Menstruation Health Management and Sports

Pune, 28th May 2025: Each year on May 28, the world marks Menstrual Hygiene Day, a date chosen to reflect the average 28-day cycle and five-day period experienced by millions. Initiated in 2014 by the German NGO WASH United, the day was created to confront the real challenges of menstruation-limited access to hygiene products, poor facilities, and deep social stigma.

While awareness has grown globally, one critical space continues to lag: sports. Female athletes face the physical and mental demands of high-level training and competition while managing their periods, often without proper support. Fatigue, pain, and irregular cycles can affect performance, yet these realities are rarely acknowledged in athlete care. Menstruation remains absent from most training plans, coaching strategies, and recovery protocols. The result is a silent disadvantage that persists across disciplines, from track events to ballet. Addressing menstrual health in sports is not an extra-it is essential to fair and effective athlete support.

Elite sport demands precision, discipline, and relentless performance. Yet when it comes to how the female body operates across a 28-day hormonal cycle, the system looks the other way. In 2025, it remains shockingly common for top-tier female athletes to be expected to perform as if they are physiologically identical to their male counterparts, despite overwhelming evidence that their cycles impact everything from energy availability to muscle function.

According to data published in Frontiers in Sports and Active Living (2024), 77 percent of female athletes report that their menstrual cycle negatively affects their performance. Nearly 80 percent experience at least one significant symptom, such as fatigue, cramps, mood swings, or heavy bleeding. These are not marginal cases. This is the norm, and the fact that it is not reflected in how we train, manage, and support female athletes reveals a systemic failure.

It is reported that 65% of long-distance runners and close to 80% of ballet dancers report experiencing amenorrhea, a condition where menstruation stops altogether. In the general population, the rate is a mere 5% only. This disparity is not biological-it’s structural. It stems from overtraining, under-fueling, and chronic energy deficiency, all of which disrupt hormonal balance. These are not signs of fitness. They are symptoms of a system that prioritizes performance at any cost, including reproductive health. Hormonal imbalances do not just affect fertility; they impair recovery, increase the risk of bone injuries, and weaken the immune response. In short, they sabotage the very performance outcomes athletes are chasing.

Despite this, training programs continue to be modeled largely around male physiology. Men follow predictable hormonal patterns that allow for consistency in energy levels, recovery, and endurance. Women do not-and yet the same regimens are applied. The result? A performance environment that treats menstruation like an unpredictable nuisance often pushes athletes through physical discomfort and diminished capacity without any adjustments to workload or expectations. Pain becomes invisible. Fatigue is misread as a lack of discipline. Underperformance is internalized as failure.

This silence around menstruation is not a small oversight. It is a barrier to equity. Periods are still viewed as a private issue, not a performance factor. Menstrual literacy is not included in trainings. Period tracking is rarely integrated into training data. Recovery, hydration, and nutrition plans are not typically designed to align with the hormonal phases of the cycle, even though science shows how estrogen and progesterone levels influence everything from inflammation to joint stability. People monitor sleep cycles, heart rate variability, and lactate thresholds, yet treat the menstrual cycle as a taboo subject, unworthy of technical consideration.

Period-informed training is not a theoretical concept-it’s an actionable and evidence-based strategy. Athletes should be able to track their cycles just like they track their sprint times or lifting volumes. Coaches should understand how to modulate workloads depending on whether an athlete is in the follicular or luteal phase. Sports organizations should invest in research that treats the female body as a subject worth studying, not as an inconvenient variable. Ignoring menstruation is not neutral. It actively harms performance, undermines health, and reinforces a culture where silence is safer than honesty.

From silence to strategy

For too long, menstruation has been treated as a private inconvenience in a public arena. Female athletes have competed at the highest levels while managing symptoms like nausea, pain, and exhaustion-quietly, invisibly, and without systemic support. That silence is finally breaking. British long jumper and Olympian Jazmin Sawyers has spoken candidly about the absence of menstrual health discussions in elite training environments, despite the obvious impact cycles have on strength, focus, and recovery. Indian cricket icon Jhulan Goswami has also called out the lack of resources and conversation around menstruation in professional sports, advocating for menstrual management to be integrated into team protocols. Olympics weightlifter Mirabai Chanu also reported being on her third day of menstruation and was feeling weak during her performance. She missed out on a medal. These voices are not asking for accommodations. They are demanding that the reality of female physiology be taken seriously in performance science.

This mindset is embedded in a system that was never designed for women. Training schedules follow fixed calendars, not fluctuating hormones. Nutrition plans are often one-size-fits-all. There is no built-in flexibility to recognize that a woman’s energy levels, coordination, and even cognition change throughout her cycle. For example, studies show that estrogen levels influence ligament laxity and may increase injury risk during certain phases, yet injury prevention strategies seldom consider this. Meanwhile, athletes are left to self-manage symptoms with over-the-counter painkillers and improvisation, often fearing that even mentioning their cycle will be interpreted as a sign of weakness or unreliability.

This is not about turning sports into a medicalized bubble. It’s about recognizing menstruation as a normal body function. Female athletes have already proven they can perform under conditions that ignore or deny their body functioning. Cycle tracking, individualized nutrition, strategic rest, and medically guided interventions should be part of standard athlete care. Meanwhile, sports governing bodies must back this up with policy. Menstrual health is not a niche concern but a core part of athletic performance.

Authors: Adrija Madhwal, Undergraduate Student, FLAME University; and Prof. Melody Kshetrimayum, Faculty of Literary & Cultural Studies, FLAME University.