Blood, Sweat and Tears

Blood, Sweat and Tears

When you have to get your game on, the last thing that you want to deal with is a monthly visit from Mother Nature. The key is to stay focused, stay informed and prep appropriately.

Here is a brief play by play on what happens in the month leading up to your period:

  • Phase 1: The follicular phase
    At the beginning of the cycle, signals from a region of the front of your brain (the hypothalamus) stimulate hormones that tell your ovaries to make follicles. Each follicle makes eggs.
  • Phase 2: The ovulatory phase
    Next, the follicle with the strongest, healthiest winner of an egg releases its egg for potential fertilization by an incoming sperm. The losers get resorbed.
  • Phase 3: The luteal phase
    Then, the lining of the uterus that began to thicken in the follicular phase (egg-making phase) in response to a rise in estrogen will be maintained if the egg is fertilized.
  • Phase 4: The menstrual phase
    If the egg is not fertilized, then the luteal phase transitions to the menstrual phase, where you bleed the lining out (also called a menstrual cycle.)

Belly pain and bloating may be the obvious, notorious symptoms that interfere with performance on the field. However, hormonal fluctuations can cause silent physiological changes that explain why players are more prone to injury and fatigue.

A rise in a hormone called progesterone elevates normal body temperature.

During the days before your period starts, the body temperature rises to accommodate a potential bun in the oven, or fertilized egg, and prep the body for pregnancy. This means that the starting point for releasing extra thermal energy is also higher. This is dangerous for athletes who typically push past the point of exhaustion since they may be more prone to heat stroke on hot days on the field. Remember that during this time your heart also works harder.

How to stay in the game:

This is not the time to ignore the subtle signs of heat exhaustion. A higher core body temperature may reduce the safe margin for heat accumulation. Stop, drink water and cool off when your body is telling you to before you’re face down in the green.

Prostaglandins are raging.

If you’re prone to aches and pains after a game, then know that these may intensify with your period. Painful belly cramps are caused by increased prostaglandin secretion from the endometrium (which bind to pain receptors that send pain signals to your brain.) Prostaglandins are found in many tissues, and if more of them are floating round and binding to pain receptors, then this means you are truly sensing more pain.

How to stay in the game:

NSAIDs (non-steroidal anti-inflammatories like Advil and Motrin) are effective in reducing symptoms because they prevent prostaglandin formation. Dose appropriately. If you weigh 120 pounds, for example, then you may need 600 mg for pain control. (That’s three pills every six to eight hours.)

Your ACL (anterior ligament) is more sensitive.

As estrogen levels rise, athletes may be more prone to ACL injuries. This is because there are estrogen receptors on your ACL, and estrogen has an inhibitory effect on collagen production, which strengthens your bones, tendons, cartilages and other connective tissues. Knee laxity (or looseness) increases with elevated estrogen and progesterone levels in the days before your period. A time lag of three to four days was found between hormone level changes and laxity changes, meaning that increased knee laxity may also last through your period.

How to stay in the game:

Develop proper alignment when moving across the field. Move with your knees directly over your feet and do not let your knees collapse inward. Having adequate strength in your hips and thighs is key to providing support for your knees. Sets of squats and lunges are exercises that specifically help develop hip and thigh strength.

Can oral contraceptives help?

Birth control pills can do more than just prevent an unwanted pregnancy. Regularly menstruating female athletes do not need to adjust their menstrual cycle to maximize performance, but use of birth control pills, and other devices can reduce symptoms of painful, lengthy periods and make it easier to anticipate cycles.

References:
Constantine et al The Menstrual Cycle and Sport Performance. Clinics in sports medicine 24(2):e51-82, xiii-xiv
Moller-Nielsen J, Hammar M. Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exercise.

Photo Drobot Dean via Adobe Photos

 

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