By Rhea Panwar
For decades, women have trained, competed and excelled in sporting environments never designed with their bodies in mind. Periods were dismissed as ‘private matters,’ hormonal fluctuations ignored and uniforms created without the slightest consideration for leakage or comfort. Through it all, female athletes were asked to perform, fuel and recover according to standards calibrated to the male body, treated, in effect, as “mini-men,” rather than athletes with their own physiological realities.
In recent years, however, the landscape of women’s sports has begun to shift. Researchers are finally turning their focus to the unique mechanics of the female body, examining how hormonal fluctuations influence energy, how menstrual phases may alter training response and why injuries such as ACL tears disproportionately affect women. Yet as Team GB runner Calli Hauger-Thackery observes, discussing periods is “still so taboo and it shouldn’t be, because we’re struggling with it.” Her words are a reminder that, despite progress, cultural and structural barriers still shape female athletes’ experiences.
From adolescent girls skipping PE out of fear of leaking to Olympians pushing through cramps on the world stage, periods are not a side note. Until sport fully recognises this reality, women will continue to face stigma, structural obstacles and preventable harm.
That gap is what sports gynaecologist Dr Lamia Zafrani confronts every day. “My work as a sports gynaecologist involves working with active women, recreational and elite athletes across multiple sports, managing any women’s health or gynaecological issues affecting performance, including pelvic pain, menstrual disorders through pregnancy, postpartum return, through to menopause,” she explains. “What I find is most athletes see me for hormonal optimisation too and how this can improve their performance or prevent injuries.”
The Hidden Reality: Periods and Performance
The truth is unambiguous: periods shape performance, and they do so in ways that are complex. The menstrual cycle does not just bring cramps and headaches; it interacts with mood, energy, sleep, and motivation, weaving itself into every facet of an athlete’s routine and readiness. While most sport science still defaults to male‑centred data, the lived experience of female athletes fills in the gaps. In a global study by the Women in Sport and Physical Activity Journal, 87% of athletes reported that their cycle affects their performance or training, yet fewer than half had ever discussed it with a coach. Among adolescent girls, one in two skip sport entirely to avoid period embarrassment, contributing to dropout rates twice those of boys. Fear of leakage is widespread. Around three‑quarters of athletes worry about it during competition, and seven in ten teenage girls avoid activity because of pain, stigma or anxiety.
For Dr Lamia, these numbers are not abstract. They show up in her clinic as runners who dread a race-day bleed, footballers who quietly sit out of training, and recreational exercisers who abandon new routines because they are never taught how to work with their cycles rather than against them. At the same time, she stresses that there is no single way to ‘have’ a period in sport. That nuance matters. Some athletes feel strongest at particular phases; others notice dips in endurance or motivation. High performance is possible across the cycle – Paula Radcliffe’s marathon world record in 2002, run through intense period pain, remains an iconic example – but the fact that world records can be set on any day does not erase the reality that symptoms like fatigue, poor sleep and anxiety can erode performance when left unrecognised and unsupported. The challenge is not to decide whether periods ‘help’ or ‘hurt,’ but to accept that they are a constant presence in women’s sport and equip athletes with the knowledge and care to navigate them.
Elite athletes sometimes use hormonal interventions, such as the contraceptive pill, to manage the timing of their periods. But experience shows it isn’t always straightforward. Radcliffe has spoken about the risks of using norethisterone to delay menstruation, recalling how Jessica Judd was given the drug before the 2013 World Championships, an intervention that worsened her performance rather than helped. Radcliffe explains, “It wasn’t the first time they’d given it to an athlete and it hadn’t helped… Too often in sport, doctors are men and they don’t understand.” Such cases highlight the need for individualized, evidence-based guidance, rather than a one-size-fits-all approach, and underline the ongoing gaps in knowledge around hormonal management for female athletes.
The Overlooked Danger: RED-S and Injury Risk
For Dr Lamia, one issue looms larger than any other when it comes to menstrual health: RED-S, Relative Energy Deficiency in Sport. “Currently the most overlooked gynaecological issue I see is the impact of low energy availability or RED‑S on female athletes,” she says. When the body is under‑fuelled, performance inevitably drops, but the consequences extend far beyond fatigue. “Not only does it effect fueling and performance,” she explains, “but not having a period due to RED‑S can have long term effects on bone density, fertility and even future pregnancy outcomes.”
Stigma and misinformation around periods often distort how athletes interpret these warning signs. More than a third of female athletes ignore a missed period, treating amenorrhoea as a normal – even desirable – side effect of training hard. In Dr Lamia’s clinic, it is the opposite: a red flag. If menstrual bleeding stops because of low energy availability, it is a signal that the body is no longer getting what it needs to sustain health, let alone adapt to training. Left unaddressed, this hormonal disruption increases vulnerability to bone stress injuries, disordered eating, irritability and gastrointestinal issues, making RED‑S one of the most pervasive yet preventable threats to women’s long‑term health and performance.
Growing evidence is also helping to connect menstrual physiology with specific injury patterns. As Dr Lamia points out, “there is emerging data around the effects of the menstrual cycle hormones and injury risk,” with FIFA and others commissioning studies on ACL injuries across the cycle. Oestrogen can increase ligament elasticity, which may partly explain why ACL ruptures occur an estimated three to eight times more often in female athletes than in males, depending on the sport. Athletes themselves often sense patterns before the evidence catches up. “From experience, athletes do notice more injuries during certain stages of their cycle as well as strength changes,” she says, even if the science is still being mapped out.
Together, these findings echo what clinicians like Dr Lamia have observed for years. However, awareness and open conversations remain limited. A striking insight from the BBC Women’s Sport Survey reveals that only 40% of athletes feel comfortable discussing their periods with staff. Many athletes believe coaches “only know about bleeding and cramps,” leaving them uncertain about where to seek effective guidance. Such gaps not only disrupt performance but also have a profound impact on mental health, reinforcing shame and anxiety around a natural part of women’s physiology.
“This is actually improving,” says Dr Lamia, reflecting on growing awareness and coach education.“Thankfully coaches are being trained in women’s health issues (at least in professional football) but other sports and their governing bodies are just starting to see the importance of this.” She stresses that training coaches and performance staff alongside athletes “means athletes feel more comfortable bringing up these issues, and performance coaches and medical teams feel comfortable asking the questions.”
Yet, Dr Lamia warns that knowledge and conversations are only the beginning. “Once issues are identified,” she says, “there’s still a gap in how specific, performance-informed gynaecological care is delivered. That’s one of the areas where I focus my work.” Without closing this gap through better support systems and investment, the progress in visibility and dialogue risks stalling, leaving many athletes without the personalised care they need to thrive.
For her, that gap ultimately comes down to resources. “Honestly, the one umbrella issue which stops us being able to provide all of the above is a lack of funding,” she says. “If we had proper funding channels in women’s sports then we’d be able to address athlete education, coach education, kit reform etc. The will to do all these things is now there… The thing stopping us from driving meaningful change is a lack of funding and resources.” That conviction extends beyond elite arenas. “You don’t need to be an athlete to make use of a sports gynaecologist,” Lamia adds. She frequently works with “regular women who want to be more active whether that’s through pregnancy and postpartum safely, or if they’re embarking on a fitness journey but their gynaecological issues are holding them back.”
Athletes, organisations, and anyone interested can reach Dr Lamia Zafrani at DrLamiaZafrani@gmail.com or visit www.DrLamiaZafrani.com.
Listen to Dr. Lamia’s podcast episode with Wempower here.
Campaigns, Visibility and Cultural Shift
Change is happening, led by athletes and campaigns determined to make periods visible in sport. High-profile competitors like New Zealand golfer Lydia Ko and Chinese swimmer Fu Yuanhui have broken taboos by openly discussing menstrual cramps, bleeding and hormonal fluctuations during global broadcasts. Ko’s candid remark, “It’s that time of the month,” became a viral symbol of this shift, while Fu Yuanhui’s openness at the Olympics sparked broader discussions about women’s bodies and performance.
Campaigns such as Knix’s Sport Your Period have amplified this momentum, encouraging athletes, including Olympians Brandie Wilkerson, Meghan Rapinoe and Ilona Maher, to speak candidly about menstruation and wear a small red dot in competition as a symbol of visibility and solidarity. Wilkerson captures the stakes, “no one should stop doing the sports they love because they are afraid their period might be seen.”
Yet visibility is only the start. Structural change is urgently needed. Easy access to menstrual products, improved toilet facilities, comprehensive menstrual health education for athletes and coaches, and revising uniform policies are critical steps toward true gender equity. Advocates stress extending these efforts beyond elite athletes to all adolescent girls, helping them feel informed, supported and confident. Breaking the stigma must be paired with systemic reforms that keep girls and women in sport for life.
Uniform, Inclusion and Athlete Agency
Women’s sports kits have largely ignored one obvious fact: periods happen. The fear of leaks and discomfort on the field is very real and it has left many athletes feeling anxious during competition. England footballer Beth Mead’s blunt declaration, “White is not practical when it’s the time of the month,” catalyzed change. Responding to athlete feedback, the England Lionesses ditched traditional white shorts for navy in 2023, following in the footsteps of teams like Manchester City, West Brom, Orlando Pride, and Ireland’s women’s rugby squad. Even Wimbledon evolved a 146-year-old tradition by allowing dark undershorts, offering players much-needed comfort and confidence.
Leakage anxiety is far from trivial, it affects confidence and participation, particularly among teenage girls, contributing to dropout rates that already outpace boys’. At the Tokyo 2020 Olympics, Germany’s women gymnasts made a powerful protest by wearing full-length unitards against the sexualization of female athletes, challenging the expectation that women must expose their bodies while men remain covered.
These developments underscore the imperative for inclusive policies that empower athletes to choose clothing based on comfort, performance needs and cultural considerations. More than participation, such choices honor diversity, supporting athletes of colour and respecting cultural sensitivities, while signaling to young girls that sport prioritizes their wellbeing. Recruiting more women into leadership positions is crucial to ensure decision-making reflects those most affected. For broadcasters and marketers, the lesson is clear, just as athletes deserve agency over their uniforms, audiences deserve sports that celebrate performance without objectification.
Beyond uniforms, creating a sporting world that truly works for women means tackling menstrual health, breaking stigma, and building structural support at every level. Coaches need better education to understand how the cycle impacts performance, while athletes must feel empowered to manage their health openly. Policies such as flexible schedules, allowances for menstruation-related absences, inclusive uniforms, privacy in changing rooms and access to period products help create safe, supportive environments. Facilities should be clean, accessible and equipped with hygiene provisions, and sportswear innovations (from Nike to Modibodi) can provide practical performance support.
Representation matters too. More women in coaching, leadership, and management ensures policies reflect the lived experience of athletes. As Dr Lamia Zafrani notes, “We look at gynaecological issues from a wider, holistic lens, considering nutrition, training, lifestyle, to develop individualised plans that respect each woman’s journey.” Open conversations, from Olympians to teenagers, help break stigma, while structural reform safeguards health, prevents injury, and sustains participation. When menstrual health is treated as central, not peripheral, sport finally works for women – at every level, on every field and in every game.
This conversation is part of Wempower’s new series Level the Playing Field, dedicated entirely to women in sport. Each Monday, we publish a new story highlighting the women reshaping the world of sport — on and off the field. To read more inspiring stories of everyday women making a real difference in the world, be sure to check out the latest edition of Wempower magazine, or listen to our podcast.
