For professional surfer Tyler Wright, excruciating period pain has been an unfortunate and often exhausting reality since her teenage years.
This month, the two-time world champion revealed she had been hospitalised, bed-ridden and unable to eat due to period pain just three days out from a World Surf League competition.
"At times, it’s deflating physically and emotionally, feeling like you have no say in it," she wrote on Instagram.
"Managing my period has been a journey."
Wright said she had struggled with her period since her teenage years and said when she was younger, she had not realised it "wasn't normal" to suffer "monthly excruciating pain that would lead to passing out, vomiting, and hours on the toilet".
Wright said she now works with a team of specialists and follows a customised program based on four menstrual stages.
She said while she remains heavily reliant on painkillers while menstruating, her program also involves "listening to her body" and careful planning.
"Even if that means less time practicing in the water before comps, prioritising sleep and recovery leading up to my period, and being aware this is the time I am at highest risk of injury," she wrote.
The concept of training in accordance with the menstrual cycle has been gaining traction in recent years, with athletes increasingly tracking their periods in an effort to work with - not against - them.
So how can you structure training around your period, is it really effective, and can it improve performance?
How can periods impact athletes?
Tyler Wright's story is an example of extreme symptoms, but the impact of periods and the menstrual cycle can vary from person to person.
Rachel Harris is leading the Australian Institute of Sport's Female Performance and Health Initiative, based on improving education and women's health literacy among female athletes, coaches and staff.
Dr Harris said symptoms throughout the menstrual cycle can be physical, mental and emotional.
"For some women, they have quite negative symptoms at different parts of their cycle; it might be pain, heavy menstrual bleeding, (or) significant headaches," she said.
"It can even be things like a change in mood, and some women do have significant mental health issues along with changes in hormones."
Dr Harris said those who have conditions such as polycystic ovarian syndrome or endometriosis or are on hormonal birth control can have additional symptoms.
Former AFLW player Tiarna Ernst (left) is an obstetrician, gynaecologist and fertility specialist, and says understanding their menstrual cycle can be a "superpower" for athletes. Source: AAP / Daniel Pockett
Dr Ernst said she was frequently impacted by periods while playing for the Western Bulldogs and Gold Coast Suns.
"The significant strenuous activity resulted in me having lots of period pain … I used to describe it as (feeling like) my uterus was falling out," she said.
"I've definitely first-hand experienced period pain, and I think that did impact on my performance on game day."
Dr Ernst has worked with City Fertility to establish Ignite Athlete, an online platform that provides information and research on the menstrual cycle and other medical factors that can impact athletes and women across elite, amateur, and social sports.
She believes understanding the menstrual cycle can be a "superpower" for athletes, but it has not been studied or understood enough in the past.
Dr Ernst said only six per cent of sport and exercise studies have been focused on women.
"All women are designed to have periods, that is something we can't stop, so I think it is a superpower, in fact, if we have the ability to understand more about the menstrual cycle and where potentially performance may be improved," she said.
"We may actually find preferred windows of training and optimising performance; I don't think it's a bad thing at all."
What is cycle syncing and can you train around your period?
While the symptoms can often be challenging, Dr Harris said the menstrual cycle can also be harnessed to maximise performance.
"There are actually other women who feel really great ... some women feel more powerful or feel like they have better endurance at different parts," she said.
"One of the big things we need to remember is our menstrual cycle can certainly have positive impacts as well as negative impacts."
Australian surfer Tyler Wright says she follows a customised training program based around her menstrual cycle. Source: AAP / Aaron Hughes / PR image
On TikTok, #cyclesyncing has almost 300 million views, while #cyclesyncingworkout has nearly 13 million.
During the last FIFA Women's World Cup, the winning US team tracked their menstrual cycles and adjusted training and recovery accordingly.
The menstrual cycle has four phases; menstruation, follicular, ovulation and luteal.
While video tutorials on social media offer generic advice and information, Dr Harris and Dr Ernst both advise athletes to track their cycle and symptoms for several months.
"The hormones fluctuate at the different times of the cycle … some women might say, 'I'm really good at doing skills at this time of the month', or 'I feel really strong, I feel really powerful, I'm going to push it at the gym'," Dr Harris said.
"The important thing to remember is that is really individual; if we have a group of 100 women, we can't say all 100 of them are going to have those same feelings at different times of the cycle."
Dr Harris said athletes like Tyler Wright or triathlete Emma Pallant-Browne - who recently went viral online after a photograph was published showing her bleeding during a race - are helping reduce the taboo around periods.
"Women don't generally like to talk about that ... often women are embarrassed to talk about it, and there's a bit of shame involved," she said.
"I think it would be great if (the narrative) does change, but it certainly does have a long way to go ... one of the really big things we need to be doing is normalising these conversations."
