Are female athletes getting the advice which suits them? Dr Emma Ross, Baz Moffat and Dr Bella Smith of The Well HQ believe not – and insist it’s time to think differently

As women pursue peak performance, we have to think differently about what it takes to allow them to fulfil their potential, because what works for women won’t always be the same things which have worked for men.

Currently, female athletes usually train and are coached in a way which doesn’t always consider the ‘female’ part of being a female athlete. The support that is applied to their performance – nutrition, physiology, psychology, etc – tends to be based on research which has been done on men, or what has been seen to be successful with male athletes.

But women are very different from men. Women have periods and menstrual cycles, they may use hormonal contraception, they have breasts, they are far more likely to have pelvic floor dysfunction, they have a much higher risk of injury, they manage emotions and derive confidence differently from men.

We believe we need to get better at looking at fitness and performance with a female filter, considering the female-specific factors so that active women can truly get the best out of themselves, whatever their ambitions are in sport.

We want to start an education and a conversation about what we believe are the non-negotiables when it comes to girls and women getting the best out of themselves.

Mastering your menstrual cycle

In 2017 Bobby Clay shared her story in AW. At 15 years old she was a GB middle-distance runner but by 20 she had osteoporosis. Bobby never started her periods, which by 16 would be a cause for further investigation in anyone, but particularly elite athletes.

The menstrual cycle and having periods is a vital sign of health. It is the body’s way of saying that it is coping – with training, with stress, with life. If your body isn’t coping – for example you aren’t getting enough well-timed nutrients to fuel your training – the system that will shut down first (because it’s not needed to keep you alive) is your reproductive system. And so out goes your menstrual cycle.

By removing the menstrual cycle, however, you also remove all of the amazing influences the menstrual cycle hormones have in your body for your short and long-term health. Oestrogen is amazing for building bone strength as you develop in your teens and twenties.   Without it (your oestrogen disappears when you lose your cycle), you don’t build bone strength and you become very susceptible to stress fractures.

Bobby Clay (Mark Shearman)

Clay spent a whole year with only four weeks fracture-free. We see girls and women losing their periods because of sport, and normalising it. It isn’t normal and needs to be addressed.

But here’s the good news about the cycle. Those same hormones aren’t just amazing for bone health – at times of the cycle when oestrogen is high it makes the female body so good at repairing and building muscle that doing more strength training in the first half of the cycle has been shown to improve strength gains by 15% more than training sessions which are regularly spaced across the cycle.

The cycle has so many powers that we can capitalise on as athletes if we tune in and understand it!

Better known are the more challenging symptoms we can experience across our cycle, mostly in the premenstrual phase and during our period. Pain, fatigue, digestive issues, and emotional fragility. A total of 88 per cent of active women say their menstrual cycle impacts their training and performance, yet 80 per cent of athletes say they can’t talk to their coaches about it.

We have to open up the conversation because we’ve seen the power of cycle tracking in improving an athlete’s ability to predict her symptoms and do something about them (there’s so much that can be done by the way), and that sharing how your cycle impacts training can help your coach or medical team support you better.

Happy on hormonal contraception? 

Whilst we talk about the importance of understanding and considering the menstrual cycle, we also know that up to 50 per cent of active women take hormonal contraception (the figures decrease with advancing age).

Some athletes thrive on hormonal contraceptives but conversation we are not having enough of is that, as well as having many benefits, the pill can have an impact on physical and mental health.

It can increase biological markers of chronic stress and it can increase the likelihood of developing depression. In athletes it can decrease VO2 max  by around 11 per cent and, in a study of Australian athletes, 38 per cent of those using the pill experienced side effects such as low mood, anxiety and weight gain.

Using hormonal contraception is a very individual choice. The important thing, as with taking any medication, is to look out for it impacting you in negative ways, and if you notice that, you can do something about it, like go back to your GP and revisit your options – of which there are plenty.

It’s also important to be aware that when you are using hormonal contraception, you are suppressing your natural cycle, and any bleeding you have is called a withdrawal bleed (in response to the synthetic hormones) rather than a period.

As such, bleeding when you are using contraceptives cannot be used as that vital sign of health we’ve mentioned, and you have to be extra diligent about fuelling, rest and recovery to ensure your body is coping with your sport.

Battling to find the best bra 

The chances are that if you are a woman reading this, you aren’t in a sports bra that fits brilliantly. There’s even a chance that you are not in the right type of sports bra at all or that you don’t even wear a proper sports undergarment.

Yet a well-fitting sports bra can impact your performance by as much as 4 per cent, because even a small amount of breast movement during running can shorten your stride length, increase the energy cost of movement and affect breathing mechanics.

Still, 80 per cent of women are not in the right fitting bra, and 40 per cent of athletes are in the wrong design of sports bra for their breast size and sporting movement.

All of this data led Emma to work with the Breast Health research Group at the University of Portsmouth on a pioneering project which meant that every female athlete going to Tokyo would be fitted in a bespoke bra.

Up until 2017 a generic sports bra had been popped in the Olympic kit bag, completely ignoring the performance gains that could be made by getting everyone in a great bra, that fitted them perfectly.  So, if you do nothing else after reading this – get yourself a sports bra that fits you well. The big brands have good fitting guides on their website.

Perfecting your pelvic floor 

Pelvic Floor dysfunction (be it wetting yourself, having irresistible urges to empty your bladder or bowels, or just not feeling right) has been normalised in many sports. There is now compelling data to show that more athletes are wetting themselves than compared to the normal population, and the higher the impact the sport is, the more likely this is to happen.

This may well seem like a normal part of sport, but it’s a sign of dysfunction and is not okay at all.

Our pelvic floor is supposed to keep us dry and if it’s not doing that then that something is not quite right and needs to be addressed.

There are so many amazing products and services out there now and doing your pelvic floor exercises (properly!) every day is the first place to start. Find good advice on how to do them, as we see so many women who have been doing them wrong for years! Connecting with a good women’s health physio (look at the NHS Squeezy App for a UK Directory) who can help keep your pelvic floor healthy is an absolute non-negotiable for all active women.  If you are a Mum or Menopausal too, this work is doubly important!

Tailoring your training to female physiology 

As mentioned, best practise on how to train for endurance, strength and power is often based on principles designed for men, which doesn’t take into account that women’s bodies work and adapt differently.

That means that, given the same training programme, there will be very different adaptations in women compared to men.

For example, we know that women gain strength differently. Women improve their strength more through neuromuscular adaptation than by building muscle. This matters, because it means that S&C programmes for women need to be really functional and specific to their sport – you can’t just get muscles stronger is isolation. Women’s muscles are also more fatigue resistant than men’s, meaning that during submaximal resistance work they don’t tire as quickly.

This means that women need to be extra diligent about doing training that causes enough stress to the muscle, so it adapts to training and gets stronger and more powerful. Don’t just follow the same reps and sets pattern that your male running partners are using!

» The Well is a digital hub and a collective movement to educate and empower active women and those that support them so that women can be healthy and optimise their training and performance. The Well was founded by Dr. Emma Ross, sports physiologist with 10 years of experience of working with Olympians and Paralympians at the English Institute of Sport, Baz Moffat, a retired GB rower and women’s health coach, plus NHS GP Dr Bella Smith. Go to TheWell-HQ.com for webinars, blogs and online courses