Let’s talk. Period.

We women love running. Period.

What was that? We love running, sure…  but who said anything about that P word? Well, no, that was just me being crafty – y’know, a play on punctuation…

ok, never mind.

Period. P-E-R-I-O-D.

There it is, in red – and bold – for all to see.

For those too shy to say the word aloud, there’re a gazillion euphemisms for a women’s “time of the month”, like “code red”, “shark week”, “girl flu”, “on the rag”, “Aunty Flo’s visiting”, “moon time” for the yogis amongst us, and of course the beaut: “having the painters in”. Then there’s that horrid one, “the curse”. I’ve always found that one particularly awful – after all, a women’s period symbolises the essence of life, it’s what makes us special, its very existence allows us to give life. That’s something powerful, and it’s what makes us women.

Let’s be clear: it’s not that we don’t love our period. But when the word appears in the same sentence as the word “running”, that’s when our attitude changes – never once have I met a woman athlete who gets excited about exercising with her period!

The subject of menstruation is, to some degree, taboo the world over. Many men cringe at its mention, and some societies forbid discussion around the topic, seeing women as unclean during their seven days of monthly bleeding. I know I’m generalising rather dangerously here, but guys, you’re to blame for that ridiculous approach – thousands of years of patriarchal society has had men believing women’s fertility was something they didn’t need to know about. Everything other than the sex part of procreation was not their territory – it was considered messy and dirty and it was hushed up. Menstruation was something only whispered about between mothers and daughters, or sometimes even not at all. Often young girls would enter puberty without any information or guidance, leading to fear and falsehoods. Rather than celebrating their womanhood, their monthly bleeding would make them feel shameful. Sadly, this remains the status quo in many societies around the world.

The hushed silence around women’s periods remains strong today. Even in less conservative societies, most women are embarrassed to speak openly about it – they feel awkward to ask questions, even of their mothers, sisters or best friends. But slowly, the conversation is gradually starting. Speaking openly on a public forum like this takes a degree of bravery – it shouldn’t have to be that way, but it’s the reality. I’ve wanted to write this blog for years, but only now have I taken the leap. We women want to talk about this – periods are an integral part of our lives, and let’s face it, of our men’s lives too. The shroud of secrecy, awkwardness and embarrassment around menstruation needs to be lifted, and the discussion needs to open.

Periods are a fact of life. We menstruate – or we don’t but should, or we used to and don’t any longer. We have children – or we want to, or choose not to. Our bodies are beautiful, complicated operating systems that give us an enormous power of choice. Periods come with pain and, of course, inconvenience – for more than 30 years of our lives, our periods require a lot of faffing about, plenty of forward planning, and a fair degree of logistical preparation around our lives. And nowhere is this more true than with sport. We’re not only affected for the 5-7 days of bleeding, but for the other 24 too – and in many different ways.

“Women are not small men.” Dr Stacy Sims

We’re different from men, and we should celebrate those differences. And most importantly, we need to normalise talk about menstruation.

Oh and guys, just a heads-up: any whingeing you do to women about the inconvenience of “having to shave daily” falls on deaf ears – every time, guaranteed. We have absolutely no sympathy. Fact.

Hormones rule

Whether we like it or not, women’s hormones rule the roost. They’re the moody ones, not us – and when it comes to unpredictability, they’re the champs! Throughout the month we ride a rollercoaster of energy surges and slumps, where the level of oestrogen and progesterone is never constant and where we are energy-wise today is not where we’re at tomorrow. They make us bloat, cramp, give us mood swings and the munchies and, worst of all, the dreaded PMS.

How your period affects energy levels

Before we look at race day, let’s have a brief overview of our cycle. A period usually lasts 5 to 7 days. Days 1 to 14 is called the follicular phase, then we ovulate and enter the luteal phase, which lasts til the final day of the cycle (the day before bleeding starts).

Week 1: The first day of your period is the start of your cycle. Oestrogen and progesterone levels are at their lowest on day 1, and they begin a gradual rise over the next 12 days. Energy levels gradually pick up as this week progresses. Menstrual cramps can be common in the first couple of days, caused by the elevated production of prostaglandins, the hormones produced by the uterus that cause it to contract. During your period, the wall of the womb contracts more vigorously to help the womb lining shed (it’s not needed because you’re not pregnant).

Week 2: In the week after your period ends, your energy levels rise as oestrogen levels continue to heighten. On day 13, oestrogen levels peak, together with luteinizing hormone (LH), to induce ovulation  (releasing an egg from the ovary).

Week 3: After ovulation, oestrogen levels continue to rise but not as rapidly as progesterone, making you feel less sprightly than usual.

Week 4: In the days leading up to your period, both your oestrogen and progesterone levels drop. This can be a tough time for women athletes, with premenstrual symptoms like bloating, food cravings, feeling emotional and heavy and having general lack of zest making us wonder where our fitness went. Premenstrual bloating is probably the most common symptom of PMS, and it’s awful. The body’s tendency to retain fluid in the days leading up to the start of our period can add a couple of kilos to our race weight (even though only temporarily), and this is not helped by often quite inexplicable food cravings, particularly for sweet treats.

The length of the cycle can vary – in serious athletes it’s often longer than 28 days, as the stress of intensive training decreases the secretion of oestrogen and progesterone.

THE SCIENCE BEHIND HOW HORMONES AFFECT ATHLETIC PERFORMANCE

This is a topic all women athletes want to talk about. Many of us actually do chat about it, but we don’t necessarily come up with the answers to the many questions we have. So for this article I turned to science and asked those in the know – Dr Tanja Oosthuyse (School of Physiology, WITS University) and Associate Professor Andrew Bosch (UCT Division of Exercise Science & Sports Medicine) who have studied the topic extensively.

In a nutshell, oestrogen makes us feel light-footed and fit, and progesterone does quite the opposite!

A competitive athlete herself, Dr Oosthuyse says it’s worth knowing how oestrogen and progesterone influence our bodies during exercise so we can work with these effects to gain advantage, and know what to do to prevent any potential negative effects.

Weeks 1 & 2 – good for fast & furious

The early and mid-follicular phase of your cycle is probably the best time to focus on speedwork. In the luteal phase (weeks 3 & 4), oestrogen and progesterone not only decrease the liver’s output of glucose but also the uptake of glucose by muscles for use as an energy source. High intensity efforts like speedwork require high rates of carbohydrate/glucose use, and if the liver supply and muscle uptake is impeded it can negatively affect high speed efforts. During the luteal phase, you’re best boosting your system with carbs during your high intensity sessions or races.

Weeks 2, 3 & 4 – good for long and steady

Oestrogen promotes greater use of fat for energy production. But if you’re racing during this phase, or even doing a long training run, you still need carbs as a fuel source, so don’t be tempted to cut them out or reduce them. As Dr Oosthuyse points out, the higher fat oxidation in the luteal phase will simply be a bonus during ultras, but it would be a bad mistake to cut down on carb intake.

Weeks 1 & 2, start exercise fully charged

Oestrogen reduces protein breakdown and assists the storage of liver and muscle glycogen (carbohydrate), which is a huge advantage for endurance exercise. Oestrogen levels are highest in the luteal phase (and even mid-cycle), which means glycogen storage is higher in the second half of your cycle. So, if your long training session or race takes place during the first half of your cycle, you’d be wise to top up your glycogen stores with some extra carbs in your diet.

More breathless in weeks 3 & 4

The high level of progesterone in the luteal phase increases breathing rate, causing women athletes to feel a little more breathless during exercise. But it’s not all bad – Dr Oosthuyse says studies she’s done showed that this higher breathing rate does not significantly affect our energy expenditure and other studies show it has no effect on performance. So, nothing to worry about there!

Beware of muscle breakdown

Progesterone (highest in week 3 and 4) promotes protein breakdown. If you run long without taking in calories, you’ll be breaking down muscle you’ve worked hard to build. You can reduce this protein breakdown by taking in carbs, or even more effectively by taking in protein with your carbs during your session. This is particularly important during the luteal phase (weeks 3 & 4).

Train fasted, but wisely

Many athletes include a few fasted training sessions in their training plan to benefit from the greater metabolic signalling response that enhances cellular energy-producing pathways. Oestrogen also keeps us lean by reducing fat uptake into adipose tissue – it shuttles fat towards muscles for use as an energy source. But do be careful not to compromise training intensity by training in a fasted state – the benefits of fasting are good, but you still want to achieve a quality session. Dr Oosthuyse suggests using a protein hydrolysate supplement during a session can benefit fasting-exercise intensity, regardless of what phase of your menstrual cycle you’re in, as it increases carbohydrate oxidation.

Oestrogen has antioxidant and anti-inflammatory effects. In fact, oestrogen can squeeze into the lipid membranes that surround all our body cells, stabilising them and preventing the typical post-exercise tissue damage that occurs during hard sessions.

“In a study in our lab we found that after a session of downhill running, women recovered faster and, after two days, had lower markers of tissue damage than men. When comparing between menstrual phases, there was lower evidence of muscle damage in the women who participated with higher oestrogen concentration during the mid-cycle (ovulation) phase and during the middle of the luteal phase (week 3) compared to those with low oestrogen in the early follicular (or menstruating) phase (week 1),” says Dr Oosthuyse.

A possible prevention to suffering achy muscles on race day would be to make sure you have two or more exercise-free days before the race if race-day falls on day 1 or 2 of your period.

REDUCING THE NEGATIVE EFFECTS OF PMS

Cut the cramp

• Avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Ibuprofen, Cataflam, Voltaren, Ponstan, etc. Also avoid painkillers. These drugs hinder kidney function during exercise and increase your risk of suffering potentially fatal hyponatremia (low sodium concentration in the blood) that causes tissue swelling, especially over marathon or ultra-marathon distances.
• Rather clutch a hot water bottle. Holding warmth against your stomach will raise your core temperature, increasing circulation and producing natural endorphins to help ease the pain.

Beat the bloat

• Ironically, drinking more fluid is the solution here – it helps flush the body and encourage digestive circulation. Use water and herbal teas, particularly green tea and ginger tea.
• Avoid foods that are high in sodium (salt) as it has water-retentive properties
• Increase potassium and magnesium intake to help counterbalance the level of sodium in the body.
• Cut out refined sugar – the consumption of sugar triggers the release of insulin into the bloodstream, which in turn causes the body to retain sodium, leading to water retention and bloating.

Avoid inflammatory foods

As oestrogen and progesterone levels drop, there’s an increase in prostoglandins, which drive an inflammatory response. In the days leading up to your period, try to avoid eating anything that’s pro-inflammatory, like processed meats or much dairy. Rather reach for anti-inflammatory foods, antioxidants and fibre.

The huge bonus for active women is that physical activity can help reduce symptoms of premenstrual cramping, bloat and mood swings. Boon for running!

PMS munchies!

It’s a day or two before your period, and you’re reaching for every scrummy snack you can lay your hands on – choc chip cookies after breakfast, a muffin after lunch, your favourite chocolate before bedtime. Who of us hasn’t experienced premenstrual munchies?!

These food cravings relate to hormonal changes. Don’t fight them. Instead, try to control moods and cravings by making wise food choices at meal times to help curb the PMS sugar urge. Try to keep away from junk food snacks, as they’ll do your running no good.

Tampon tactics

I’ve long lost count of the number of races I’ve run that have fallen on day 1 of my period. And how often the physical exertion of a 5 or 7-day stage race has actually brought on my period, even though it wasn’t due. The first time that happened was during a multi-day race in Iceland, and I was caught off guard. Thankfully the race medic had stocks!

But having to plan the logistics involved in ensuring you’re appropriately sorted every several hours of an ultra isn’t easy – it’s yet another thing to have to think about when you’re running a gruelling race. If I know I’m due my period sometime near race day, I run with a super-absorbency tampon in a readily accessible pocket in my pack.

Planning your pill around your race

If you’re on the pill, and if your race is particularly important to you (as in a major goal race) and you suspect your period might fall on race day, then there are simple ways you can tweak your hormones so they’re on your side on race day. The first step – and you should be doing this anyway – is to track your cycle. Keep a monthly record of when your period begins and ends, so that over time you’re able to predict, as accurately as possible, your monthly cycle.

Then calculate what date you are likely to get your period around race day. Equipped with that knowledge, you can then extend the first of the three phases of your pill sheet. This needs to be done at least three or four months in advance of your race, so that your body is well adapted to the adjusted cycle by the time race day arrives.

VALUABLE EXPERIENCE FROM TWO WORLD CLASS ELITES

Who better to learn from than the best, right? I spoke to two world class athletes who’re not shy to speak publicly about their personal experiences around menstruation. Both are champions in their respective disciplines, and both are actively advocating lifting the hush on menstruation.

Ann Ashworth (36) – Comrades Marathon winner (2018)

From 2016 leading up to her Comrades win in 2018, Ann followed a very strict, fat-free, low carb, high protein diet. She developed into a fast, strong and very lean athlete, and her results were fantastic… but her body was not. Unbeknownst to her, she was pushing her body into a physical state known as “low energy availability”, which is what happens if we live and train in a state of continued calorie deficit.

What happened after that was critical to Ann’s story, but I’ve opted to save that part for my next blog – one that will hopefully help many women runners who’re constantly striving to improve but feel like their body is just not on the same team. But more about that in my next blog!

The game changer for Ann was reading “Roar” by Dr Stacy Sims, whose entire focus is on hormone / menstrual cycle-based training.

“The book examines eating and training according to the various stages of one’s cycle, and explains why we feel flat, heavy-legged and unduly fatigued at different times of the month. I knew immediately that there was truth to this because while training at altitude in Dullstroom with an all-male training camp, doing exactly the same sessions as the men, sometimes I was far ahead of the men and felt strong, fast and amazing… and other times I just wanted to curl up in foetal position at the side of the road, when the men felt fine. What I didn’t realise was that my body was reacting or adapting to the same training differently to the men. Having read ‘Roar’, I understood why.

Previously if I felt rubbish, I would just push myself harder or run for longer. Now I know when I need to cut myself some slack, both physically and emotionally. I’ve also learnt about different foods and supplements we can take to mitigate the adverse effects of our cycle at different times, and how our race/run fuelling needs to change depending on where we are in the month. It’s made a huge difference.”

Ann’s tips:

• In the first half of our cycle (pre-ovulation), adding some fat to our pre-long run breakfast (for example) goes a lot further than just eating carbs. During this phase, we should focus on good fats, low sugar and complex carbs.
• In the second half of our cycle, we need more quick-release carbs. So, for HIIT training, some fruit would work to bolster our energy levels, and the same when doing an endurance session – we need to drip feed. The last quarter of our cycle (just before your period) is when we usually start to crave sweets and chocolate, which is actually our bodies asking us for more sugar, because we need it.
• I take magnesium and zinc in the second half of my cycle (and half a Panado a few days before my period starts). Dr Stacy Sims also recommends using natural supplements such as maca root powder in the last third of your cycle.

Lucy Bartholomew (24) – Ultra-Trail Cape Town 100km winner (women’s record) 2019, Ultra-Trail Australia 100km winner (women’s record) 2017, and a multitude of other wins around the world

Lucy is lucky, she doesn’t feel much difference before or during her period.

“I am super lucky to have a light period with little to no pain or discomfort. I do notice though that I feel a lot more hungry, and I give peace and space to my mind to allow myself to fuel this adequately and eat what I crave or what I feel my body needs, regardless of the exercising regime. I truly believe the body is so amazing at telling us what it needs, and how it needs to be treated, and I respect that.”

Lucy keeps her fuelling regime fairly consistent throughout the month, and just carries more food and of more variety during certain times of her cycle, to match what her body craves.

“During my period, I usually keep my runs to the same schedule that I would do on any other week, and just focus on showing up, trying my best, and listening to what my body is telling me. After training I’m careful to refuel properly, and to send some self-love my way as sometimes for me during this time my body image doesn’t feel as positive.”

I asked Lucy if she has ever been caught unaware by her period on race day.

“I have! During one race, I remember running along and feeling myself starting to chafe between my legs. I knew that chafe = moisture + friction, and I remember being puzzled what the moisture was. When I realised, I was so afraid someone would see that I actually went through a puddle and splashed muddy water all over me to hide it. I remember finishing and wanting to get away as soon as possible. It turned out that no one ever noticed, and I can laugh at this now. These days during my period I try to be as environmentally-friendly as possible by using washable liners.”

Lucy’s tips:

• Following a plant-based diet, I take iron supplements regularly but I make sure I prioritise them during my period, together with iron-rich foods and Vitamin C to enhance iron absorption. I also take protein powder with digestive enzymes. Protein powders ebb and flow in my diet depending on my training, but I find that during my period they satiate me a lot more, and provide some really important building blocks for my body to come out the other side stronger. The protein powder I use has enhanced digestive enzymes, which support digestion and reduce bloating for me.
• Sometimes it’s the hard way, but learn what works for you with training, nutrition, rest, products. Everyone is unique. There are some amazing podcasts and books you can read on how our hormones affect us – I recommend ”‘Roar” by Dr Stacy Sims. There are also some great apps you can download to track your feelings and on how to adjust your training.
• Don’t let your menstrual cycle hold you back. Accept and embrace this as part of being a woman and be proud of it. Being a woman isn’t a hindrance, it’s a superpower!