Earlier this month, pro golfer Lydia Ko openly told a male reporter that she was suffering from period pains in an LGPA post-round interview. For the reporter, her honest admission was enough to make him lose his words; but for many people around the world, Ko’s candour was a much-needed and long-overdue breath of fresh air.

The interview went viral for all the right reasons, with other athletes and public figures quick to praise Ko for speaking so openly about an often-overlooked aspect of women’s sports.

With nearly half the global population menstruating at some time in their life, it’s a wonder why the underlying stigma around periods is still so profound.

Sexual Health Quarters Community Educator Felicia O’Keefe says the period stigma begins from an early age and continues to affect individuals well into their adult life.

“We learn not to talk about certain things, and that some topics are taboo, shameful, embarrassing, or inappropriate. Periods fall into the categories of bodily functions, bodily fluid, and sexual & reproductive organs, and these are all areas which are rarely discussed openly which contributes to ongoing stigma and shame,” she says.

However, O’Keefe says the conversation around menstruation is starting to change, with more progressive advertising, new legislation to increase accessibility to period products and more open discussion among peers.

“It’s great that people are normalising periods! Having the confidence to talk openly about this very normal, common experience will help people get the support they need if they notice that something is not right.”

The sport science world has seen a growing interest in the effects of menstruation and pre-menstrual syndrome on athlete physiology, including major research initiatives and period tracking technology.

However, the stigma remains prevalent in the press, with few female athletes speaking about their experiences publicly.

The need for better research and education

Dr Rachel Harris is a sport and exercise medicine physician, chief medical officer for the Australian Paralympic Team and a former Olympian.

Since its establishment in October of 2019, Dr Harris has led the AIS Female Performance and Health Initiative, which aims to improve education and resources for those involved in elite sport and develop a coordinated research strategy for female athletes in a high-performance setting.

She says accurate female-specific research has been missing for far too long and this has affected the health outcomes of athletes in the short and long term.

“There is so much more to be done, so a coordinated approach collaborating with key academic leaders in this space is important to fill these gaps.”

Menstruation and menstrual hormones have a significant impact on the bodies of female athletes and directly affect their performance, whether it be positively or negatively

Common menstrual symptoms include heavy bleeding, cramping, breast tenderness, increases in fluid retention, and changes to recovery patterns and fatigue levels. It’s not all bad news, however, with some athletes reporting feeling stronger and faster at different stages of their cycle.

A 2020 study of 15 international female rugby players found 93 percent of participants reported both physiological and psychological menstrual-cycle related symptoms, with 67 percent claiming these symptoms adversely affected their performance.

Dr Harris says the list of potential impacts periods can have on athletes is endless, and many persist beyond the playing field.

“Lack of oestrogen and progesterone due to energy imbalance can also lead to periods stopping, which has dire consequences on bones, fertility, injury and illness for athletes, and this in turn can mean missed training and competition, and long-term issues with fertility and bone health amongst other things,” she says.

Women who suffer from endometriosis or polycystic ovarian syndrome (PCOS) are even more vulnerable, with symptoms being so severe they often can’t participate to their fullest potential or sometimes can’t participate at all.

“We need to be normalising the conversation, empowering athletes and their supports with the right information, so they can seek help if required,”

Dr Rachel Harris

In the past few years, there has been a rise in elite sports teams and institutions implementing female-specific research programs to enhance athlete performance.

The Chelsea women’s football team have been using Orreco’s FitrWoman app to monitor players’ menstrual cycles and adjust their training program since 2020.

Former captain of the English women’s hockey team Kate Richardson-Walsh says they have been tracking their periods since before the 2012 London Olympics.

Another team collecting menstrual cycle data is the AFLW Fremantle Dockers.

Kate Starre introduced period tracking to the Fremantle Dockers in her first season as High-Performance Manager five years ago. She says there was already discussion around the potential correlation between injury and menstruation, but there was little research to show for it.

Starre says the reason for collecting menstrual data has since changed but it is still a valuable part of their overall research program.

“Now we have found that we have some of our athletes who struggle with heavy periods, struggle with endometriosis, and that’s affecting their performance,” she says.

Starre says assistance to athletes who struggle with severe menstrual-related symptoms is now the best and only reason to collect menstrual data. She says regularly monitoring symptoms and their effects on athlete performance can also help early diagnosis of endometriosis; a diagnosis which can otherwise take up to ten years.

“If we within the athletic community can reduce that diagnosis to even a couple of years, and then help the athlete deal with it in a better way, that’s a huge win.”

The majority of sports institutions which collect menstrual data currently operate under an opt-out system, with players choosing whether to not have their private data monitored instead of the other way around.

Starre says she doesn’t think every club should be collecting data and would recommend only doing so if an athlete wants to or has identified menstrual-related issues they would like assistance with.

The AIS Female Performance and Health Initiative also acts under the belief that menstrual cycle data collection should never be mandatory for athletes.

Confronting the stigma head-on
Breaking down the barriers caused by the period stigma can also help to prevent drops in athlete participation.

A 2021 study of 6812 women identified through the Strava exercise app found that menstrual cycle symptoms were associated with a greater likelihood of missing training or competitions.

Even at a grassroots level, small changes can be made to help reduce the impacts of period stigma on women’s sport. Starre says abolishing the ingrained tradition of wearing white shorts for away games could improve the experience for many players who struggle with heavy menstrual bleeding.

“It sounds like such a petty thing, but I even know at the elite level… to have to go out there and perform in white shorts is actually quite anxiety-producing, and to me it’s such a simple fix.”

Starre says keeping young players in the game should always be prioritised over superficial traditions.

For many young athletes, discussing menstrual-related problems with male coaches can be extremely challenging. Due to the presiding stigma, athletes can be made to feel embarrassed, uncomfortable or even guilty for bringing their problems to attention.

Better resources and education for coaches and athletes could help to bridge the gap in communication, as well as counter falling participation rates.

A 2021 survey of 18 male coaches across multiple elite women’s sports teams was conducted to identify what coaches of elite female athletes want to know about the menstrual cycle and how it affects health and performance. The study found training management, physical performance and communication as the most important aspects identified by participants.

Dr Harris says confronting the stigma head on will improve the lives of athletes around the world.

“We need to be normalising the conversation, empowering athletes and their supports with the right information, so they can seek help if required,” she says.

Kate Starre says menstruation should be viewed as one of the many factors that can affect an athlete’s performance and should be evaluated in accordance with these other factors rather than being pushed to the side.

“I definitely think we should be researching on how we can provide better services, facilities [and] resources to young female athletes for them to be better equipped for the elite environment.”

While the global attitude towards menstruation has shifted of late, O’Keefe says normalising the conversation will take a much bigger push from public figures especially.

“In recent years we have seen athletes talking openly about how their periods affect their performance, but it’s also important to hear from role models who discuss more serious issues relating to their periods, such as endometriosis.”

Lydia Ko’s interview may have only made ripples in the daily news headlines, but what it means for people who menstruate all over the world is something to behold. The influence of athletes like Ko can help provide a gateway for discussion of previously-taboo topics.

O’Keefe says the fight to break down the period stigma is far from over but working to develop open communication and better education is a great start.

“I hope that we can keep challenging the stigma around periods so that people can accept this natural part of life for many people, and seek specialist help if needed.”