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Code red!

Let’s talk about PMS, periods and sports performance

Published:Sunday | August 14, 2022 | 12:11 AMInca Brady - Contributor
Dr Inca Brady
Dr Inca Brady

AUNT FLO, code red, leak week, girl flu, shark week, the red wedding, Beelzebub’s tea party, Ragnarök, hide the knives week, that time of the month – all terms used to refer to the most taboo of topics with regard to the female reproductive system...

AUNT FLO, code red, leak week, girl flu, shark week, the red wedding, Beelzebub’s tea party, Ragnarök, hide the knives week, that time of the month – all terms used to refer to the most taboo of topics with regard to the female reproductive system – menstruation and its merry companion, the premenstrual syndrome or PMS. Like society in general, the subject of a female’s period or PMS is rarely acknowledged or spoken of in the sporting arena even though research has shown that these natural phenomena might have negative physical and psychological effects on sports performance.

PMS refers to physical and mood disturbances that include, but are not limited to, angry outbursts, confusion, anxiety, depression, irritability, social withdrawal, abdominal bloating, weight gain, headache, breast tenderness, joint and muscle pains, that is experienced at least five days before the period and which eases by day four of the menstrual flow. In addition to the passage of blood and the risk of leaks that may cause public embarrassment due to soiled clothing, the period is sometimes accompanied by lethargy, abdominal cramps, migraines, bouts of diarrhoea, nausea and vomiting which increases the risk of dehydration that, if left unchecked, can have detrimental effects on athletic performance and overall health and well-being.

Research has shown that there is a higher rate of injury in women in the premenstrual and menstrual phase of their cycle, with women with PMS having an even higher risk. It is therefore unconscionable that these issues are not discussed publicly in a region where our female athletes are most often the crown jewels of our national athletic and sports programmes.

A study done in Britain found that up to 77 per cent of elite athletes reported negative effects during their menstrual cycle. Research conducted with female athletes on sports scholarships at The University of the West Indies (UWI), Mona, found that 80 per cent of the interviewees felt that PMS symptoms negatively impacted performance during training and competition. In this same study, more than 50 per cent of female athletes interviewed did not report their symptoms because they felt uncomfortable discussing it with their coaches and felt that they were being perceived as “lazy” and “lacking motivation”.

Sixty-seven per cent of athletes believed that the coach expected them to train and compete at the same level even if they knew the athlete has PMS or menstrual symptoms.


Even after acknowledging that they had bothersome symptoms, these female athletes showed true grit and athletic determination as only 10 per cent of the group reported missing a practice session and PMS symptoms had no effect on attendance at a competitive event. This might be due to athletes being better able to cope with pain or discomfort, which is often experienced when playing sports competitively, when compared to the general population.

While mental fortitude and a competitive spirit to win despite the odds are admirable and traits needed for athletes to succeed, they are not valid reasons to suffer in silence.

There are several treatment methods available, ranging from pain medication, anti-depressants, heat and exercise therapy, oral contraceptives, and cognitive behaviour therapy that have been proven to relieve these symptoms. Other treatment modalities such as diuretics, certain classes of analgesics, and over-the-counter supplements are not suitable for athletes as they might contain banned substances and constitute a doping violation. Treatment should only be started after consulting a team or sports medicine trained physician.

In the UWI study, athletes also had their own suggestions on how to better enable them to cope with symptoms while training and competing. These included holding training seminars educating both staff and athletes on how to recognise and manage the signs and symptoms of menstruation and PMS and the effect they have on athletic performance, having increased availability of sports medicine doctors or medical personnel such as a physiotherapist to whom complaints can be made, and modifying training regimens for those experiencing symptoms.

Armed with the knowledge that symptoms of PMS and menstruation are linked to increased injury risks, and a decline in sports performance, conversations need to be started and plans put in place to address any concerns brought forward by athletes so that coaches, sports administrators, and trainers may address same. In the words of a female athlete at UWI, “Anyone who chooses to train females should know that we women come with a package (monthly blessing) [and should] be sensitive and understanding.” The taboo surrounding menstruation and PMS has timed out. Code reds are normal. They can cause discomfort. Discomfort that is treatable. Let us start talking.

Sport Pulse and Sport Matters are fortnightly columns highlighting advances that impact sport. We look forward to your continued readership. Dr Inca Brady practises in Jamaica and is a graduate student pursuing a Master of Science degree in Sports Medicine at The University of the West Indies.