Should You Alter Your Period to Perform Better?

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The first few days of Diane Nukuri’s menstrual cycle are debilitating.

Cramps that cause vomiting make her bedridden for two to three days at a time. If she over-exercises her body during this time, she tends to injure herself. She remembers retaining so much water weight at the 2019 Prague marathon (due to hormonal fluctuations), she didn’t fit into her uniform. The advice she’s received from friends ranges from nutritional shakes to “It might go away when you have a baby.”

The 37-year-old professional marathoner has been working hard to figure out how to train and race around her period, but even the best plans backfire. In 2017, Nukuri wanted to run a fast marathon route like London, but ultimately chose Boston (a hillier route) because of her cycle. She expected her period to start a week after Boston, but it came the day before the race. Her plan was foiled again that same year at the New York City Marathon, when she says she was in peak fitness. Her period came a week earlier than expected.

“If I didn’t have these kinds of problems, I feel like my running career would have been a lot better,” says the three-time Burundian-American Olympic runner.

Nukuri isn’t the only elite runner to speak publicly about how her period is affecting her running. Olympian this summer only Eilish McColgan and Dina Asher Smith issued public announcements calling for more open dialogue and sports science research on how the menstrual cycle affects performance. Athletes find they need to stand up for themselves in the doctor’s office. There is no one-size-fits-all patch that a doctor can prescribe for women to address period problems.

The period as a sign of life

In the summer of 2019, Nukuri got an MRI for a thigh tear. The pictures showed that she had something in her lower abdomen. An ultrasound showed uterine fibroids. The surgical removal eased some of her usual discomfort during her period, and she says it gave her peace of mind that she wasn’t “crazy.” show stats that nearly 25% of black women ages 18 to 30 have uterine fibroids, compared to 6% of white women.

RELATED: How fibroids can affect your running

So why doesn’t she just skip her period altogether? Many women now temporarily eliminate it through hormonal birth control by skipping the placebo pill. In her TEDx talk “Making periods optional,” Sophia Yen, gynecologist and co-founder of Pandia Health, says it’s unnatural for women to have as many periods in their lives as they do. She promotes #periodsoptional to reduce ovarian, endometrial and colon cancer.

“In any sport you want to have enough blood on board to get oxygen to maximize your performance. The main cause of anemia in a menstruating woman is menstruation. We’ll have blood drawn every four weeks,” she says.

But Trent Stellingwerff, Senior Advisor for Research and Development at the Canadian Sport Institute Pacific, disagrees: “For women who run five to six hours a week – no matter how fast – the best canary in the coal mine that we have is your menstrual cycle status. I wouldn’t cut out the period because [then] Without extensive blood work and ovulation tests, we have no way of knowing their energy availability status,” says Stellingwerff, whose wife, an Olympic 1500-meter runner, took part in some of his studies.

Every period is different

Nukuri was 23 years old and had been enjoying a stellar running career in college when she first saw a doctor at age 18 for heavy bleeding and cramping that began shortly after her period started. She was offered the pill (hormonal birth control) but no ultrasound (which she thinks may have detected the fibroids). “I got really sick then. I never felt like I was getting in shape,” she says. Three years later she decided to go off birth control and she started to get better.

Nukuri says she’s “tried everything” to ease her negative period symptoms, but she’s found that what might work for one woman doesn’t necessarily work for all. “Sometimes it matters how stressed you are with work or your personal life,” she says.

Stellingwerff agrees: “The woman’s menstrual cycle is incredibly complex.” When a woman performs best during her cycle with a normal cycle of 28 days (plus or minus seven days), that’s very individual.

“I’ve seen women do amazing things with birth control. I’ve seen women do incredible things without birth control. I’ve seen women perform amazingly every day and at every stage of the menstrual cycle,” says Stellingwerff.

Case in point: Sara Vaughn, Miler turned marathon runner and mother of four, peaking at all points of her cycle, even during her period. “I’ve had some of my best races in the middle of the first week of my cycle.” She cites her first Team USA as an example. “I got my period on the day between the preliminary round and the final.”

The 36-year-old notes that after each of her pregnancies, her period symptoms have changed, sometimes for the better, sometimes for the worse. “I’ve always reminded myself to give your body a chance to do what you’ve trained for, no matter how you’re feeling. You can still get the job done.”

Let’s talk periods

While competing at the University of Colorado at Boulder, the NCAA Cross-Country All-American said she never spoke to any of her coaches about her period. But the women on the team shared with each other. “There was a belief among my teammates that losing your period was a badge of honour. That means you didn’t train hard enough when you got it,” she recalls.

Vaughn has never lost her period (which started when she was 15) unless she was pregnant or breastfeeding. She remembers her sophomore year of college seeing a team doctor because she wasn’t feeling well. She hadn’t had her period in a few months and she was on birth control. “Instead of saying, ‘This is a health issue. Or maybe you’re pregnant,” they said. “You’re training really hard. That makes sense.’ Almost like a pat on the back,” says Vaughn, who was pregnant with their first child, Kiki. Her three daughters are now 16, 12 and 7 years old.

“I will encourage my kids not to take hormonal birth control,” says Vaughn, who didn’t like how it made her feel. “You don’t have a monthly check on your health.”

The internationally renowned exercise physiologist and nutritionist Stacy Sims also advises against manipulating the menstrual cycle. “I try to discourage people from using oral birth control or hormonal birth control to manipulate their cycle,” she says. “Then they down-regulate their own natural endocrine cycle, which is what we want because it tells us if we’re overtraining, overexerting or overworked.” She warns that this then leads to RED-S (Relative Energy Deficiency in Sport). can, formerly known as the Athlete Triad.

Sims argues that we can train according to our menstrual cycle, that there are hormonal patterns in the cycle that are common to most women.

Get to know your menstrual cycle

From day one (first day of bleeding) to day 13, estrogen and progesterone are at their lowest. The body is most resistant to stress and the immune system is strong. It’s time to train strength and speed. On days 15-21, she recommends more steady-state exercise, such as hills. The five days before your period starts, progesterone and estrogen levels are high. The body is less resilient and the immune system more susceptible to inflammation. Sims suggests women focus on rest and exercises that develop balance and technique. If cramps are severe, consider 5 x 20-30 second bouts with plenty of rest. Sims says it creates an anti-inflammatory and growth hormone response that tells the body to reduce spasms.

“It’s not about talking about the negative points of the menstrual cycle, because there shouldn’t be a negative point,” Sims says in his TED Talk Women are not little men points to nutrition as a tool to create a level playing field. She encourages women to learn how to use their response to exercise at different points in their cycle to lead to better performance.

However, Stellingwerff argues that it is too early to suggest that female runners follow a menstrual cycle formula. The current data, he says, is based on studies that have been “moderately to poorly conducted” over the past decade. “Being able to apply the gold standard methodology to female subjects in exercise physiology is quite challenging,” he says, given the many variables. Is a woman on contraception or not? Is the contraceptive hormone hormone based or copper based? “It’s a real challenge to draw firm conclusions from data when the methods are poorly performed.”

Stellingwerff and Sims agree on one thing. Female runners should track their individual data over several months. If you’re exercising regularly on the fifth day of your cycle, keep this in mind. If you’re feeling consistently bad during the last week of your cycle, don’t plan an important race for that week.

Melody Fairchild, author of girls run and US World Mountain Team gold medalist, is perhaps best known for being the first high school girl in history to break 10 minutes in the two-mile course. A year after her mother’s death, Fairchild decided to take a year off from college to give her “body, mind, and spirit space to rest” — something her mother had encouraged her to do. Only then did her period start. She was 19 years old.

The Boulder Mountain Warriors youth coach says, “Had it not been for my time off, I would have pushed myself to who knows what end and delayed the onset of my menstrual period even longer. Changing the menstrual cycle in favor of performance means denying the truth that the female body menstruates. Period.”