Rugby teams treat menstrual cycles as a 'fifth vital sign' to help players perform

Rugby teams across the international and club game are systematically tracking players' menstrual cycles and treating them as a "fifth vital sign" so medical and coaching staff can adapt training, nutrition and recovery during competitions such as the Women’s Rugby World Cup.

Coaches, physios and sports scientists say collecting daily data on symptoms, cycle phases and wellbeing helps identify when a player may need workload changes, extra recovery or nutritional support. The approach aims to sustain performance across multiweek tournaments, during which many players will compete through one or more menstrual cycles.

Abi Okell, lead physiotherapist at Sale Sharks Women and former player, said a regular menstrual cycle is an indicator of overall health and fertility and therefore a useful metric for clinicians. "A lot of people describe our cycle or our period as the fifth vital sign of a female," she said, naming temperature, blood pressure, pulse and respiratory rate as the other four.

Okell and others said teams prefer menstrual tracking to the artificial bleeds that come with some contraceptive regimens because those withdrawals can mask the natural hormonal signals clinicians use to assess health. "The main things that we look for is that they are tracking day one of their bleed," Okell said.

Teams use a variety of methods to monitor cycles and related symptoms. England’s Red Roses use a wellness monitoring form filled in by players; some squads run group briefings ahead of major tournaments to explain the physical changes that can occur across the four menstrual phases and what to expect. Wales has piloted Vodafone’s Connect app, which layers GPS and performance data with self-reported menstrual phase and wellbeing.

United States second row Erica Jarrell-Searcy said players on her squad complete daily questionnaires about soreness, mood and recovery. "Every morning you fill out a form saying, ‘I’m this sore, I’m in a great mood or a bad mood,’" she said. Some teams and athletes also use ovulation testing and saliva oestrogen measures to pinpoint cycle stages.

England winger Abby Dow said her squad discusses periods periodically, particularly when preparing for major tournaments or integrating new players. "Rugby as a sport isn't going to wait for you if you are on your period and no-one is going to tackle you easier because you are bleeding," the 27-year-old said. The emphasis, she added, is on practical management rather than removing players from sessions.

After clinicians review tracking data, changes to training can be made, often modest and individualised. That can include reduced intensity, trimming extra conditioning, adding mobility in warm-ups or shifting gym workloads when a player is in a fatigued state known in some setups as the "red zone." Okell said adaptations are cycle-informed rather than cycle-mediated: the cycle influences decisions but does not determine whether a player participates.

Nutritionists also use cycle information to tailor macronutrients and supplements. Players may increase carbohydrate intake ahead of heavy sessions, and clinicians consider iron, vitamin and mineral replacement for those with heavier bleeds. Teams have also devised quick interventions for cramp management. Jarrell-Searcy described a team-prepared mixture dubbed "Sylvia's Cramp Cocktail," a blend of vitamins and minerals intended to relieve menstrual cramping so an athlete can continue training after a short delay.

Teams caution that menstrual symptoms vary widely and individual athletes experience different effects on strength, endurance, focus and recovery. The BBC’s Elite British Sportswomen’s Study 2024 found that 88 of 143 respondents said their performance had been affected by their period, and the same number reported missing training or competition because of it.

Evidence linking the menstrual cycle directly to injury risk remains inconclusive. A review cited by clinicians notes that a causal relationship between cycle phase and injury has not been established. Okell said that while physiological risk is unclear, practical issues such as altered movement patterns or reduced confidence because of fear of leakage can in some cases change biomechanics and potentially raise injury risk.

Players and medical staff say normalising conversations about the menstrual cycle and removing stigma are central to better care. Open recording and discussion of symptoms allow staff to spot irregularities that may signal broader health issues as well as to make short-term performance and welfare decisions. "It's about working out how can we maximise ourselves and when you are not feeling so great, how can we adjust things like the gym to suit you," Dow said.

As the women’s game continues to professionalise, teams are increasingly integrating menstrual-health data with wider monitoring systems to build personalised plans that support both performance and long-term health. Clinicians emphasise confidentiality and individual consent for such monitoring and say the goal is to give players tools and adjustments that keep them performing across demanding schedules without reducing opportunities or singling out athletes for absence from training or play.

Research teams continue to study hormonal influences on performance and injury, and clinicians say better, larger-scale data will help clarify which measurable cycle-related changes should prompt specific interventions. For now, squads at international and club level are treating menstrual health as a routine part of athlete monitoring and care during tournaments and across seasons.