Menstrual Health, Performance and Load Management: The Missing Piece in Female Athlete Care

Women's sport is growing rapidly, but the science supporting female athlete health is still lagging behind.

One of the most important messages emerging from the AFL Barwon and Epworth Geelong Female Festival of Sport Seminar held on 7 July 2026, is that the menstrual cycle is not simply a reproductive function; it is a vital sign.

The menstrual cycle provides valuable insight into an athlete’s overall wellbeing, energy availability and hormonal balance. When cycles become irregular, absent, unusually painful or excessively heavy, it is indicative that overall function is sub-optimal. Menstrual health should be considered a key component of athlete monitoring, and most importantly, overall health.

"Your menstrual cycle is a vital sign. When it changes, pay attention." - Dr. Alex Bonner, Gynaecologist OGB Surfcoast.

Understanding the Performance Connection

The menstrual cycle and hormonal fluctuations affect energy levels, mood, sleep quality, muscle repair, recovery and pain perception.

During the first half of the cycle, many athletes report feeling stronger, more resilient and recovering more effectively. Following ovulation (the middle of the cycle) body temperature may rise, perceived exertion can feel greater and sleep quality may be impacted. Some athletes continue to perform strongly, while others notice considerable changes in their training capacity.

The key takeaway is there is no universal experience. Social media, apps and wearables may suggest how an athlete should feel during different phases of the cycle, yet in reality, individual variability is significant. This is why tracking symptoms, energy levels, recovery and performance alongside the menstrual cycle in its entirety, can be an excellent performance tool.

Injury Risk and the Female Athlete

Discussion surrounding female athlete injury risk often centres on anterior cruciate ligament (ACL) injuries, which occur at significantly higher rates in women than their male counterparts.

The relationship and understating of the role that hormones play in ACL injury is complex, and one that is continuing to be researched globally; with current evidence identifying that hormones are not a sole cause of increased ACL injuries. Rather, hormonal influences are likely one contributing factor amongst a broader mix of biomechanical, anatomical, environmental and training-related factors.

Effective prevention strategies include strength training, neuromuscular conditioning, movement education and appropriate load management, measures that benefit all athletes.

“Understanding women in sport can help us minimise risk and optimize performance.” - Dr. Rekha Ganeshalingam, Orthopaedic Surgeon, Epworth Geelong

Why Load Management Matters

Load management refers to balancing training, competition and recovery to maximise adaptation while minimising injury risk.

For female athletes, load management cannot be separated from health. Painful periods, heavy bleeding, endometriosis, hormonal disorders and inadequate energy (nutritional) intake can all influence an athlete’s ability to train consistently and recover effectively.

Individualised programming does not necessarily require complicated systems. Sometimes it is a simple question: “How are you tracking this week?” Creating environments where athletes feel comfortable discussing symptoms allowing informed decisions around training volumes, recovery strategies and support.

"Menstrual cycle awareness is performance awareness." - Dr. Alex Bonner, Gynaecologist OGB Surfcoast. 

Recognising REDS

An important health consideration in female athletes is Relative Energy Deficiency in Sport (REDS).

REDS is a systemic response to the body receiving insufficient (nutritional) energy to meet basic physiological functions plus athletic demand. An early warning sign can be changes to the menstrual cycle, hence the importance of tracking and viewing the cycle as a report card of health.

REDS is driven by low energy availability and subsequently can disrupt several bodily functions including, but not limited to menstruation and bone health. Left unaddressed, REDS can increase injury risk, impair performance and have lasting consequences on long term health.

The important message for athletes, coaches and parents is that menstrual changes should never be dismissed as a normal consequence of training hard. This is the body sending distress signals.

"Know your body. Know your edge. Know your menstrual cycle. Track it. Learn it. Use it." - Dr. Alex Bonner, Gynaecologist OGB Surfcoast. 

Creating a Better Sporting Culture

Many athletes still feel uncomfortable discussing menstrual health, particularly in environments led by male coaches or support staff. Open conversations and upskilling all involved in athlete care are essential if we want women and girls to participate in sport safely and confidently.

Creating a healthier sporting culture starts with education. It means normalising discussions about menstrual health, encouraging cycle tracking, recognising symptoms early and valuing health as highly as performance. It means helping athletes understand that painful periods may be common, but they are not necessarily normal, and that seeking help is a sign of strength, not weakness.

The opportunity is clear: when sport begins to treat menstrual health as a legitimate performance variable rather than a topic to avoid, everyone benefits.

Learning to listen (to your body) may be one of the most powerful performance strategies available.

“Supportive, healthy and successful sports environments aren't in the dark about women's health." - Emily Brown, Physiotherapist Corio Bay Health Group.

Further reading and resources:

AIS Female Performance Health Initiative Education Modules

Low Energy Availability - Are you eating enough?

Relative Energy Deficiency in Sport (REDS)