Whether you are a professional athlete or a marathon runner, Aunt Flow hurls her wrath at everyone, equally. Period talk is usually hush-hush even in athletic communities but it was refreshing to witness Chinese swimmer Fu Yuanhui in the 2016 Summer Olympics being blatantly honest about having her period during the tournament and not using it as an excuse for winning the bronze.

But does being on your period take a toll on your performance when you are competing or running? According to Dr. Petra Casey, M.D., Associate Professor of Obstetrics and Gynecology at Mayo Clinic, this is a complex issue.

“There is no concrete consensus on whether period flow affects one’s capabilities. There are just as many studies that say that performance does not vary throughout the menstrual cycle as there are studies that say it does. In general, in those that say that there is a difference, they say that the sweet spot is somewhere between the middle of one’s period ” she said in an interview with Vivien Williams of The Mayo Clinic News Network.

This time-frame, she explains is scheduled towards the end of the follicular phase, which falls in the first half of a woman’s menstrual cycle. So if we look at the typical menstrual cycle that is 28 days long, the first five days would be when the flow occurs. Then, the first 14 days are considered the follicular phase where the egg is getting built up.

The second half of the follicular phase ( the next 14 days) is when the lining of the uterus gets lush, in preparation to accept a fertilized egg. This luteal phase is considered less favorable for athletic performance because of the production of extra estrogen. It is advised that women load up on carbs during the second half of their menstrual cycle if they are going to participate in an endurance event. However, there are just as many women athletes who have also set personal records during their luteal phase.

There have been no concrete links to show decrease in performance during menstruation, however the bigger problem is that too much athletic activity could cause amennorhea

The main concern for Petra is not the decrease in performance but the fear that these women might lose their ability to get periods a condition called amenorrhea that many female athletes face. So why does this happen? Amenorrhea is basically your brain sending the wrong signal to your uterus. The hormones that are produced in the brain, cascade down to signal the uterus.

This leads to the production of GnRH(Gonadotropin Releasing Hormone) which triggers the follicular stimulating hormone and the luteinizing hormone that are produced in the ovary.

Women are physically active (in this case sportswomen and athletes) this signal doesn’t translate to production of estrogen and progesterone, so the woman loses her periods. They may become irregular initially and then they may stop completely. Why amennorhea is dangerous is because it does not allow the body to develop properly resulting in problems such as osteoporosis and heart-related conditions when they hit their 30’s or later.

Many studies have been conducted on what triggers this. It is still unclear whether it’s due to the body’s fat percentage, it’s weight or the cortisol levels that stimulate decrease in GnRH, based on stress and the intensity of workouts. All of that is a little bit unclear, but, at the end of the day, a woman will not have her period if she is too lean, and she may be working out too intensely for too long. And many sportswomen aim to be lean because in endurance sports being lean is an added advantage.

Amenorrhea usually is temporary and the body will regain its ability of menstruation once the female reaches the required body mass index. Petra says that this is like reverse puberty, where the girl has to reach a certain threshold of weight or body fat percentage in order to start her periods.

But the bigger question is how does one tackle periods regardless of them being bad or good for your performance? The answer is simple. Female athletes been using birth control pills to manipulate their periods for a long time now. But Petra says that this will not enhance your performance but will simply add more progesterone and estrogen to the mix. She advises that, one should not use this right before a marathon as it is known to decrease performance levels.

She says that one should try it out before and in the lowest possible formulation levels. This is nothing new and will not affect your chances of conceiving even after you quit the pill. Your body will go back to baseline and resume its bodily functions. Athletes or not, women all over the world have been using the pill to monitor control over their menstrual cycle. When asked about the safety of these pills, Petra replies “Oh, absolutely. Been using them for decades!”

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