In November and December 2019, I was one of just 50 lucky people in the world to take part in Dr Stacy Sims’ inaugural 7-week long online course titled ‘women are not mall men’. In this blog I try to share some of the key things I took away from the course. Keep reading if you want to get some pointers for how women can change up their training and nutrition throughout the menstrual cycle or optimise their performance as (peri)menopause kicks in.
Take-Away #1: Equal but Different
Without giving away too much of the course contents, one of the chapters in the course is called ‘Train like a woman’. Not only is this title perhaps more to the liking of some women who don’t like being referred to as ‘girls’ once they have reached a certain age, but it is also more technically correct. Up until puberty, boys and girls aren’t all that dissimilar really. But when puberty hits, and ‘boom’ the hormone floodgates properly open, everything changes and the dichotomy between the sexes gets bigger still…
Generally, (highly trained) women are unlikely to beat similarly sized (highly trained) men in strength, speed and indeed also in absolute physical endurance. Higher testosterone, taller height, broader shoulders, denser bones, longer forearms, narrower hips, larger muscles, larger lungs, larger heart, more red blood cells (and thus a higher VO2max), more lean body mass etc. can give men certain athletic advantages.
Yet, as long as women train smart and with their unique personal physiology (we got some advantages of our own too!), we stand a pretty good chance to be on par with the men, especially in ultra-distance races or other events where success lies not just in physical strength but other skills such as mental focus and concentration or the ability to pace and take care of ourselves play an important part too.
So, if we accept that women’s physiology is in many ways different, then why trust in training methods based on research carried out by and large on men?
Despite a decreasing gender gap in sports participation, women are still significantly underrepresented in sport science studies. A review carried out in 2014 of 1382 sport science studies involving over six million participants between 2011-2013 found that 39% of studies included both male and female participants. Dig a little deeper, and you’ll find that the number of studies involving exclusively female athletes and drawing explicit conclusions by gender was significantly smaller.
The usual excuse for the lack of research completed on women, is that women’s innate hormonal fluctuations make the research complicated and time-consuming. But just because it is more difficult, doesn’t mean it cannot or should not be done. Just like men, female athletes want to become fitter, faster and stronger ! It just requires a little more planning, supportive funding and less socio-cultural bias in the academic world.
In turn, coaches will need a much better understanding of female-specific issues and the many physiological and psychological differences not just between the sexes or indeed between women themselves, but also at different phases of the menstrual cycle and different points in life.
Take-Away #2: Period as Ergogenic Aid
Do you remember getting your first period and your parents going like “oh congratulations! You are a woman now” ? I frankly couldn’t see why I should be happy with blood in my pants every month, mood and body shape and composition changes, or unpleasant PMS symptoms. In all honesty it has taken me several decades to grasp the importance of that first period as a 40+ year prospect of hormonal flux. Embarrassingly, it wasn’t until I became aware of Dr Stacy Sims’ work that it fully sunk in with me that having your period is not just a monthly inconvenience but also a totally free barometer of healthy hormones gifted to us by mother nature and, this is the best bit, a fantastic ergogenic aid.
“What?!” I hear those of you think who just googled the meaning of ergogenic. “Your period as a bloody performance enhancer?!” Yup. Your parents were right after all when they congratulated you on becoming a woman when you had that first bleed. As Dr Stacy Sims urges in her book ROAR, stop worrying about having your period on race day. In fact, your hormones are favourable for performance once you have started bleeding. Some women go to great lengths to stop/avoid having their periods during key races. Instead, you/ your coach should try to schedule that FTP test, HIIT session or tough race exactly for when you are bleeding.
Why? Because (with the exception of perhaps the first day) throughout your period and the days that follow in this ‘low-hormone’ phase, you are more likely to make strength gains, have better endurance, recover faster and feel less pain. Your have more carbohydrate tolerance, your core body temperature is lower (and thus you may sleep better), your resting heart rate is lower, your heart rate variability is higher, your respiratory rate is lower etc etc.
Yet, this message (of your period being an ergogenic aid) is not being heard loudly enough yet. A 2015 study by Women in Sport found that 42% of active women in the UK believe that their menstrual cycle has a negative impact on training and performance. Whilst there certainly are times when it is harder to hit top end, contrary to what many people think, it is NOT actually during your period, but during the ‘high hormone’ phase that women are most likely to see a drop in performance.
Performance gains can be had if you and your coach can track your cycle and plan for the right session at the right time. Get your strength and speed sessions in during the low hormone phase when you feel strong. Work on skill and back off on intensity during the late luteal phase (week before period). And even if your race falls bang on a late luteal phase day, Dr Stacy Sims has several ‘bio-hacks’ be it for PMS cramp, avoiding hyponatremia risk or acclimation protocols for races in the heat.
Take Away #3: Talk about it !
For some women talking about ‘private’ things such as periods can be difficult. Some coaches (men in particular) find it hard to ask things like “when was your last period?”, “how long/heavy do you bleed for?”, “what PMS symptoms do you have, if any?”, “how does it affect your sleep, training or eating ?” etc.
But talking about such things is key. Some women who do a lot of sports, don’t have a regular period. For some, that is due to obvious reasons (pregnancy, menopause) or their choice of birth control (more about that later). But for others, it is due to menstrual dysfunctions which can have several causes (including premature ovarian failure, polycystic ovary syndrome, thyroid disorders, eating disorders, excessive exercise, insufficient/poor quality nutrition, stress etc). Doing any of those causes any justice is impossible in this blog and most are far beyond my area of expertise. However, the important thing is that you should talk about it and, if possible, try to re-instate your period, both for general health and performance reasons.
Technology is making things easier for coaches too. Rather than feeling awkward or like you are inconveniencing your athletes with private questions, apps like Fitrwoman and the associated Fitrcoach platform, can give a daily overview of exactly what is going on with your athletes, what symptoms they are experiencing and at what phase of their menstrual cycle they are, which in turn can help with session scheduling and supporting nutritional advice.
Take Away #4: Periodise with Physiology
Many coaches adopt a 3 week ‘on’, 1 week ‘off’ approach for the periodisation of training mesocycles as the body needs a lighter period to recover from accumulated training stress in order to bounce back stronger. If your menstrual cycle is 28 days and your coach has aligned your training cycles accordingly, this 3:1 pattern may work. However, contrary to popular belief, many women have menstrual cycles that are either shorter (say 21 days) or much longer (35-40 days) and period durations also vary from 4-8 days.
So your training periodisation could be altered to this pattern to avoid ‘recovery’ weeks when you could actually be hitting your training really hard or have high intensity sessions scheduled at times when your physiology just doesn’t let you hit top end, especially if you suffer badly from PMS.
What is more, research shows that if you are set to do an FTP test during the latter end of the high hormone phase (luteal phase), your FTP could be 8-10 watts lower. Basing your training and racing planning on this could skew things. Instead, you could optimise your training by using periodisation and the timing of key sessions to your advantage.
Take Away #5: Consider birth control options
Women have a plethora of options when it comes to birth control. But what many women are not aware of is that the synthetic hormones found in hormonal contraceptives downregulate your natural estrogen and progesterone. This means that, for example with a monophasic oral contraceptive pill, your hormonal levels are elevated to a consistently raised level of oestrogen and progesterone, followed by a ‘sugar pill’ week with lower synthetic hormones.
The combined oral contraceptive pill especially can hold you back in your athletic performance. Raised levels of oestrogen cause your body to spare carbohydrates; your cardiac output will be reduced and there will be less oxygen available for your working muscles; your body’s ability to activate fast twitch fibres will be reduced and you will struggle to hit top end.
Studies that have looked at the effects of hormonal contraception on athletic performance have found that women who are on a combined oral contraceptive pills have a decreased anaerobic capacity by as much as 6-11%. In elites this reduces to 3 -4%, but when you are talking about people investing a lot of effort in seeking marginal gains a drop of 3-4% is a lot!
From an aerobic capacity point of view things don’t look too good either as the combined oral contraceptive pill is associated with increased oxidative stress and systemic inflammation that can’t just be overcome with nutrition.
Finally, the pills with the highest progestin (synthetic progesterone) in the formulation cause the strongest decrease in the stimulus for muscle protein synthesis. So you may put more body weight on through muscle mass (certainly compared to non oral contraceptive pill users), but the muscle will lack strength (so is dead weight and doesn’t help for sports).
There are many reasons why women use a particular type of birth control method. But you may try just using condoms for a period of time to see how your body is functioning without exogenous hormones or consider other methods such as an IUD. For example, the Mirena coil which delivers a low and very targeted dose of progestin into the womb and can also reduce PMS symptoms and reduce the severity of blood flow in women with heavy periods. As a side note, the Mirena can also be used as the progestin component in combination with oestrogen pills and patches as part of menopause hormone therapy.
Take-Away #6: Menopause: Lift Heavy Shit
I could, and may at some point, write a whole blog post just about training and nutrition during peri- and menopause, but for now, I’ll keep it to just the most pertinent thing I picked up from the course.
Quoting Dr Stacy Sims here, ‘lift heavy shit’ is key for women from their mid- to late 40s, as the (peri)menopause kicks in. I could have picked a bunch of other things relating to menopause, but as I specialise in ultra-distance cycling, this is really important.
A lot of things change just before and after menopause. Periods start to become irregular until you are officially ‘post-menopausal’ once you haven’t had a period for 12-24 months. Symptoms that are often spoken about include hot flashes, night sweats, mood swings, ‘brain fog’, reduced libido, increased anxiety, disturbed sleep etc.
From a performance point of view however, there are other more important symptoms worth focusing on. Because of a marked decline in endogenous oestrogen production, women also tend to see a decrease in lean mass, increase in fat mass (especially around the abdomen), a reduction in VO2max and aerobic fitness, increase in recovery time needed between training sessions and a decline in bone density.
Yet, it is possible to counter/reverse some of these changes, IF you change up how you are training (and eating). Cut down on the long slow miles; start including more resistance training (3 to 6 repetitions of fundamental moves), high-intensity interval training and plyometrics. I am not saying (peri)menopausal women should stop doing long-distance challenges altogether, but to prevent muscle loss and weakness they’ll have to switch their training up and focus a lot more on power training (at least 2 times per week).
So much more to learn and discover
The course was jam-packed with so many more gems, but I can’t share them all here. If you want to find out more, you really should get a copy of ROAR or listen to any of the (many) excellent podcasts that Dr Stacy Sims has done. If you want to dig deeper into the physiological processes, you may want to do the course yourself or start working with a coach or nutritionist who understands the nuances. If you are looking for more information about exercise and nutrition for peri- and post-menopausal women, there is some good news: Dr Stacy Sims’ new book will be all about that and should come out later this year!
Meanwhile, let’s keep spreading the important message that ‘women are not small men’. We can all help to make conversations about periods, hormones and menopause less taboo. I for one am really excited by what women can achieve when they start training and eating with their physiology and what fascinating things will be discovered as more research on pre-, peri- and postmenopausal female athletes will start to emerge.