Managing Premenstrual Syndrome for Female Athletes: Psychological Strategies for Peak Performance

Published on : June 20, 2024

The History of Female Participation in Sports

Female participation in modern sports began at the dawn of the 20th century, with women first competing in the Olympic Games in 1900. The 1908 London Games saw the official sanctioning of women’s participation, and Title IX marked a significant shift, leveling the playing field for all athletes. Despite these advances, female athletes continue to face unique challenges, including those related to menstrual health. One of the most significant and often overlooked challenges is Premenstrual Syndrome (PMS), which can profoundly impact both physical and psychological performance.

Linking Menstrual Health to Athletic Performance

Menstrual irregularities, such as amenorrhea (absence of menstruation), dysmenorrhea (painful periods), menorrhagia (heavy bleeding), oligomenorrhea (infrequent periods), and premenstrual syndrome (PMS), can significantly impact an athlete’s physical and mental well-being. Research indicates that menstruation is still a taboo subject, often neglected in discussions about athlete health. Understanding and addressing PMS is crucial for optimizing performance and supporting the health of female athletes.

Understanding PMS and Its Psychological Impact

Premenstrual Syndrome (PMS) involves hormonal fluctuations that significantly impact the psychological health of athletes, ultimately affecting their performance and training. During the luteal phase of the menstrual cycle, rising progesterone and fluctuating estrogen levels can lead to various symptoms. About 20% of women experience severe symptoms that disrupt daily activities. PMS symptoms include headaches, body aches, bloating, anxiety, irritability, anger, fatigue, restlessness, binge eating, cramping, and low energy.

Psychological Effects of PMS on Female Athletes

Hormonal changes during PMS create a challenging environment for athletes, as they must adapt their training and performance strategies to accommodate physiological and emotional shifts. The unpredictability of these symptoms can lead to difficulties in maintaining consistent training schedules, managing stress, and performing at peak levels.

Emotional Fluctuations: The hormonal changes can cause mood swings, increased irritability, anxiety, and even depressive symptoms. These emotional fluctuations can impact an athlete’s mental focus and motivation, making it harder to stay committed to training and performance goals.

Stress and Anxiety: Increased anxiety and stress are common during PMS. This heightened stress can affect an athlete’s ability to manage pre-competition nerves and maintain composure during crucial moments in their sport.

Fatigue and Low Energy: The physical symptoms of PMS often lead to feelings of fatigue and low energy, which can be mentally draining. Athletes may find it challenging to push through their usual training routines, leading to frustration and a sense of underperformance.

Research on PMS and Athletic Performance

A study published in the British Journal of Sports Medicine found that hormonal fluctuations during the menstrual cycle can significantly impact sporting performance. Elite female rugby players reported that PMS symptoms affected their physical ability and mental well-being, leading to decreased performance levels during certain phases of their cycle. Another study in the International Journal of Environmental Research and Public Health highlighted that female athletes in sports like rugby union and football experienced considerable physical and emotional challenges during their premenstrual period, impacting their perceived physical ability and overall well-being.

Case Study: Clinical Reasoning in Sports Performance

Consider the case of Ananya, an elite female runner from India, who experiences severe PMS symptoms every month. Ananya is a dedicated athlete with dreams of representing her country on the international stage. However, during the luteal phase of her cycle, she struggles with heightened anxiety, irritability, and fatigue. These symptoms disrupt her training sessions, causing her to lose focus and confidence.

Recognizing the impact of PMS on Ananya’s performance, her coach, supported by a sports psychologist, implements a personalized approach. They adjust her training load, scheduling lighter workouts and incorporating relaxation techniques like yoga and mindfulness exercises during her luteal phase. Ananya also engages in cognitive-behavioral therapy (CBT) to help reframe negative thoughts and develop healthier thinking patterns.

The psychologist works with Ananya to identify and challenge negative thought patterns that arise during her PMS phase. For example, Ananya often feels inadequate and fears letting her team down due to her fluctuating energy levels. Through CBT, the psychologist helps Ananya reframe these thoughts by focusing on her strengths and achievements, emphasizing that her worth is not solely defined by her performance during these challenging days.

By teaching Ananya techniques such as cognitive restructuring and self-compassion exercises, the psychologist empowers her to manage anxiety and maintain a positive mindset. This approach helps Ananya develop a more balanced view of her capabilities and reduces the emotional burden of PMS. Over time, Ananya learns to anticipate her symptoms, communicate openly with her coach, and adapt her training accordingly. As a result, her performance stabilizes, and she begins to excel in her competitions, achieving personal bests and gaining confidence in her abilities. This case highlights the crucial role of psychological support and the need for understanding menstrual health in optimizing athlete performance, especially in a developing country like India, where there is immense sports potential.

Recognizing and Managing PMS Symptoms


  • Simple Tracking: Encourage athletes to use a menstrual tracking app or a simple calendar to log their cycles and symptoms. This can help predict when symptoms might affect performance.
  • Open Communication: Create a supportive environment where athletes feel comfortable discussing their menstrual health with coaches and teammates.
  • Observation: Coaches should be attentive to signs of PMS, such as changes in mood, energy levels, and performance, and be prepared to adjust training plans accordingly.


  1. Emotional Awareness and Acceptance:
    • Athletes should be aware of their emotional states and accept that mood swings are a natural part of PMS, reducing self-criticism and frustration.
  2. Mindfulness and Relaxation Techniques:
    • Incorporate mindfulness practices, such as meditation, deep breathing exercises, and progressive muscle relaxation, to manage stress and anxiety.
  3. Cognitive-Behavioral Strategies:
    • Utilize cognitive-behavioral therapy (CBT) techniques to reframe negative thoughts and develop healthier thinking patterns, reducing the impact of PMS-related anxiety and depressive symptoms.
  4. Effective Communication:
    • Create an environment where athletes feel comfortable discussing their PMS symptoms with coaches and teammates, leading to better understanding and support.
  5. Goal Setting and Flexibility:
    • Encourage athletes to set realistic goals and be flexible with their training plans during the luteal phase to manage performance expectations.
  6. Support Systems:
    • Build a strong support system that includes coaches, teammates, and sports psychologists to provide emotional and mental support.

The Importance of Educational Awareness

Creating educational awareness about PMS is essential not only for athletes but also for coaches and supporting staff. Educational programs should be developed to inform all parties about the psychological impacts of PMS and how best to manage them. These programs should cover practical strategies, such as adjusting training loads, recognizing symptoms early, and implementing supportive measures. By promoting a deeper understanding and empathy towards PMS, coaches and support staff can create a more inclusive and supportive training environment. This awareness helps break down stigmas associated with menstruation, fostering open communication and ensuring that female athletes receive the comprehensive care they need to excel.


By integrating psychological strategies and emphasizing educational awareness, we can create a holistic support system for female athletes dealing with PMS. This multi-faceted approach not only enhances their performance but also ensures their overall health and well-being.


  1. Findlay RJ, Macrae EHR, Whyte IY, et al. How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. British Journal of Sports Medicine. 2020;54:1108-1113.
  2. Modena R, Bisagno E, Schena F, Carazzato S, Vitali F. How Do Elite Female Athletes Cope with Symptoms of Their Premenstrual Period? A Study on Rugby Union and Football Players’ Perceived Physical Ability and Well-Being. Int J Environ Res Public Health. 2022 Sep 6;19(18):11168. doi: 10.3390/ijerph191811168.
  3. Prado, R. C., Willett, H. N., Takito, M. Y., & Hackney, A. C. (2023). Impact of Premenstrual Syndrome Symptoms on Sport Routines in Nonelite Athlete Participants of Summer Olympic Sports. International Journal of Sports Physiology and Performance, 18(2), 142-147. Retrieved Jun 15, 2024, from


About the Author

Payal holds a Master’s in Sports Psychology from Liverpool John Moores University, equipped with global insights into athlete mindset. As a Sportswoman herself, she understands the challenges of menstruation and aims to address them from a physiological and biological standpoint. She aims to use her position to spread awareness and help athletes achieve their goals, bolstered by her work on projects like the Herlzone Project.

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