Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team

During the Winter Olympics, we had a blast watching our country’s best athletes win medals and make major headlines in Pyeongchang. We’re so proud!

While thinking about these stellar athletes and their performances, we considered how athletes have to practice and endure with blood, sweat, tears and more, to get to where they are today.

How do Olympic athletes do it?

It takes everything to compete at the Olympics, and for us women, it can also affect parts of our bodies in ways people don’t really talk about.

Today, we’d like to address a reproductive health topic that could improve athletes’ performance:

Do periods affect a female athlete’s performance?

Olympic figure skater Mirai Nagasu had to contend with periods as she competed in the 2018 Pyeongchang Olympics. Nagasu told Cosmopolitan that she had her period on her way to the games.

While getting her period and dealing with cramps may add stress to an already stressful situation, female athletes like Nagasu have learned to stay focused. “It’s really not that big of a deal. You just stick a tampon up there,” says Nagasu. She also finds that skating is a therapeutic exercise to alleviate cramps.

It was also a major topic in the 2016 Rio Olympics when Aunt Flo decided to visit Chinese swimmer Fu Yuanhui the night before her 4×100 meter relay.

After her race, a reporter asked why she was holding onto her stomach.

“I feel I didn’t swim well today – I let my teammates down. My period came last night and I’m really tired now. But this isn’t an excuse, I still didn’t swim as well as I should have.”

Menstruation and Risk of Injury

Northwestern Medicine Assistant Professor Lynn Rogers is trying to see if athletic performance is impacted by menstruation. Rogers, along with Dr. Ellen Casey, with the University of Pennsylvania, and research professor Yasin Dhaher, have teamed up to understand how hormonal fluctuations throughout the menstrual cycle affect how the brain and its nerves control s muscles and joints.

Understanding this connection not only helps athletes understand what they need to do to perform at their peak level but also how to prevent injuries.

Studies have shown that at certain times in their cycle, women are more prone to injuries.

According to Rogers, ACL injuries seem to occur more often in the first half of a woman’s cycle when women are 9 times more likely to get ACL tears.

However, when it comes to periods and athletic performance, the verdict is still out.

Mayo Clinic gynecologist Dr. Petra Casey agrees that there isn’t really a consensus. “There are just as many studies that say performance does not vary throughout the menstrual cycle as there are studies that say it does… However, there are just as many women athletes who set personal records during their luteal phase, during their menstrual cycle, during their follicular phase, whatever.”

Estrogens and progestins–the main hormones that fluctuate during your period–affect the muscle, tendons, bones, etc. in ways that can affect athletic performance and injury susceptibilities. During the follicular phase estrogens and progestins remain steady rising slightly towards the end as the ovulation phase nears. During the ovulation phase estrogens rise to their peak with a slight increase in progestins. As the ovulation phase falls towards its ending so too do the estrogens and progestins fall. Both estrogen and progesterone rise when the luteal phase begins.

Hormonal fluctuations during the menstrual cycle

The rising and falling hormonal changes that come with menstruation can bring both positive and negative effects on the performance of female athletes. While estrogen improves muscle mass and strength, and increases the collagen content of connective tissues” thus increasing musculoskeletal health and performance, it does quite the opposite for ligaments and tendons. In tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates” by increasing the likelihood of tearing ligaments and tendons during an athletic engagement.

Female Athletes, Undernutrition, Irregular or Missed Periods, and Low Bone Density: The Female Athlete Triad

The combination of various signs and symptoms that leads to undernutrition, irregular or no periods, and low bone density is a syndrome known as the Female Athlete Triad.

Undernutrition, irregular or no periods happen with athletes who are too lean (not enough reserve energy on their body) or those who do excessive, prolonged, intense exercise, i.e. the athlete does not keep up adequate energy intake (eating enough calories) for the amount of energy expenditure (exercise) she is doing through her sport. This is because the body is telling her that she doesn’t have enough calories to support making a baby. All the energy is going towards the sport.

While periods may or may not affect a woman’s athletic performance, the reverse occasionally occurs, meaning that a ton of exercise may sometimes cause irregular periods or periods to stop altogether.

Low bone, another side effect of remaining in the undernourished state increases your risk of fractures.

The treatment for undernourishment due to athletics is to see a nutritionist and/or adolescent medicine specialist or medical provider who is familiar with the Female Athlete Triad. They will most likely advise increasing caloric intake and/or decreasing physical activity. You can do as much exercise as you want, as long as you take in enough calories to maintain your period.

However, if you are on hormonal birth control, this may mask the undernourishment by producing “artificial periods”–thereby masking the symptom that alerts many to their issues of caloric deficiencies Since birth control pills are hormonal, they work to lower and balance the amount of estrogen and testosterone in the body. This hormone-balancing often results in lowering the amount of testosterone in the body which can lead to mineral deficiencies such as low B12 and magnesium. These minerals are essential in the recovery and muscle rebuilding process and higher levels of testosterone are responsible for building strength and muscle mass more quickly.

What is the difference between missing and skipping your period as an athlete?

So, if you are an elite athlete and not achieving your peak performance, make sure you consult a nutritionist and/or medical provider familiar with athletes and undernutrition.

If you find yourself missing periods be alert to this symptom as a cause of concern and discuss the potentiality of your undernourishment with your doctor.

If you are on hormonal birth controls–which might mask the missed periods–be hyper-aware of your nutritional intake as your body’s natural alert system is offline.

Period Monitoring

As we have discussed, periods can be a great indicator of your overall health as an athlete, and missing them or having irregular periods may be (but not necessarily are) indicators of nutritional deficits.

A great way to work with your body to promote its health is to use period monitoring apps such as Clue, Flo or Ovia. FitrWomen is an especially helpful one for female athletes as it allows you to not only monitor when Aunt Flo comes around but also keep track of things such as heart rate, urine color, muscle soreness, and hours of sleep. These are all things that can help you keep track of your body’s health or lack thereof and can be used to ensure that your exercise routine aimed at keeping you fit isn’t posing any health risks. FitrWomen can also be used to help you understand when your body is at its peak for training and what kind of training it’s ready for. For example, since estrogen is beneficial for muscle mass and strength you are most productive in your strength training during the ovulation phase of your menstrual cycle when estrogen levels are at their peak. However, since high estrogen is a no-go for tendon health, this same period of high estrogen levels might be a no-go for exercises that strain your tendons–so instead of running and cycling try floor routines that put less strain on your tendons.

Will Female Athletes Get Their Periods Back?

The good news is that if you are a female athlete who has been missing periods due to being too lean or working out too intensely, you can easily get your periods back.

By simply increasing your body weight or reducing the intensity of your workouts, your body will return to its state where it can support a baby, and your period should gradually begin to make its way back to saying its monthly “hello”.

Once your period is back and regular, your ability to have a baby will also be back. It’s like your periods never went away in the first place!

Note: just because you don’t have a period, don’t assume you can’t get pregnant. If you are having vaginal intercourse and don’t want to get pregnant, make sure you use birth control.

Another Option: “Turn Off”/Skip Periods

Runner Kiran Gandhi started her period the night before she ran her first marathon, the 2015 London Marathon.

Gandhi chose to run without tampons or pads and finished her race with blood running down her legs. She felt that running with feminine products wasn’t for her because “it seemed like it would chafe me, it seemed uncomfortable, and I didn’t want to have to stop running to deal with something.”

But many women don’t realize that turning off their periods is even an option.

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By turning off their periods with hormones, women can improve their athletic performance by:

  • Preventing premenstrual and menstrual symptoms
  • Reducing the risk for injuries.
  • Reducing discomfort from cramps and feminine hygiene products
  • Decreasing anemia or iron deficiency resulting in more oxygen

How Can Female Athletes “Turn Off” Their Periods?

Turning off periods is super easy through the birth control pill or ring.

For those on the 4-week pack of birth control pills, women simply skip the last week of their pill pack and go directly into their new pack.

Women using the birth control ring can simply change out their ring on the same day each month or every 4 weeks. The ring actually has 35 days’ worth of hormones so by changing it out on the same day each month, women will skip their periods.

With the ring, there may be some breakthrough bleeding at day 28 or so when trying to get to no periods. If that happens, just take out the ring, have “a period” and then put back a new ring after 5 days of bleeding. Then next time, change the ring on the day before the breakthrough bleeding happened. For example, if the breakthrough bleeding happened on day 30, then change the ring on day 29.

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What is the best birth control for athletes & fitness competitors?

Many female athletes long for relief from the annoyances of periods which is one benefit to hormonal birth controls–you can skip them! Furthermore, balancing your hormonal fluctuations with hormonal birth control can be a plus for women athletes as they can reduce the injury susceptibility that comes with these fluctuations. However, remembering that hormonal birth controls and period skipping may mask symptoms of underlying issues is a must! If you choose to skip periods you must be extra-vigilant to ensure your overall health is not at risk as your body’s natural alert system is offline.

Is It Safe To “Turn Off”/Skip Periods?

Yes, “turning periods off” is safe. Some women may feel that it’s unnatural to skip periods, but women now have 300-500 periods in their lives versus 100 in the “old days.”

Unfortunately, Dr. John Rock, one of the developers of the birth control, put in a week of placebo pills so that women would bleed.

Now, why would he do that when his two co-founders said it was unnecessary for women to bleed monthly?

Simple – to receive support from the Catholic Church.

Dr. Rock proposed that the birth control pill was simply to make periods regular and thus could be used with the rhythm method. By having 100% predictable periods on the pill, couples could use the rhythm method perfectly. Although Dr. Rock won the argument with his pill co-founders to make women take placebo pills 1 week out of 4 and bleed unnecessarily, he lost the argument with the Catholic Church and was unable to get their endorsement of his co-invention.

Had Dr. Rock’s other co-founders won the argument, women would’ve been skipping periods on the birth control pill much earlier.

Most female physicians skip their periods using hormonal methods. Physicians also prescribe birth control to turn off periods in women to help improve: seizures, diabetes, anemia, heavy periods, severe menstrual cramping, and acne.

Learn More About How to Skip Periods

To learn more about how to safely skip periods, watch our video,  or read our previous blog, or listen to this podcast.

And whether you’re an athlete or just someone who wants to skip periods, we make it easy for any woman to get prescription birth control. Find out how you can get birth control delivered right to your door. Free*.

We also have a team of expert doctors who can provide a confidential online doctor visit if you need a new or renewal of a prescription.

Plus, Pandia Health will provide automatic refills, so you can focus on your athletic performance or simply staying fit and healthy.

*No co-pay and no deductible under the ACA (Affordable Care Act) as long as you have insurance. We accept most forms of insurance except for Kaiser and TriCare.

Disclaimer: The views expressed in this article intend to inform and induce conversation. They are the views of the author and do not necessarily represent the views of Pandia Health, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice.

FAQ’s

How much exercise causes missed periods?

There is no set amount of exercise that will cause periods to be missed. Amenorrhea is caused by the body not having enough caloric intake to maintain the exertion that one undergoes during their workouts. Certain exercises such as running and ballet can be especially draining and require more caloric intake to offset the exertion and prevent Amenorrhea.

Does working out affect your period?

Exercise can have an effect on your hormones which in turn affect your periods. Common changes include breakthrough bleeding, lighter flow, reduction of cramps, and even missed periods. While some of these symptoms can be pleasant pros to added exercise, missed periods can be a symptom of a bigger problem.

Do female athletes get their periods?

Many female athletes do get their periods however some may experience missed periods–which is symptomatic of a larger health issue–while others may choose to skip their periods altogether using hormonal birth control.