Frank Horwill



  • These articles were first published many year's ago and whilst some are as relevant today as they were when new, many are now mostly of historical interest as modern research and coaching methods have superseded them.

Running and Menstruation

By Frank Horwill

In 1930, Sir Adolphe Abrahams, who was considered to be an authority on sports medicine, stated: "One girl has been credited with the ability to run over the marathon course of 26½ miles in 3 hrs 40 mins 5O secs., a feat which I am disposed to doubt". This attitude prevailed for a further 40 years. No doubt it was reinforced by the fact that a female has only 13.7g/100ml of blood haemoglobin as opposed to 15.8 in men. In addition, the increased fat/body weight ratio and the increased femoral obliquity were considered a disadvantage.

In childhood, there is very little difference between boys and girls with regard to endurance running, and what difference there is favours girls who in development are slightly in advance of boys up to puberty. From late adolescence onwards, the boys rapidly outstrip the girls in physical development.

Female athletes are faced with the tedious business of menstruation and/or premenstrual problems, commonly called PMT. The effects of menstruation on the individual person vary enormously. In some, there appears to be no apparent inconvenience; in others, the changes cause considerable incapacity. The weight gain associated with retention of water during the premenstrual period is clearly a handicap to the endurance athlete. However, it has been clearly shown that physical activity, in the main, enables the female to cope with the physiological changes incurred more easily. But psychological changes can, and do, affect physical performance.

Monitor to find the pattern

In studies of large populations of women between 15 and 55 years, the four days before and the first four days of menstruation reveal that there is an increase in accident proneness, lowering of mental ability, lowered resistance to infection, increased suicide attempts and increased hospitalisation.

It is important to realise that for most women there are rarely more than two or three days when they are at greater risk. It is up to each individual, by careful monitoring, to appreciate her own specific pattern. Those showing variations in sporting performances are advised to record on their menstrual chart the times when they are off peak. But one occurrence, that of increased aggression during premenstrual tension, can lead to improved performance.

Many endurance runners, because of reduced weight, cease their periods altogether. The medical profession is split over this. One view is that it is Nature's way of saying that the female is too thin to have children. Another opinion is that prolonged cessation of the period will lead to infertility. However, I coached a female athlete who went several years without a period and, on retirement from athletics, proceeded to have four children in four years!

So what exactly is PMT?

A lot of uncertainty surrounding PMT over the last 30 years stems from an inability to define the condition accurately. Dr Katherine Dalton, an expert on the subject, defines PMT as: 'The appearance of symptoms in the premenstruum and their disappearance in the postmenstruum'. Unlike most other medical conditions, the diagnosis is based in the cyclical nature of the symptoms rather than on the actual symptoms themselves. An astounding 150 symptoms have been described in PMT. Some women suffer only one but the norm is half a dozen.

Dr Guy Abraham, a specialist in the nutritional aspects of PMT, has divided it into the following four categories:

PMT A: anxiety, irritability and mood swings

PMT B: weight gain, swelling of the extremities, breast tenderness and abdominal bloating

PMT C: headache, craving for sweets, increased appetite, heart pounding, fatigue and dizziness or fainting

PMT D: depression, forgetfulness, crying, confusion and insomnia.

Other symptoms include oily skin, acne, clumsiness and feelings of violence or, in severe cases, even suicide. Of concern to female athletes is that asthma can be aggravated premenstrually.

About half of women of child-bearing age experience at least some premenstrual symptoms. The other half may feel that their symptoms warrant treatment. Greek and Japanese women have a lower frequency of symptoms, and it is thought that this is due to dietary differences. Increasing age and increasing numbers of children also heighten the chances of PMT. Young women and girls in their teens appear to suffer more from painful periods which often improve as they get older, only to be replaced in many cases by the onset of premenstrual symptoms. The most severe and difficult cases of PMT are found in women in their forties.

Dr Abraham has shown that the majority of women with premenstrual symptoms have a poor nutritional intake compared to those who have no PMT. The former are often found to have low levels of magnesium, which affects blood sugar control and hormonal metabolism. A high intake of salt often aggravates fluid retention and breast tenderness. This also applies to fat consumption, because research reveals that PMT sufferers cannot efficiently metabolise the essential fatty acid, linoleic acid, which is mainly found in good-quality vegetable oils. This barrier is strengthened by the lack of vitamin B6, magnesium, zinc, vitamin C, vitamin B3 and chromium.

Dietary advice for PMT athletes

  1. Reduce the intake of refined sugar, salt, red meat and alcohol.
  2. Eat fish, poultry, whole grains and legumes.
  3. Reduce the intake of coffee, tea, chocolate and cola-based drinks.
  4. Reduce the intake of fats, particularly animal fats, fried foods and hydrogenated margarines.
  5. Increase the intake of fibre in the form of green, leafy vegetables, legumes and fruits.
  6. Keep an eye on your weight. If you are 5"6' tall (1.676m), don't go beyond 130lbs (58.967kg). Gradually increase your training load to reduce weight.

...and nutritional supplements

  1. Take a multivitamin supplement which contains 100mg of vitamin B6 per day, together with the B vitamins, vitamin C, plus minerals. Optivite is of proven value in treating PMT.
  2. 500mg capsules of Evening Primrose Oil, 4-8 per day, taken the two weeks before the period is due.
  3. Vitamin E, 300-500 International Units per day, is of particular value with premenstrual breast swelling and tenderness.
  4. 200-300mg of elemental magnesium per day.

The above supplements should be taken for three months before deciding whether or not they are effective. Some hormonal or gynaecological problems can have symptoms similar to those of PMT. If the symptoms do not improve or are very severe, a doctor MUST be consulted.

More about menstruation and performance

  1. About one-third of all female Olympic gold medals were won during menstruation. Two-thirds were gained a week after the cessation of the period.
  2. Menstruation can be adjusted so that the competition dates coincide with the time of maximum efficiency. This might be pre-ovulation (days 9-12) or post-ovulation (days 17-20).
  3. Sportswomen whose performances are affected by menstruation and who have a continuous programme of events can have menstruation completely suppressed for a few months. This requires expert management by a sports physician because some of the drugs (hormones) used for this purpose may be on the list of banned substances.

Professor Tim Noakes has discovered that bone density declines in non-menstruating athletes, and advises hormone replacement therapy to preserve the health of their skeletal systems.