The menstrual cycle is being ignored in rugby, but not at the WRU

The area of female health and the awareness of the impact it has on athletes and their performance continues to grow. Research is building, conversations which would have previously been had in hushed tones are now being facilitated in public forums such as podcasts and on social media, and there is a growing acceptance that the menstrual cycle in particular needs attention in the sporting environment, especially an elite one.

However, despite things appearing to be heading in the right direction, why are women’s elite teams, in rugby at least, not picking up the menstrual cycle baton and running with it? Why aren’t more teams catering to the unique needs of women?

In rugby, there appears to still be a question mark over what impact delving into the world of the menstrual cycle and the various symptoms and solutions will actually make. In my opinion, it appears to be a lazy or half-hearted approach given these teams are world leading ones for club and country, and as they say, 1% at the top of the game can make all the difference.

Take the elite competition Premiership Women’s Rugby, the highest domestic level you can play in England, played in a country with one of the deepest player pools and most established history in the women’s game, an alarming number of clubs haven’t given the menstrual cycle and the often debilitating symptoms associated, and the knock on effect on training and performance, much of a thought. When results can depend on fine margins, that seems strange right?

On the international scene it isn’t much better. When reaching out to England Rugby during the 2021 Rugby World Cup (played in 2022) around menstrual cycle support the players in the number one ranked team in the world receive, the reply I received was there wasn’t a formalised process in place, and therefore the medical team refused to be interviewed on the topic for an article.

It appears to be the case that the Red Roses at the World Cup were putting their symptoms into an app called PDMS, but according to former England prop Shaunagh Brown who raised concerns at a recent parliamentary hearing, many players had become disillusioned with doing it because nothing was happening off the back of it, no feedback was being provided and the male coaches were attending all other rugby meetings but weren’t present at meetings concerning menstrual health. Perhaps they felt it didn’t concern them? Worrying.

With other top countries, such as world number four ranked Canada, in reply to an invitation to contribute to this article, the response was that discussing how and if people are tracking their menstrual cycle can be a sensitive topic, in part due to the political landscape, and many women are uncomfortable disclosing personal health information.

The response from Scotland was that players are curently offered one on one appointments with a member of the medical team to discuss their menstrual cycle and any symptoms they may be having, and similar to England’s reponse, both unions said that plans are being put in place by medical teams to improve and bolster menstrual cycle support and resources for players around training and performance. Current world champions New Zealand are yet to respond to a request to comment.

However, in direct contrast, it does appear one country are sticking their head above the parapet and making a substantial effort when it comes to the day-to-day implementation of female health strategies and the menstrual cycle.

Step up Wales, with players speaking extremely highly of one woman in particular on the WRU medical team, who is driving the standard and setting the example; Jo Perkins.

Perkins is the Senior Physiotherapist for the Wales Women’s squad and with the help of Vodafone who have produced a tracking and monitoring app for recording and sharing symptoms and phases throughout the menstrual cycle, has helped create a culture of openness and frank communication when it comes to this stigmatised topic.

Perkins explains how the Vodafone app works and what the medical staff look for when monitoring player’s symptoms and cycles.

“First and foremost, we look to see if players are actually having a monthly bleed unless that’s influenced by them using a contraceptive or pregnancy. Periods can be a really useful sign of health at a broader level, so if a player is starting to not have a period, that is a huge warning side for us.

“This can be a sign that there’s been a compromise in their nutritional intake or how much they’re training or stress levels or travel, it’s a really helpful sign that the body might be overloaded at that time for whatever reason.

“If periods are absent for more than three months we need to intervene and have a look at the reasons why that might be. We ask, has training volume gone up? It might be an unconscious lack of energy availability, they might be eating the same but they’re expelling more energy in training, so trying to add in specific post-training food and starting there and seeing if periods return.

“If periods remain absent this can lead to a condition called Relative Energy Deficiency in Sport (REDS) which is a condition which affects so many different systems in the body and can lead to problems with bone density and stress fractures, and can lead to underperforming.

“The app is very user friendly in that it allows us to see those symptoms in real time. If a player is experiencing pain, vomiting, fatigue, heavy periods, these can be logged, so it allows us to see how well the player is and how ready they are to train and live their daily lives. If needed we can put in interventions or resiliency strategies to support them and they can start to find a picture each month of common symptoms for them.

“Secondly a period should be manageable each month, there is a real misconception that it’s ok to be lying in bed for days and be vomiting or have debilitating headaches or anxiety and depression, that’s simply not ok. Periods should be mild and manageable if it’s a healthy cycle.

“Symptoms might be experienced at any point of the menstrual cycle not just during their bleed. Some women suffer with ovulation pain mid-cycle or severe constipation, anxiety and depression in the pre-menstrual phase, so it allows us to look at patterns and intervene and educate to give the player support.”

Perkins agrees that not addressing menstrual cycle symptoms and having women suffer in silence or treated like small men, which has been the case for so long, is simply not an option anymore.

“A recent study of players not on a contraceptive showed that 67% of them felt their menstrual cycle or period in particular influenced their ability to train. It’s such a huge number who felt their ability to train at their best was affected by their cycle.

“For so long, female athletes in general haven’t had the support they deserve. At Wales we realise it’s so important we talk about these topics and everyone is involved in the processes. The players don’t hold back when discussing issues with the coaches, we have posters up on the walls talking about strategies and the coaches know the strategies and chat about it with the girls.”

As Perkins reiterates, creating a culture of openness and sharing is so important to find the right solutions to improve the individual symptoms of a player, it may be uncomfortable at first to speak to a male coach about certain topics, but this is the reality of being a female athlete, and society and the culture of elite sporting environments must catch up.

“We have created a culture now where players are happy for us to speak to the coaches and divulge the information (inputted into the app), and the app allows the coaches to see symptoms that the players are presenting with and we are and should be treating that as if the player is saying their hamstring is tight.

“If a player needs to be modified it would be seen like any other sports medicine complaint. It shouldn’t be something we talk about in private or is dismissed. I’m very lucky to be working with a really forward-thinking management team.

One area which has received attention of late is ACL injuries in female players in rugby and women’s football.

But despite the fact we know female are much more likely to suffer from this career threatening injury, the body of research behind it is not yet rigorous enough to implement intervention and prevention strategies, as Perkins confirms.

“There is certainly a variety of research on injuries and the menstrual cycle being done, but the reality is there just isn’t enough at the moment to make definite correlations. We just don’t know enough yet.

“An injury like an ACL is multifactorial, there’s not just one reason why these are happening, that’s important to state. They are individual and unfortunately females are up to eight times more at risk than their male counterparts, we need to keep pushing the research in all areas of female health.

“Ideally, we need to keep pushing and the more information and education we can get out there the better, but this needs to come from the governing bodies. Women in the media and elite athletes are talking about it more and it’s becoming more normal. There is also a growing body of female health researchers who are so passionate. I have every confidence that they’ll be more and more research coming out over the coming years.”

When it comes to the menstrual cycle, as Perkins states, having a period is a vital and useful sign of health for female athletes. It is time unions and clubs took more responsibility around topics of female health and didn’t treat it as a nice to have or a side project.

When it comes to a team of women, female health needs to be front and centre, with the onus on elite teams to lead by example.