Horses for courses: Supporting female athletes through applied practice and research

Dr Kerry McGawley

December 4, 2023


The sports scientist’s job isn’t to provide references, it's to effect positive change

By Dr. Kerry McGawley

In his 2016 editorial in the International Journal of Sports Physiology and Performance,1 Professor Aaron Coutts uses Nobel Prize recipientDaniel Kahneman’s best-selling book Thinking,Fast and Slow to conceptualise the relationships that exist between research and practice within high-performance sport. Coutts describes the daily work of the sports science practitioner as the faster-thinking system, operating in unison with coaches and athletes to deliver innovative, efficient, and effective performance programs. By contrast, the sports science researcher represents the slower-paced system; one that is deliberate, logical, and laborious. In an ideal world the two systems – and each person within those systems – will work together harmoniously, despite differences in priorities, agendas, and even opinions.


Right now, we have a golden opportunity to work constructively together as we coordinate our fast- and slow-thinking systems to support female athletes. Females are usually the disadvantaged sex in sport, so our responsibility to collaborate effectively somehow feels even more important.


Sex differences in sport are complex and include biological, psychological, sociocultural, and sport-specific factors.2 Within sporting contexts, girls and women receive significantly less financial investment, media coverage, exposure to role models, opportunities to compete/participate, allocation of facilities, coaching/practitioner support, and representation in research compared to their male counterparts. However, we’re experiencing a shift in sex and gender dynamics, with equality now at the fore in many cultures. This movement has been reflected in sport, where we have seen a notable rise in the support of female athletes. Major efforts are now being made to better understand and manage the effects of female hormone cycles, menstruation and menstrual disturbances, contraceptive use, pregnancy and post-partum, menopause, and female anatomy on training, performance, and health.


Sex-specific challenges are necessarily and concomitantly being approached by innovative, solution-driven sports science practitioners acting“fast” to support high-performing athletes, coaches and physicians, and methodical, systematic sports science researchers working “slowly” to prioritise scientific rigour and control. Just as laboratory-derived data can help to inform field-based practice, so too can field-based data help to inform novel laboratory studies, which in turn can provide mechanistic explanations for real-world observations. Rather than functioning as mutually exclusive silos, the combination of fast- and slow-thinking systems will elevate and accelerate our knowledge and understanding of the complex challenges that face female athletes (Figure 1). This collaborative process can also help us to educate and empower more girls and women within sport.

Fig 1


Figure 1. Examples of the “fast” and “slow”work carried out by sports science practitioners and researchers, respectively.


When supporting female athletes, practitioners need to consider the best available scientific evidence alongside extensive individual training, performance, health, and well-being data.3 In the absence of specific scientific studies, practitioners use mechanistic principles and athlete data – often collected over several years and seldom published – to support decision making on the ground. Tracking individual menstrual cycles and symptoms is paramount in this context, as individual databases provide a wealth of subjective information for practitioners to base recommendations upon. It’s neither necessary nor realistic to underpin each field-based decision with a well-controlled, high-quality, peer-reviewed study. The sports scientist’s job isn’t to provide references, it's to effect positive change. Highly skilled practitioners incorporate science into the daily support of individual athletes by assimilating a vast amount of objective and subjective information, often in high-pressure environments, to provide effective solutions.


Researchers have been investigating the effects of the menstrual cycle and hormonal contraceptive use on athletic performance for at least 30 years,4yet more high-quality research is still needed to better support female athletes.5,6 However, research is slow and female athletes are suffering with adverse menstrual cycle symptoms now, with many perceiving their menstrual cycles to negatively affect training, performance and well-being.7,8Athletes need immediate help to alleviate symptoms and overcome these negative perceptions. In practice, sports scientists adopt a trial-and-error approach to test a range of strategies that haven’t typically been investigated under controlled experimental conditions in elite athlete populations. These experimental management strategies are implemented while adhering to the overriding principle of First do no harm.9Often a placebo effect, or the psychological benefits of simply working through an issue with an experienced practitioner, can be as useful as any physiological mechanism. Indeed, athletes’ beliefs and expectations about an intervention or treatment can produce powerful performance-enhancing effects and these should be seen as real effects to be harnessed.10


This is a call for sports science practitioners and researchers to acknowledge the usefulness and application of each other’s work, and to collaborate supportively and respectfully as we pursue the common goal of helping female athletes. There’s a place – and a pressing need – for the fast- and slow-thinking systems to operate effectively together in this area of sports science.




1.    Coutts A.J.(2016) Working Fast and Working Slow: The Benefits of Embedding Research inHigh Performance Sport. Int J Sports Physiol Perform. 11(1):1-2. doi:10.1123/IJSPP.2015-0781

2.    Hallam L.C.& Amorim F.T. (2022) Expanding the Gap: An Updated Look into SexDifferences in Running Performance. Front Physiol. 12:804149. doi:10.3389/fphys.2021.804149

3.    Bruinvels G.,Hackney A.C. & Pedlar C.R. (2022) Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance.Sports Med. 52(7):1457-1460. doi: 10.1007/s40279-022-01691-2

4.    Lebrun C.M.(1993) Effect of the Different Phases of the Menstrual Cycle and OralContraceptives on Athletic Performance. Sports Med. 16(6):400-30. doi:10.2165/00007256-199316060-00005

5.    McNulty K.L.,Elliott-Sale K.J., Dolan E., Swinton P.A., Ansdell P., Goodall S., Thomas K.& Hicks K.M. (2020) The Effects of Menstrual Cycle Phase on ExercisePerformance in Eumenorrheic Women: A Systematic Review and Meta-Analysis.Sports Med. 50(10):1813-1827. doi: 10.1007/s40279-020-01319-3

6.    Elliott-SaleK.J., McNulty K.L., Ansdell P., Goodall S., Hicks K.M., Thomas K., Swinton P.A.& Dolan E. (2020) The Effects of Oral Contraceptives on ExercisePerformance in Women: A Systematic Review and Meta-analysis. Sports Med.50(10):1785-1812. doi: 10.1007/s40279-020-01317-5

7.    Solli G.S.,Sandbakk S.B., Noordhof D.A., Ihalainen J.K. & Sandbakk Ø. (2020) Changesin Self-Reported Physical Fitness, Performance, and Side Effects Across thePhases of the Menstrual Cycle Among Competitive Endurance Athletes. Int JSports Physiol Perform. 15(9):1324-1333. doi: 10.1123/ijspp.2019-0616

8.    Armour M.,Parry K.A., Steel K. & Smith, C.A. (2020) Australian Female AthletePerceptions of the Challenges Associated with Training and Competing whenMenstrual Symptoms are Present. Int J Sports SciCoach. 15(3):316-323. doi: 10.1177/1747954120916073

9.    ACOG ClinicalPractice Guideline No. 7. (2023) Management of Premenstrual Disorders. ObstetGynecol. 142(6):1516-1533. doi: 10.1097/AOG.0000000000005426

10. Halson S.L.& Martin D.T. (2013) Lying to Win – Placebos and Sport Science. Int JSports Physiol Perform. 8(6):597-9. doi: 10.1123/ijspp.8.6.597

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