When Dina Asher-Smith and Daryll Neita made it to the 100m final of the European Championships, it should have been a show of British dominance. Asher-Smith pulled up and Neita wasn't quick enough for the gold because of her stomach pains. Asher- Smith shared her frustration at the impact of her period on her sport. She said it would have been fixed by now if it were a men's issue.
It is a feeling shared by many other people. Many female players have an event that can cause significant distress and impact heavily on their performance once a month for up to five days. Athletes need a better understanding of the symptoms that can show up.
Fluctuating hormones can be the difference between winning a medal and going home empty-handed
It's being heard more and more. The coach of the US women's football team partly attributes their World Cup win to the way sports science companies help athletes work proactive with their cycles. Several European countries have begun projects to prepare their athletes for the Olympics in Paris.
What can anyone do to help athletes with their periods? In a field full of unknowns, some researchers believe that understanding the menstrual cycle will free athletes from symptoms and allow them to new heights.
The menstrual cycle is not just a fleeting annoyance for F or an athlete with bad period symptoms. It can be the difference between winning a medal and going home empty-handed, as the Chinese swimmer discovered at the Rio Olympics when she failed to make the podium.
It is no surprise that the demand for solutions to period problems in sport has increased because of the high stakes and the fact that women's participation in elite sport has soared.
It is true that research is lacking, but it is also true that it is happening. It has been said for a long time by my international colleagues who study women's health and female athletes. Only 39% of sports science studies participants are women.
There is research but often it is not high-quality. This has resulted in only patchy evidence taking off, such as training or eating according to a prediction of what phase the athlete is in. "There isn't research evidence to support that."
bulletproof evidence is not as important in elite sport as it is in academics. Athletes want to find what works for them, not necessarily what produces a statistically significant result, according to a researcher at a university.
She says that it is great if they feel that their performance is better. There is a long history of doing things that are not scientifically proven. She says that ice baths are controversial but that many athletes use them because they make their legs feel better.
Anti-Inflammatory food is one of the most popular interventions. During the menstrual cycle, inflammation in the body increases at different points, and since some studies have linked such inflammation to unwanted symptoms, the logic goes that athletes can counter their symptoms by consuming foods thought to reduce inflammation.
Orreco supports this idea. Esther Goldsmith, one of Orreco's sports and exercise physiologists, said that the company uses the data from its athlete clients to advise on nutrition.
The players from the England women's football team have benefited from this approach. She says that one of their players was hurting. The sink was thrown at her. The player's symptoms were gone six months after she changed her diet and lifestyle.
The evidence is sometimes conflicting. While there is some evidence that ginger can reduce period pain, there are few, small and often imperfect studies on the subject. She says, "We can't just sit back and say, 'No sorry, we can't intervene because the research isn't there.'"
Some people prefer to use hormonal birth control to deal with their periods. If you skip the break on the pill, the monthly bleeding won't be an actual period because the pill blocks ovulation. Athletes on birth control won't have periods.
That can be a problem. In her upcoming book, Hormones, Health and Human Potential, she details how hormonal contraception can mask the sudden loss of periods, a strong indication of the condition known as Red-S.
Balance is easy to get wrong as an athlete. She developed Red-S when she got a sport scholarship to the US and was eager to progress. She says that she increased her training load and began to experience more and more pressures on her body.
The quicker run times were due to this. Most of the time, she felt unwell and tired. It was hard to function as a human being and an athlete. She didn't know that she had stopped getting her period because she was on the pill.
There could be a perfect hormone level for breaking world records
Long-term bone health can be affected by Red-S. Oestrogen is important for maintaining bones when the body has an energy deficit. If athletes get Red-S when they should be building bone density, they will be at a higher risk of stress fracture, low bone density and osteoporosis.
Boys and men are the same. As testosterone is converted to oestrogen in the body, their bone health may suffer. Red-S symptoms can be too intimate to discuss openly. One of the signs of Red-S in a male athlete is that they don't have morning erections. We need to normalise it and not sexualise it.
When Woolven got in touch with Keay, she was able to get back on her feet. She started Project Red-S to spread awareness. She says that understanding periods are markers of health that athletes should look out for is important. It is like a concussion in rugby. She says athletes don't know the full extent of their health risks.
Some people think that the menstrual cycle could be more than a marker. France's National Institute of Sport, Expertise, and Performance is interested in the possibility that working in sync with the menstrual cycle could lead to gains in performance and more medals.
"We are approaching human limits of performance," says Juliana Antero, who is heading up the Insep project Empoweher. In 2015, she was involved in a study that looked at 3,263 world records and found a decrease in both the degree of improvement and the number of records.
There were occasional step changes, such as the 2008 to 2009 introduction of polyurethane swimsuits, and Antero believes that understanding the menstrual cycle could provide anotherbump. There is a chance of breaking world records.
As new hormone-testing technology becomes available, athletes may be able to better understand their hormones and their performance. The English Institute of Sport is trialling hormone saliva tests in a bid to provide track-side results in minutes, for symptom treatment and for performance gains.
The idea is intriguing but not convincing. Tracking and managing symptoms will help some sportswomen. She might have had a chance at gold if she could have avoided her calf pain. She thinks the potential gains will be marginal for athletes who are not very affected. I don't believe it will change the face of women's sport.
She says we have to remember that a lot of sportswomen don't cycle. I would scream from the rooftop if I were an elite sportswoman who was underachieving because of my cycle. Will it change a whole team, a whole squad, a nation, all sports women? It's probably not.
She believes that the effects of the menstrual cycle on performance will change in the near future. Trials struggle to pick up anything because the hormones are not consistent for each participant. We could untangle how the individual's cycle affects them if we tracked it. I think we can improve female-athletes performance.
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