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According to the International Olympics Committee, at least 40.5 per cent of athletes at the Paralympics are women, 100 more female athletes than in Rio de Janeiro in 2016.
But on top of the extreme pressure that comes with competing on the world stage at the Olympics, female athletes also have to contend with their periods, which can be accompanied by other symptoms such as cramps, feeling bloated and uncomfortable, and breast tenderness.
How does menstruation affect female athletes and what do they do to manage them?
Menstruation and risk of injury
Some studies have found that the risk of injury in female athletes increases at particular points in their menstrual cycle.
According to a 2021 study on female footballers, researchers found that fluctuations in reproductive hormones such as oestrogen and progesterone can influence certain tissues, such as muscles, tendons and ligaments.
Muscle and tendon injury rates were 88 per cent greater during the late follicular phase of the menstruation cycle, which is when the brain sends signals to the ovaries to prepare an egg that will be released.
British Olympic athlete Eilish McColgan told BBC Sport in 2019 that she had to pull out of a race in Rome the year before when she got her period and pulled her hamstring shortly after.
She said there was “no doubt in my mind it was all connected”, adding that the radiologist who scanned her muscle later said “he’d never really seen that much inflammation in one muscle before”.
Overall tiredness caused by menstruation can also affect an athlete’s performance. At the 2016 Rio Olympics, Chinese swimmer Fu Yuanhui was asked why she was holding onto her stomach after her 4x100 metre relay race.
She said: “I feel I didn’t swim well today. I let my teammates down. My period came last night and I’m really tired. But this isn’t an excuse, I still didn’t swim as well as I should have.”
Some athletes monitor their periods to ensure they are able to train and compete at optimum times in their cycle.
In a short film interview with Women’s Health, Lioness and Chelsea FC football player Fran Kirby said her team uses the “Fit For Women” monitoring app to track their cycles and train accordingly. She added that periods can “affect you so much, whether it’s your coordination or your reaction time – which is so vital in so many sports”.
Last year Chelsea Women became the first club in the world to tailor their training schedule to players’ menstrual cycles to enhance performance and reduce injury rates.
Olympic hockey gold medallist Sam Quek told BBC Sports she used an app on her phone that would record her heart rate, the colour of her urine, how many hours she slept, if she had muscle soreness and whether it was the first day of her menstrual cycle.
More recently, the English Institute of Sport announced a research collaboration with Manchester City Women that uses technology called Hormonix, which will allow players to access information about their hormone levels and gain deeper understanding into how their menstrual cycles may influence their health and performance.
Captain Steph Houghton said: “I’m really happy to be able to take part in this study – menstruation has always been a taboo subject, but it shouldn’t be as it’s a key part of life for women, especially those who are professional athletes.”
Taking birth control pills to delay or “pause” a period is also common practice among female athletes.
However, scientists have said there needs to be more research in this area, as hormonal contraceptives affect women in different ways.
According to the Sports MD website, there are “contraindications [specific situations in which a drug or procedure should not be used because it may be harmful] to using hormonal birth control methods in athletes at all levels”.
“These include personal history of blood clots or history of blood clots in first degree relatives, known disorders in blood clotting, poor liver function, breast cancer, history of heart attack, high blood pressure, smoking, migraine headaches or recent surgery,” it adds.