How Do Menstruation, Hormonal Contraception Impact Women In Sports?

The 2024 Paris Olympics will be historic: they will be the first gender-balanced Games. However, sports science is not yet at this stage, as only 9% of articles in sports science have focused solely on women .

Athletes have hormonal specificities due to the secretion of ovarian hormones (estrogen and progesterone) which are specific to them and which can vary depending on the phases of the natural menstrual cycle or the use of hormonal contraception.

Different ovarian hormonal statuses (i.e. different phases of the menstrual cycle or taking hormonal contraception) can induce metabolic changes (for example a change in energy expenditure and the use of lipids and carbohydrates to produce this energy) which can interfere with the needs related to their sports practice, whose training is punctuated by the competition calendar.

Women athletes trained in the same way as men

Regardless of their level, the vast majority of female athletes are trained in the same way as men, without taking into account the individual factors specific to them. Many female athletes notice this lack of consideration of their hormonal status on their well-being in training.

For example, Olympic handball champion Estelle Nze Minko asked in 2022 in the daily newspaper Le Monde  : “Why not look at the menstrual cycle, which has a major influence on performance?”

It seems important to lift the taboos and especially the lack of knowledge among sportswomen and their coaches about the functioning and impact that ovarian hormonal variations can have on health and the potential implications for sports practice.

Many women experience premenstrual (i.e., during the week before menstruation) and menstrual (i.e., during menstruation) symptoms in particular, which should be further described and addressed.

Do menstrual and premenstrual symptoms have a negative impact on sports practice?

Given the lack of validated tools in the scientific literature to monitor ovarian hormonal status and weight variations in sportswomen, a questionnaire called "Answ'Her" was developed in a first cross-sectional study that we conducted (to be published in the Journal of Sports Medicine and Physical Fitness ).

The questionnaire was then used to conduct a survey to assess ovarian hormonal status and weight variation habits in sportswomen, as well as the proportion of them suffering from discomfort related to symptoms (premenstrual or menstrual) and their impact on sports practice.

This survey was conducted among French sportswomen of all levels practicing different types of sports: team sports (rugby, football, volleyball, handball), combat sports (judo, jiu-jitsu, boxing), strength sports (weightlifting, bodybuilding, powerlifting), endurance sports (running, cycling) or artistic sports (gymnastics, dance, skating).

Whether they used hormonal contraception or not, the majority of these sportswomen (78.7% exactly) said they perceived a negative impact of their ovarian hormonal status on their sports practice and on their performance, mainly associated with menstrual and premenstrual symptoms.

Communicating about pain, fatigue, mood changes

The main menstrual and premenstrual symptoms reported by the athletes in the questionnaire were abdominal pain, fatigue, bloating and mood swings, in line with previous studies on this topic. Interestingly, 77.3% of the athletes surveyed also experienced weight fluctuations, which could be associated with a period interruption of more than three months and irregularities in their menstrual cycle over the past three years.

The Answ'Her questionnaire therefore appears to be a simple tool to enable discussions to be initiated between sportswomen and their coaches regarding the menstrual cycle, weight variations and the feelings of sportswomen.

Furthermore, this can make it possible to initiate consultations with health professionals (midwives, gynecologists, nutritionists) with a view to providing individualized care for sportswomen, whether in terms of training or nutritional monitoring, in order to optimize their mental and physical health.

Does ovarian hormonal status influence energy expenditure in athletes?
To date, there is no consensus on nutritional and training recommendations for female athletes in relation to their ovarian hormonal status. Furthermore, no study has really looked at the impact of hormonal status on body composition, energy intake and expenditure in female athletes, in relation to different training loads (designating the volume, intensity, and frequency of training), which vary during a sports season.

To find out, the laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions (AME2P) at the University of Clermont Auvergne is the first to set up a research project whose objective is to determine the impacts of ovarian hormonal status on energy expenditure and nutritional regulations in sportswomen, depending on the training load.

This study was conducted on 32 national and international level sportswomen (21 rugbywomen and 11 footballers, aged 23 on average). Among them, 23 had a natural menstrual cycle and 9 were on hormonal contraception (contraceptive pill). In particular, we measured their energy expenditure in fasting conditions, after a meal and finally during exercise, which corresponds to the three main components of total energy expenditure over the course of a day.

Great variability from one woman to another, and from one cycle to another

During periods of high training load, our initial results suggest that female athletes using the contraceptive pill would have a greater energy demand during exercise than those with a natural menstrual cycle.

However, at rest, fasting or after taking a calibrated meal, no difference was observed between athletes using hormonal contraception or not, nor between the phases of the natural menstrual cycle.

In athletes with a natural menstrual cycle, a difference in carbohydrate utilization between the phases of the menstrual cycle was also observed, being greater in the luteal phase than in the follicular phase.

Finally, the analysis of these first results allows us to highlight the great variability of metabolic responses from one woman to another and, for the same woman, from one cycle to another. It would therefore be more interesting to have an individualized approach to these results.

For better management of training and nutrition for sportswomen
Our results during periods of low training load are still being analyzed. The measurements taken as part of this monitoring have already made it possible to provide awareness-raising, nutritional advice and training management elements for athletes and their coaches. The aim is to optimize the care and well-being of athletes.

The results of the various studies conducted as part of this research project will make it possible to identify the energy and nutrient needs of sportswomen based on their ovarian hormonal status.

Thus, in the long term, the objective would be to develop plant-based food products adapted to the macro (lipids, carbohydrates and proteins) and micro nutrient (vitamins and minerals) needs of sportswomen, in particular to limit the inconveniences linked to premenstrual and menstrual symptoms through an innovation project called SportVeg.

This article by Sarah Bagot, PhD student, Clermont Auvergne University (UCA), was first published in The Conversation.