We are just weeks away from the Olympics, an event that will once again etch its name in the history books by delivering perfect gender parity between female and male athletes at Paris 2024, a first for the Games.
For the 5,250 female athletes who will compete at the Summer Games, on top of the extreme pressure that comes with battling it out on the world stage, they will also have to contend with an often-underestimated barrier – their periods.
Awareness is growing in the world of sport about the impact of menstrual cycles, with the Olympics at the forefront. However, as Keogh, an ambassador for women’s health brand Active Iron explains, there’s definitely a lot more to be done, particularly for the younger generation of elite sportswomen.
“I think some athletes may naively think that missing their period is a good thing, as they don’t have to deal with the symptoms every month, but in the long run that’s just not healthy and can lead to much bigger health problems,” Keogh said, reflecting on her experiences.
“As an athlete, you’re always looking towards the next goal, especially with a major event like the Paris Olympics on the horizon. You’re obviously very competitive and you will do anything to get faster, or perform better,” says Keogh.
“Sometimes that can come at the detriment of your own health, you might not actually realise you’ve been ignoring symptoms for a long time, or that your period is late or hasn’t arrived at all. That’s why it’s so important that you track your cycle, and we educate younger athletes on how to do that so they can stay on top of their menstrual cycle and avoid any long-term health problems.
“If you are ignoring symptoms, not listening to your body, or maybe you’re pushing out the fact that it’s late, or you haven’t had that many cycles in a given season, it’s very difficult to recover and get back on track.”
It’s an opinion shared by Renee McGregor, leading sports nutritionist and eating disorder specialist, and health advisor for Active Iron.
Over two decades she’s supported athletes globally at Olympic (London, 2012), Paralympic (Rio, 2016), and Commonwealth (Queensland, 2018) level, as well as acting as the current Nutrition Lead for the English and Scottish National Ballet.
She said: “Balancing preparations for the Paris Olympics while managing menstrual cycles can be a very difficult situation for female athletes. They push themselves in training and don’t want any barriers to peak performance. To manage periods and the associated symptoms, most female athletes opt for some form of hormonal contraception, which stops menstruation and bleeding.
“The problem with contraception, particularly hormonal IUDs, is that it can disguise what’s really going on with the athlete’s body, such as low energy availability or stress. This increases the risk of developing Relative Energy Deficiency in Sport (RED-S), which can have numerous negative consequences on performance and heightens the risk of injury.”
How to manage symptoms
“When it comes to periods, knowledge is power. I think tracking your cycle is one of the most important things you can do, because missed periods or longer cycles highlight that your body’s functioning properly. While they can impact athletic performance, it’s a sign of health at the end of the day and that’s much more important than how you perform,” adds Keogh.
She highlights that understanding your menstrual cycle allows you to identify negative changes, such as late or missed periods, early on and address their causes before they become major health issues. For athletes, changes might indicate that you are under-fuelled or experiencing high stress levels due to your training program. Recognising these signs helps you understand that what you’re experiencing is neither normal nor common, prompting you to take necessary action.
“Tracking my cycle helps me distinguish between period-related tightness and potential injuries. If I know my period is coming or I’m in the early stages of my cycle, I ease up a bit at the gym and avoid pushing for personal bests. It also reminds me to prioritise good habits like getting plenty of sleep and ensuring proper nutrition.
“Having open conversations with teammates is also important. While you might think that what you’re experiencing is ‘normal,’ you could discover that none of your teammates are going through the same thing. This could indicate that your symptoms are more severe and may require medical support.”
Dealing with fatigue
One common menstrual symptom that many athletes — and indeed many women — face is fatigue. Heavy menstrual bleeding often leads to a feeling of exhaustion, commonly referred to as period fatigue.
However, as Keogh points out, it’s crucial to distinguish between regular tiredness and chronic fatigue. Understanding this difference can help athletes manage their energy levels more effectively and seek appropriate medical support when needed.
“When I first joined the High Performance team, I discovered my iron levels were low. As an athlete it’s part of your job to be tired, so I figured the fatigue I was experiencing was normal. It wasn’t until after these tests that I realised that it was something much more than just tiredness from my training load, but more importantly I learnt it was something I could better manage.”
Low iron levels are a common phenomenon in athletes, particularly those involved in endurance sports. It has been reported to impact 3-11% of male athletes and 15-35% of female athletes .
Female athletes are at an increased risk of low iron due to monthly menstrual losses, which are the most common cause of iron depletion. Women of childbearing age need almost twice as much daily iron as men, as they lose an average of 20-90 ml of blood during their periods.
So, how do you manage low iron levels and what impact can it have on your body?
Sufficient iron levels are critical for athletes because iron is essential for producing myoglobin, a protein vital for storing and carrying oxygen within muscle tissue. Therefore, inadequate iron levels can substantially impair athletic performance.
“I tried several over-the-counter iron supplements, but they didn’t agree with me. In fact, taking them made me feel worse and I was dealing with fatigue and other period symptoms as a result. Eventually, I found Active Iron, an iron supplement which helped avoid the side effects that had been affecting my training. It wasn’t an overnight change, but after a couple of months, I noticed a significant improvement in my energy levels and my ability to handle my weekly training load.”
Are periods a disadvantage for female athletes?
According to a study, 60% of female athletes reported that their periods affected their performance or caused them to miss training or competition, but what if your menstrual cycle strikes when you’re on the biggest stage of all? Olympic rower Keogh knows about that more than most.
Another study highlighted that physical symptoms such as cramps and reduced energy levels, alongside psychological symptoms like worry and distraction, significantly impacted training and competition for over two-thirds of athletes (BMJ Sports Medicine).
She said: “For the next generation of athletes coming through, who might not be able to put their finger on why they’re not performing consistently, or why an event may have gone wrong, they may underestimate the kind of effect their menstrual cycle has on them. In that regard it can be a disadvantage if you don’t arm yourself with the knowledge to better understand and manage it.
“I suppose in terms of my own experience, what you think is normal may not be normal. Every athlete, and every person — not just athletes — is different and experiences different symptoms. Until it’s actually spoken about, you may not realise that it’s not normal to be in pain for five days, to be very fatigued, or to experience those symptoms.”
“Having these open conversations about periods and sharing our stories is key. It shows us there’s no one-size-fits-all fix; everyone’s experience is different and needs an individualised approach. So, let’s keep the conversation going and make sure everyone’s getting the support they need, their own way. By shining a light on these topics, we not only empower ourselves but also pave the way for a more inclusive and understanding approach to menstrual health.”
For more information, visit: https://www.activeiron.com/
