changes, and increased risk of blood clots. Some athletes may experience changes in their performance or physical condition due to these side effects,” says Dr Gaba.

Besides, every woman responds differently to hormonal contraceptives. “Finding the right type and dosage of contraceptive that works without significant side effects can be a trial-and-error process. Some athletes prefer not to interfere with their natural menstrual cycle and choose lifestyle adjustments, non-hormonal medications or menstrual products designed for active use. Besides drug regulations at big sports means that hormonal contraceptives could pose a problem,” she adds.

Dr Sharma advocates hormonal pills only for certain conditions like PCOS (polycystic ovary syndrome) and endometriosis (tissue growth outside the uterus). “They should be used only under the supervision of a doctor, so that risk versus benefits can be assessed properly,” she says.

How do women athletes manage their periods then?

Tracking apps can help athletes predict their periods, understand their symptoms, and plan their training and competition schedules accordingly. “Some of them wear tampons and menstrual cups as they allow for greater freedom of movement and are less likely to cause discomfort during physical activity. Some athletes use pads or specially designed period underwear for added comfort and protection,” says Dr Gaba. She also highlights the need for adequate nutrition and hydration.

“Consuming foods high in iron (like leafy greens, red meat, and legumes) helps prevent anemia, which can be exacerbated by heavy periods. Staying well-hydrated can help reduce bloating and cramps,” she adds.