Podcast, Science, Training

Kerry McGawley, PhD (part 2) | EP#410

 October 2, 2023

By  Bernardo Gonçalves


Kerry McGawley - That Triathlon Show

Kerry McGawley is Associate Professor at Mid Sweden University, a coach and coach educator, and a very good age group triathlete. In this interview, we discuss the current science on the female athlete, where we need to do more in both academia, in sports organisations and in society, and practical takeaways. This is part two of a two-part interview, where part one was about Kerry's own training as an age-group 70.3 World Champion.

In this episode you'll learn about:

  • Mother-athlete challenges
  • Menstrual cycle phases and performance
  • Menstrual health literacy and barriers to coach-athlete communication
  • Amenorrhea and associated injury risk and performance outcomes
  • Next steps in academia, organisations and elsewhere

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Work with female athletes

03:30 -

  • While directing the research centre, I hired a Finnish researcher as a postdoc around five years ago. 
  • She was intensely interested in menstrual cycle physiology and female athlete research, which intrigued me. We began collaborating on various projects and co-authored several papers.
  • My interest in this area started when the topic gained popularity about five years ago. 
  • Over the last two to three years, it has become even more well-known that there's a significant lack of research and understanding in female athlete physiology. We haven't been adequately educating coaches and athletes in this area.
  • Initially, I focused on how hormonal and menstrual cycles might impact training and adaptations, including considerations like periodisation, recovery, and fatigue management. 
  • As I delved into the research, I realised that the existing studies were often inconclusive and poorly controlled.
  • Much chatter suggested that high-intensity interval training (HIIT) and strength training should be done in the first half of the menstrual cycle, with the second half considered catabolic, recommending recovery and long, slow-distance training. 
  • However, the evidence for this was weak, with slightly stronger support for periodisation in strength training but still not strong enough to apply rigidly to everyone.
  • My perspective broadened as I spoke with athletes, particularly during training camps with cross-country skiers. 
  • I realised that athletes and coaches had limited knowledge in this area, and it became clear that we needed to raise awareness and provide education.
  • This realisation was reinforced when a paper in Norway explored the experiences and knowledge of elite female cross-country skiers and biathletes regarding their menstrual cycles. 
  • We investigated this issue further among Swedish elite cross-country skiers and biathletes.
  • As a result, my role has evolved beyond being just a physiologist. 
  • It became apparent that we needed to foster communication and education between athletes and coaches to address these critical aspects of female athlete health and performance.
  • I began researching this topic and hired a research assistant who is now one of my PhD students. 
  • She has a unique background as a cross-country ski development team coach and works with the cross-country ski federation. 
  • Her PhD work bridges the gap between the federation and the university. Initially, our research was heavily focused on physiology, but it has evolved into a vital educational component. 
  • We now use pedagogical models and interventions to enhance communication and knowledge among athletes and coaches. This also involves understanding how to work with younger athletes effectively.
  • Our research has expanded to encompass a broader scope, including both male and female athletes. We investigate hormonal and other health responses to their training. 
  • One of my recent publications focuses on menstrual health literacy, which addresses the lack of knowledge and communication among athletes, coaches, and practitioners. 
  • The paper offers recommendations and highlights available resources published by federations for reference.
  • Another area of my research is centred on mother athletes, which I find particularly fascinating due to the gender-based disparities in opportunities for parenting among elite athletes. 
  • Female athletes undergo pregnancy and related physical changes, which can significantly affect their careers. They may lose sponsorships, jobs, and team positions and face challenges in balancing family life with travel, racing, and training.
  • In a recent qualitative study, we interviewed Norwegian and Swedish elite cross-country skiers, including current and former mother athletes and those planning to have children in the future. We identified four key challenges they face. 
  • This research is crucial not only from a social perspective but also in terms of policy-making, as it sheds light on the need for support and consideration for athletes at different stages of their lives. 
  • It's also relevant to age group athletes and those not supported by federations, raising awareness about their multifaceted challenges.
  • One significant challenge we've identified is the timing issue. Elite endurance athletes often peak in their careers while they may want to start a family, typically between the ages of 30 to 35. 
  • This creates a dilemma that athletes must navigate.
  • Navigating the challenges of pregnancy while maintaining fitness is a significant concern for female athletes. 
  • Recent research, particularly in running, has shown that mother-athletes can return to and even surpass their previous performance levels with proper support and training. 
  • This highlights the evolving understanding of what women can achieve athletically during and after pregnancy.
  • Another notable issue is the disparity in how male and female athletes are treated regarding parenthood. 
  • Male athletes often continue their careers without significant interruptions, while female athletes may risk losing their place on a team or in a federation. 
  • This disparity underscores the need for fair policies and support systems that allow female athletes to continue their careers after becoming parents.
  • Furthermore, the challenge of balancing motherhood and athletic excellence is complex. Female athletes, often driven by ambition and a desire to excel in all aspects of life, face the dual challenge of being world-class athletes and mothers. 
  • This balancing act can be particularly demanding for these high-achieving individuals.
  • These issues touch upon the physical aspects of athletic performance and delve into the sociological aspects of gender, parenthood, and the expectations of female athletes. 
  • It's an area of sports evolving and demanding a more inclusive and supportive approach for female athletes as they navigate pregnancy, parenthood, and their athletic careers.

Combining an athletic career with parenting

13:25 -

  • Support structures played a vital role in balancing parenthood with athletic pursuits. 
  • It was crucial to have parents, whether the athlete's parents or the child's grandparents, available to help with childcare. Additionally, receiving support from the team was essential. 
  • This included accommodations for bringing babies to training camps and races and flexibility in allowing athletes to modify their training routines to accommodate family responsibilities.
  • I would say that the combination of support from federations and the family structure was particularly significant. Athletes also approached this challenge with varying mindsets. 
  • For instance, one athlete felt comfortable leaving her child in a well-organised childcare arrangement while she was away, allowing her to be highly focused at home. 
  • This meant she could maximise her time with her child. On the other hand, some athletes found it more challenging and opted to forgo training camps instead of staying at home.

Menstrual cycle performance research

15:12 -

  • The study involved healthy women, primarily recreational, and was designed to examine responses across various phases of the menstrual cycle. 
  • The study included 16 normally menstruating women with regular cycles and 12 hormonal contraceptive users. 
  • It wasn't a direct comparison between these two groups but aimed to observe how each group responded within the same study context.
  • The participants were tested at four menstrual cycle phases in the normally menstruating group. 
  • The first test occurred during the menstrual bleeding phase, which posed logistical challenges, as participants needed to contact the researchers as soon as their period began to schedule the lab visit within a few days. 
  • Subsequent tests were conducted during the mid-follicular, ovulatory, and mid-luteal phases. These phases were chosen because they correspond to different hormonal profiles, particularly estrogen and progesterone levels, which are believed to impact physiological responses and performance.
  • The study employed an incremental test to assess various physiological variables, including VO2 measurements, blood lactate responses at aerobic and anaerobic thresholds, absolute and relative VO2 peak, maximal running speed, maximal running time, and maximal heart rate. 
  • Interestingly, the study's findings indicated no significant differences in these measures between the menstrual cycle phases within the two groups.
  • This outcome is critical as it suggests that the menstrual cycle's various phases do not substantially impact the tested physiological variables during an incremental exercise test.
  • It's interesting to note that a project in Norway focused on female athletes. 
  • They conducted a study similar to ours but with a more extended timeline, spanning three menstrual cycles. 
  • Their findings align with ours, showing consistent responses across different menstrual cycle phases. 
  • This consistency was observed in natural menstrual cycles and contraceptive pill users in our study.
  • This consistency challenges the common practice of excluding women from studies due to the perceived complexity of hormonal cycles. 
  • There isn't substantial evidence to support the notion that menstrual cycles significantly impact physiology and performance. While hormonal fluctuations occur, they may not substantially affect performance variables. 
  • This implies that the timing of tests, such as FTP tests, may not be crucial concerning menstrual cycle phases.
  • Numerous other factors likely have a more significant influence on performance in both men and women. 
  • It's frustrating that women are often excluded from studies based on hormonal variability, while similar variability in men due to factors like diet, sleep, relationships, and work is not given the same level of attention. 
  • We may have overemphasised the impact of menstrual cycle hormones on performance.

Amenorrheic/eumenorrheic study

21:36 -

  • The average age of the athletes was around 20 years old. The research included both athletes and a control group of non-athletes. 
  • The study focused on Finnish middle-distance runners, with 13 athletes who were considered elite and eight controls.
  • One significant aspect of the study was assessing the athletes' menstrual health. 
  • It was found that over half of the athletes were amenorrheic, meaning they had irregular or no menstrual cycles. This group exhibited lower body mass, fat mass, relative fat mass percentage, and BMI. 
  • While these traits might be seen as advantageous in running, it was noted that these athletes were more prone to injuries, performed worse, and ran less.
  • In contrast, the eumenorrheic group, with regular menstrual cycles, had fewer injuries and accumulated more running distance. 
  • Notably, the total annual running distance positively correlated with changes in performance. 
  • This suggests that consistently maintaining menstrual health and training is crucial for long-term athletic performance.
  • The study emphasised balancing energy intake or availability with body mass and health outcomes. 
  • Athletes have been prevented from racing in sports like cross-country skiing due to low-fat mass or bone mineral density. 
  • This highlights the need for monitoring and establishing healthy baselines for athletes to ensure their well-being and performance.

Menstrual cycle as a signal of REDs

27:00 -

  • It's not entirely clear-cut, but the menstrual cycle does provide a valuable signal when used appropriately.
  •  I'd like to mention a paper by one of my PhD students. The title of that paper is quite intriguing. In the study, we conducted focus groups to examine communication between coaches and athletes regarding the menstrual cycle. We found some interesting insights. The title of the paper is a quote from one of the athletes we interviewed. 
  • She recounted something a coach told her during her career, which was pretty unsettling. The quote is, "Do elite sport first. Get your period later."
  • This statement is concerning, especially in weight-bearing sports like cross-country skiing, running, road cycling, triathlon, etc. 
  • It reflects a somewhat traditional belief that has persisted. We also heard other comments in the interviews, such as athletes being told that they aren't training hard enough if they have their period. 
  • These ideas are simply not true. You can be healthy and happy and still perform at the highest level during your periods. 
  • There's ample evidence supporting this.
  • The real issue is that some old-school coaches perpetuate these ideas to young, influential athletes. 
  • These athletes often aren't taught any differently because there's a lack of education on hormonal cycles, menstrual cycles, hormonal contraception, and related topics in our curriculum, whether in schools or athletic development programs. 
  • This is what needs to change.
  • What struck me the most about the paper we wrote was the level of understanding among the senior cross-country skiers in the Swedish team who had achieved significant success in their careers. 
  • At the senior level, they had multiple world championships and Olympic gold medals, yet they had experienced these beliefs and comments throughout their careers. 
  • It's important to note that this wasn't in some remote or backward coaching environment; it happened in countries generally considered forward-thinking.

Takeaways from the menstrual cycle

30:03 -

  • We focused on understanding the communication barriers surrounding menstrual cycle issues in elite female cross-country skiers from Sweden, including both athletes and coaches. 
  • The study involved 13 elite female cross-country skiers in their mid-20s and eight coaches (two women and six men). These athletes were experienced in their careers.
  • The research included a survey assessing the educational backgrounds of the coaches and their knowledge about the menstrual cycle. The findings revealed a lack of formal knowledge among both coaches and athletes about menstrual cycle-related matters.
  • The study explored the coach-athlete relationships, which were found to be generally positive, with high scores, suggesting good communication. However, despite the positive relationships, there were still barriers to discussing menstrual cycle-related issues.
  • An intervention involved an online educational session with a gynaecologist who specialised in elite sports and worked with the Swedish Olympic Committee. Additionally, focus group discussions were held, including sessions with athletes alone and interactive sessions involving both coaches and athletes. 
  • These sessions aimed to improve knowledge and communication about menstrual cycle-related topics.
  • We identified three main barriers to effective communication on menstrual cycle-related matters.
  • Coaches lacked formal knowledge about menstrual cycles. This was attributed to inadequate education in this area, both for coaches and athletes. 
  • Athletes felt uncomfortable discussing menstrual cycles, irrespective of their relationship with others. Social taboos and gender dynamics, such as age gaps and coaches being men, contributed to this discomfort.
  • Discussions about the menstrual cycle did not naturally occur during training camp meetings or other regular interactions between coaches and athletes. These discussions were not integrated into the training routine, indicating a structural barrier.
  • Athletes often have access to nutritionists and psychologists, but one critical aspect has been missing: female physiologists. 
  • There hasn't been a structural support system or dedicated professionals to address female athletes' physiology issues.
  • In a paper I co-authored, we proposed a model to address this gap. The goal was to improve the overall support system for female athletes in elite sports. 
  • This model included recommendations to enhance menstrual health literacy, a topic I explored in another paper.
  • The first step in this process was to create a foundation of robust and reliable knowledge. 
  • This knowledge base would come from research on female athletes' physiology and menstrual health. 
  • However, merely generating knowledge isn't enough. The next crucial step is transferring this knowledge into practical applications within the sports community.
  • One innovative idea that has emerged is the inclusion of female physiologist specialists within multidisciplinary teams working with athletes. 
  • This shift acknowledges the unique physiological needs of female athletes and the importance of addressing them in their training and performance. 
  • Female performance experts who specialise in these areas can also be valuable contributors.
  • While not all female athletes may require extensive interventions, even raising awareness and implementing basic practices can make a significant difference. 
  • This includes tracking menstrual cycles and building individualised databases, like collecting and analysing other performance-related data.

Pieces of advice to female listeners

36:02 -

  • Understanding your body's menstrual cycle and its effects on your training is crucial.
  • Tracking your cycle can be done without an app, using methods like a physical calendar.
  • Avoid convincing yourself of negative symptoms just because you're in a particular phase.
  • Be objective about how you feel during different phases of your cycle, and adapt training accordingly.
  • Some months may present more significant challenges, so listening to your body and adjusting training plans as needed is essential.
  • Don't assume every month will be the same; outlier symptoms may occur but shouldn't dictate your entire training program.
  • Accumulate information about your cycle to anticipate better how it might affect your training.
  • Coaches, especially male coaches, should be aware of these considerations to support their athletes effectively. They might not have personal experience, but understanding these dynamics is crucial for effective coaching.
  • Kelly McNulty is a valuable resource in the field, and she played a significant role during her PhD in advancing menstrual health awareness. 
  • She was active on social media platforms like Instagram and Twitter, although I'm not sure if she's currently maintaining her online presence. 
  • Several initiatives are emerging to promote menstrual health literacy, especially through various companies. 
  • It's crucial to be discerning when choosing which programs to follow, as some might not be reliable. For instance, Wellness HQ, associated with Emma Ross, is a reputable source, considering her background as the former head of physiology at the English Institute of Sport and her PhD in physiology.
  • I'm currently starting to collaborate with Orico, a sports performance support company, on projects related to female athletes. 
  • These are reliable experts with the proper qualifications and experience to provide trustworthy information. 
  • Solving the menstrual health challenge will likely require the efforts of multiple groups, as it's a complex issue.
  •  It's essential to scrutinise the sources of information and ensure they come from reputable individuals or organisations. 
  • This scrutiny should apply to all aspects of athlete health, just as you would evaluate nutrition or training advice from various sources.

Rapid-Fire Questions

43:16 -

What's your favourite book or resource related to endurance sports?

"The Great Swim" by Gavin Mortimer. It's an inspirational story about four American swimmers 1926 competing to become the first woman to swim the English Channel.

What's an important habit you've benefited from athletically, professionally or personally?Commitment. It's more of a characteristic, but when I decide to do something, I'm committed to following through on it. That commitment has been a key factor in my achievements.

Who's somebody that you look up to or that has inspired you?

I don't have sports heroes, per se. I draw my inspiration from my friends, particularly my female friends who are better athletes than I am. I'm fortunate to be surrounded by incredibly talented individuals who have always inspired me. It's not about one famous athlete; the people close to me drive me to be better.


Bernardo Gonçalves

Bernardo is a Portuguese elite cyclist and co-founder of SpeedEdge Performance, a company focused on optimising cycling and triathlon performance. He writes the shownotes for That Triathlon Show, and also produces social media content for each new episode.

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