During her early years as an athlete, taking the oral contraceptive pill was a no-brainer for Great Britain kayaker Kimberley Woods. Aside from its practical effectiveness in preventing pregnancy, the pill helped relieve the painful menstrual cramps which made her feel sick and ill during training.
Being able to manipulate her monthly withdrawal bleeds to fall outside competitions by “doubling up” on pill packets was another big win.
So in 2015, when she was randomly prescribed a cheaper, alternative pill – which contained the same hormonal quantities as her previous one – Woods felt no reason to question it.
She started taking Rigevidon, one of the most commonly used contraceptive brands in the UK, where around 3.5 million women take some form of birth control pill.
“That was the start of a lot of mental health stuff,” Woods tells Telegraph Sport. “I became very conscious of my body and how I looked. So many issues came up around that time, but I never put two and two together.
“I became a lot more anxious and a lot more self-critical, even with my paddling. The nature of being an athlete, things are so much more heightened. I got really low, really depressed, it was taking a massive toll and I ended up self-harming.”
Woods, who has spoken publicly about being bullied for her athletic physique during her childhood, is unsure of the extent to which her new pill contributed to her mental health problems. Intensive therapy – including support from the Priory clinic in London – was an opportunity to process the uncomfortable experiences in her past.
After making significant progress, she stopped counselling in early 2019 and, months later, decided to ditch the pill altogether when her coach pursued a key line of inquiry.
Craig Morris had spent the past 14 years working with predominantly female paddlers, but only during British Canoeing’s Olympic selection in 2019 did the esteemed canoe slalom coach realise there was an important area the organisation was not tapping into: female hormonal health.
He approached Dr Georgie Bruinvels, a lead scientist in female athlete health at Orreco, a sports science company that founded the period-tracking app FitrWoman, eager to know everything about the effect of the contraceptive pill on performance. He wondered whether his athletes could benefit from working with, not against, their menstrual cycles. “This was one area that has traditionally been seen as out of bounds,” says Morris, “but we would all say that our collective understanding was pretty weak.”
His experience is symptomatic of a knowledge gap across high-performance sport. A 2020 study published in the Journal of Science and Medicine in Sport involving 189 Australian elite sportswomen found their understanding of the menstrual cycle and the oral contraceptive pill was “low”. While the pill has been identified as the most common type of contraception among elite female athletes – around half are thought to be on some form of hormonal contraception – research into its effect on performance remains largely inconclusive.
After transitioning off the pill, Woods’s mood and emotions became less erratic and her energy levels rose. “I was so up for everything,” she says. “When mistakes were happening, I wasn’t so emotionally attached to them. Being able to track my menstrual cycle and understand my natural hormones opened another world towards training.”
Her team-mate Mallory Franklin, who is on course to make history at this year’s Tokyo Olympics by becoming the first woman to represent Great Britain in the canoe single class, also became intrigued. For five years, Franklin had benefited from the contraceptive implant – a tiny rod placed in a woman’s arm which releases the hormone progestogen into the bloodstream to prevent pregnancy. Following discussions with Bruinvels, she was curious about whether there were any marginal gains to be made by having it removed.
“I thought the worst case [scenario] is that I go back to having normal periods, and using other forms of contraception with my other half,” says Franklin, Great Britain’s most successful female paddler who claimed a record eight world titles in 2018. “It’s become more of an issue – I’m in conversations with Georgie and a group of people because I’ve started to get quite serious symptoms with my periods, including lower back pain.” Armed with the expertise of the FitrWoman team, Franklin insists the pros of transitioning off contraception outweigh the cons. “When I hit phase four of my cycle [before menstruation] I know I need to be implementing things to look after my back more,” the 26-year-old says.
Franklin and Walsh’s journeys are not unique. In the past year, FitrWoman’s client base has tripled, with sportswomen becoming increasingly curious about how they can harness the powers and pitfalls of their periods.
“We’ve seen more athletes wanting to come off the pill and contraception over lockdown,” says Bruinvels. “Athletes have had more time to consider health and what they can do to support their performance naturally. They want to be more mindful of what they’re putting into their bodies. We’ve had some good success stories of athletes who’ve come off the pill who have suddenly stopped having repetitive brain fog, recurrent injuries and mood changes. But for others, the pill can really work for them.”
As an openly gay woman who does not suffer with severe menstrual symptoms, Emma Wiggs, the British reigning Paralympic, world and European para-canoeist champion, has never used hormonal contraception to aid her athletic career. Last year she turned 40, but only in the past 18 months has she fully understood her menstrual footprint. Targeting her strength training during the first half of her cycle and particularly around ovulation – when women experience a tiny spike in testosterone – has been a psychological game changer.
“It’s allowed me to not use my period as an excuse, but understand why I’m a kilo or two kilos out week on week,” says Wiggs. “Before, I would have obsessed about that, impacting my rest, recovery and mood.”
Her predominantly male coaching team are now “brilliant” at acknowledging her period and deliberately schedule her body composition tests every six weeks on the same day of her cycle.
For Morris, removing the stigma around menstrual health is not a domain exclusively for male coaches. He points to British Canoeing’s “Female Friday” social media campaign that the organisation started last year to encourage paddlers of all abilities to share experiences around menstrual health.
“I know female coaches who are also uncomfortable about speaking to athletes about their menstrual cycles,” he says. “There might be obvious gender barriers in that as men, we can’t pretend to understand the process that women go through, but we have to go with them or be led by them on it.”