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An estimated 75% to 85% experience Premenstrual Syndrome (PMS) symptoms at some point during their reproductive years (1). While PMS is often associated with emotional and physical discomfort, its impact on athletic performance (2) is a concern for female athletes. This blog post aims to shed light on PMS and its potential impact on athletic performance, along with effective strategies to help female athletes manage PMS symptoms, allowing women to maintain peak performance throughout their menstrual cycle.

What is PMS?

Premenstrual Syndrome is a cyclic, recurrent condition that typically occurs in the luteal phase of the menstrual cycle, usually one to two weeks before menstruation begins. The exact cause of PMS remains elusive, but hormonal fluctuations, particularly changes in estrogen and progesterone levels, are believed to play a significant role (3). The most common symptoms include mood swings, irritability, bloating, breast tenderness, fatigue, and changes in appetite but there are a wide range of physical and emotional symptoms that women suffer from such as:

The Impact of PMS on Athletic Performance

For many women, managing PMS becomes more challenging when it intersects with their commitment to athletic pursuits. Hormonal fluctuations during the menstrual cycle can affect energy levels, endurance, strength, and recovery. Understanding and addressing these challenges can empower women to optimize their training and performance, irrespective of their menstrual cycle phase.

How to Manage PMS Symptoms

Lifestyle Changes

In some cases, making lifestyle changes can succeed in relieving PMS symptoms. Lifestyle changes that can help you manage PMS symptoms include:

1. Getting Regular Exercise / As well as improving overall fitness and health, engaging in regular physical activity has been shown to alleviate PMS symptoms (4, 5). Both aerobic exercises, such as running or swimming, and strength training can contribute to relieving PMS symptoms by releasing endorphins which improve your mood and affect pain perception. A minimum of half an hour of exercise a day is recommended to reduce symptoms of depression, anxiety, fatigue, and fluid retention.
2. Having a Balanced Diet / Adopting a well-balanced diet that includes whole grains, fruits, vegetables, and lean proteins can help regulate blood sugar levels and minimize mood swings and cravings associated with PMS (6). Including calcium-rich foods like dairy and leafy greens is recommended, as well as avoiding alcohol and caffeine.
3. Managing Stress / Stress can exacerbate PMS symptoms so avoiding and managing stress during this time can help with the overall management of your PMS symptoms. Practices like mindfulness, yoga, and deep breathing exercises can help manage stress levels and promote overall well-being (7).
4. Getting Adequate Sleep / Prioritizing quality sleep is crucial to manage PMS symptoms, in particular, a lack of quality sleep is linked with depression and anxiety and can make mood swings worse (8). Establishing a consistent sleep routine by creating a comfortable sleep environment and getting a minimum of 7-8 hours of sleep per night can contribute to better overall health (9).
5. Recording your symptoms / Each individual is different and experiences PMS symptoms differently. Recording your symptoms will help you to identify the timing and triggers of your PMS symptoms which will allow you to plan and implement strategies to manage them.
6. Not smoking / One study (10) showed that women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke.
7. Supplements / Certain supplements, such as calcium, magnesium, vitamin E, and vitamin B6, have demonstrated effectiveness in reducing PMS symptoms (11). Consultation with a healthcare professional is advised before incorporating supplements into your routine.

Medication

Over-the-counter painkillers may help lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness. Depending on the severity of your symptoms, however, your doctor may prescribe medications to treat your symptoms. Commonly prescribed medications include:

• Hormonal Contraceptives / Can help to manage PMS symptoms (8).
• Diuretics / May be used to help reduce symptoms of bloating and breast tenderness.
• Antidepressants / May be used to help relieve emotional symptoms of PMS for some women when other medicines don’t help.

All medications have associated risks. Talk to your doctor about the benefits and risks associated with each before considering treatment.

Conclusion

By understanding PMS and its potential impact on athletic performance, women can take proactive steps to manage PMS symptoms and mitigate their effects. Through a combination of lifestyle adjustments, including regular exercise, a balanced diet, stress management, sufficient sleep, and others, it will be possible for some women to manage PMS symptoms. Helping them to optimize their physical and mental well-being throughout their menstrual cycle and lessen its impact on athletic performance.

References

1. Halbreich U. (2003). The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology, 28 Suppl 3, 55–99.
2. Prado, R. C. R., Willett, H. N., Takito, M. Y., & Hackney, A. C. (2022). Impact of Premenstrual Syndrome Symptoms on Sport Routines in Nonelite Athlete Participants of Summer Olympic Sports. International journal of sports physiology and performance, 18(2), 142–147. https://doi.org/10.1123/ijspp.2022-0218.
3. Rapkin, A. J., & Winer, S. A. (2009). Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Review of Pharmacoeconomics & Outcomes Research, 9(2), 157–170.
4. Bertone-Johnson ER, Hankinson SE, Johnson SR, Manson JE. (2009). Timing of alcohol use and the incidence of premenstrual syndrome and probable premenstrual dysphoric disorder. Journal of Women’s Health, 18(12), 1945–1953.
5. El-Lithy, A., El-Mazny, A., Sabbour, A., El-Deeb, A. (2014). Effect of aerobic exercise on premenstrual symptoms, haemotological and hormonal parameters in young women. Journal of Obstetrics and Gynaecology; 3: 1–4.
6. Chocano-Bedoya, P. O., Manson, J. E., Hankinson, S. E., Willett, W. C., Johnson, S. R., & Chasan-Taber, L. (2011). Dietary B vitamin intake and incident premenstrual syndrome. The American Journal of Clinical Nutrition, 93(5), 1080–1086.
7. Jain, A., & Tyagi, A. (2011). The effect of yoga on menstrual disorders: A systematic review. Journal of Alternative and Complementary Medicine, 17(3), 207–212.
8. American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS)
9. Shechter, A., Varin, F., & Boivin, D. B. (2018). Circadian variation of sleep during the follicular and luteal phases of the menstrual cycle. Sleep, 41(10), zsy152.
10. Dennerstein, L., Lehert, P., Heinemann, K. (2011). Global epidemiological study of variation of premenstrual symptoms with age and sociodemographic factors. Menopause International; 17(3): 96–101.
11. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. (1998). Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. American Journal of Obstetrics and Gynecology, 179(2), 444–452.

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