This Is Not About Menstruation

From Liza:
Well, actually, it is. We were going to wait to talk about this until we’d all been friends longer, but I spent the day after the recent Rocky Racoon 50 Mile picking up trash on the trail–including sanitary napkins, so the time seemed ripe (so to speak.)

Feminine hygeine litter at a trail race

A used sanitary napkin left just off the trail at the Rocky Racoon 50 Mile this year. Photo: Liza Howard

Now before all you non-menstruators bail, three things:

  1.  We’ll only share the highly useful stuff.
  2.  It never pays to withhold information from yourself.
  3.  All the cool guys will read the whole article.

So when I reached the 50-mile turnaround of the Leadville 100 Mile in 2012, there was a guy waiting there for me, holding a tampon in his outstretched hand. “Here you go!” he said enthusiastically, and handed the tampon to me like he was passing off a relay baton. Now, I did, in fact, need a tampon at that moment, and I had spent the entire run off Hope Pass worrying about toxic shock syndrome. So I was happy to see it, but I felt very awkward and confused accepting a tampon from a complete stranger.

“Thanks… guy.”

I grabbed it and headed back up the road–too embarrassed to run straight into a port-o-potty. I briefly thought about catching the runner in front of me and continuing the relay. (“STICK!”)

Finally I got to some cover, took care of business, and then:

  1. Left the used tampon in the ground where trash belongs,
  2. Threw the used tampon into the woods because it’s biodegradable,
  3.  Wrapped it in a wet wipe, put it in a plastic bag, and put the plastic bag in a pocket on my vest, or
  4.  Wondered what the lead male runners were doing right now and shook my fist at the sky.

Guesses, Gina and Pam?

From Gina:
I’ll go with C. I can’t quite picture you leaving it behind… but then again taking the rag for the ride doesn’t sound super appealing.

From Liza:
Indeed, yes, I “took the rag for the ride.” (Good lord, Gina! I’m not going to be able to get that phrase out of  my head now.) Leaving used tampons or sanitary napkins somewhere visible ranks high on the list of “Things You Can Do To Negatively Impact Someone’s Run/Life.” Don’t do that to somebody. I still frown and want to wash my hands thinking about the sanitary napkins and toilet paper visible from the trail at Rocky. And remember, the secluded spot or cover you found to take care of yourself will likely be found by every other woman passing–and animals.

From Gina:
Tampons aren’t really biodegradable. Most are made of rayon or cotton which takes a super long time to break down, hence, why you aren’t supposed to flush them! Therefore, leaving them on the trail, or burying them in a hole is pretty harmful to our playground. Plus it is a total eyesore. If you know your period is coming, or you have it… just suck it up and bring a Ziploc to carry it out. Mother Nature and your fellow runners will appreciate it!

From Liza:
And when I don’t care about Mother Nature or my fellow runners late in a race–when my environmental ethics and hygiene take a backseat to exhaustion and self-pity–I keep myself in line by imagining what the trail would look like if all the racers did what I was thinking about doing. If Rocky Racoon 100 Mile’s 350-plus runners all left sanitary products or toilet paper on the 20-mile loop course… “Okay! Fine, I’ll take out the dang Ziploc!!” That’s the standard, and it’s easy enough.

Before your event, put your tampon or sanitary napkin in a Ziploc bag with three wet wipes. (You can make the package smaller by using a tampon that doesn’t have an applicator.)

Carrying a tampon while trail running 1

A packaged tampon and wet wipes ready for use on the trail. Photo: Liza Howard

Use one wet wipe for wiping, one for cleaning your hands, and one to wrap everything up in. Then put it all back in the Ziploc and put it in a pocket.

Carrying a tampon while trail running 2

How to carry a used tampon off the trail and to a garbage can. Photo: Liza Howard

Feel free to shake your fist at the sky afterwards, though.

Scarlett O'Hara shakes her fist in Gone with the Wind

Scarlett O’Hara shakes her fist in Gone with the Wind. Photo is a screenshot from the film.

From Gina:
Ironically, I’ve never run into that situation. I haven’t done too many races where I’ve been out long enough to switch it up, and for the ones I’ve had a period for… it has been light enough that I didn’t have the need to change anything.

From Liza:
Well, it’s something to look forward to, then. There was one year, I think I had my period for every race I ran. I’d just dedicate a pocket in my hydration pack a to the Ziploc bag and its contents. I could have fit it into my shorts pocket, too. I’ve never timed myself (because that would be really really weird), but I can’t imagine stowing the used supplies neatly in a Ziploc bag adds more than a handful of seconds to the time it takes to do things in an actual bathroom. Sure, sure, throwing it all on the ground would be fastest, but seven seconds aren’t going to affect your UltraSignup ranking. After Leadville, I just ran with the gear in the pocket of my hydration vest from the race start. No more awkward aid station handoffs and no more agonizing about potential Toxic Shock Syndrome.

From Pam:
Oh yeah, I’ve definitely been in races wondering about toxic shock syndrome (TSS)! Fortunately, TSS is rare. TSS became a health crisis in the late ’70s and early ’80s with the introduction of superabsorbent tampons. This is recent enough for a lot of women to still have fear about this issue, though there are currently only around 50 cases per year (as opposed to 771 tampon-related cases of TSS in 1980). So I don’t think women need to live in dread fear of TSS, but some standard precautions should be followed. Never wear a tampon longer than eight hours and use the least-absorbent model necessary. Pads can be worn longer than eight hours and have not been associated with TSS, but they are certainly not as comfortable to run in.

From Gina:
There is another alternative, The Diva Cup. It is a medical-grade silicone menstrual cup that can be left in for 12 hours, emptied, and then reused. I don’t have any experience with this, but wanted to note that it is another option for women who don’t want to carry a tampon.

From Liza:
So menstruation has a fairly small logistical impact on racing and training. But have either of you noticed how hormonal levels affect your performance? And what about training? I’ve never analyzed my training or racing through the lens of menstrual-cycle hormones, which seems foolish. Pam, you’re the doctor; what do you know?

From Pam:
Well, I’ll try to make this a little better than that lesson you got in fifth grade. And I’ll keep it brief and try to make it pertinent to running! The menstrual cycle is typically 28 days, with a range from about 26 to 35 days. Day 1 is the first day of menstruation (bleeding). Starting around Day 5 estrogen levels begin to rise with a peak right before ovulation (Day 14); this is called the follicular phase. (The follicle, or egg, is getting ready for release during this phase.) After ovulation, estrogen levels fall while progesterone levels rise in anticipation of possible pregnancy (it creates a “pro-gestational” environment, hence the name); this is the luteal phase. If no pregnancy occurs, progesterone levels fall and the uterine lining is once again sloughed.

Visual representation of the menstrual cycle

Screenshot of chart at:

Okay, now that we’ve covered the basics, we can get into how these hormonal changes can affect your running. Estrogen facilitates fat utilization, but makes it harder to use glucose. This is works well for endurance workouts or racing ultras. Estrogen does, however, cause a decrease in plasma volume (up to 4%!), which is often why women feel lean or light at this time of the month. It does mean that you have less fluid reserves during this time. Progesterone facilitates glucose utilization. This means glucose is more readily available for the body’s use. This is a good time to schedule speed workouts. Because the body is less inclined to store glucose during this phase, you may need to eat more carbohydrates if you are trying to carb load. Progesterone also increases body temperature (gotta’ keep a newly fertilized egg warm!) and the temperature at which you start to sweat. Additionally, progesterone increases respiration and oxygen consumption, so you may feel like you are working harder during this phase. But many of these changes are subtle enough to not be noticed by most women. What women do notice is the rapid fall in progesterone at the end of the cycle. Mid-cycle, when estrogen falls, it is offset by the rising progesterone, but when progesterone falls, there is no sex-hormone counterbalance, leading to the dreaded “PMS” symptoms. Some of these symptoms, such as headache and bloating, can be attributed to shifting fluid volume. Progesterone increases the plasma volume, but when it falls, the body takes time to adjust. Redistributing the water causes bloating and many women feel heavy or sluggish during this time. There is also a loss of glucose availability that the body has to accommodate. I know personally, my running suffers the most two to three days before my period. Of course, it is usually not until I start my period that I realize why all my workouts have been so terrible the last couple days!

While dealing with your period can be a nuisance, Western States champion Annette Bednosky helped me find a more positive spin for this time of the month. Unfortunately, Christian and Jewish cultures have traditionally branded women as ‘unclean’ or even dangerous during their time of the month. But many Native American and African cultures attribute great power and spiritual ability during their periods. Indeed, bloating usually starts to abate right about the time bleeding begins and by Day 2, estrogen and progesterone are both low and fairly equal–a hormonal situation which is actually great for ‘powerful’ athletic performance. Uta Pipig’s 1996 Boston Marathon win and Paula Radcliffe’s 2002 Chicago Marathon course record occurred during their periods. (Certainly there are more major wins, but women often don’t make this known publicaly).

Of course, just because your hormone situation is good for athletic performance during your period doesn’t mean there aren’t other challenges, especially during ultras which may span many hours or even days. You still may be dealing with lingering PMS and bloating, headaches, cramps and of course, bleeding!

From Gina:
Wowsa’! Thanks for the breakdown, Doc! Is it bad that I didn’t really know half of that info… until now?

My body seems to have a mind of its own and plans its own schedule which is never on a cycle. The only way I know ‘it’s time’ is when my legs are sluggish, my body feels rotund, and Justin reminds me that I’m being an “emotional snapper” (to put it nicely).

My motivation to train during this week-ish-long timeframe leading up to my period is pretty absent. Last thing I want to do is be reminded of how slow I feel when trying to run uphill, and how much water I’m retaining because my spandex tights are now two sizes too small. But this is life.

The advice I have for training through your period is to think of it as if you were training in inclement weather. Sure, most of us want to race on a perfect sunny day in warm temps, but not all events are granted those conditions. So we train through the rainy, snowy, windy, and muddy days to prepare. Training through period symptoms is the same. If you can master how to get through it in training, you won’t have to worry about it come race day.

From Liza:
I like that analogy, Gina. I’m going to start adding tornado and hurricane icons to my training plans from here on out. I hope folks find this article useful. I can’t believe how we got through the whole thing with so few puns.

(PS. Good job, cool guys, if you’re still here!)

[Authors’ Note: Multiple-time USA Team member (100k and 24 hours!) Carolyn Smith, MD and Jason Karp, PhD have written an excellent book called Running for Women. We used it as a resource for this article and recommend it to anyone else who would like more information on this subject and other women’s specific topics.]

Call for Comments (from Meghan)

  • How do you manage transporting tampons and the like on long trail runs and races? What is your system?
  • Do you notice that your menstrual cycle affects your running in a noticeable way? Can you describe it?
Trail Sisters

is a group of three women, each with unique opinions, ideas, and attitudes toward all things trail and ultrarunning. Pam Smith is a mom, physician, and lover of running who lives in Oregon. Liza Howard is a mom and 100-mile specialist from Texas. Gina Lucrezi is a Colorado-based short-distance speedster exploring the realms of ultrarunning.

There are 43 comments

  1. Kim

    Well, that is the one good thing that has come out of menopause so far! But yes, I’ve had tampons and wipes (in a baggy) on more drop bag lists than I ever wanted. And yes I’ve taken the ‘rag on the ride’ too.

  2. Sarah

    PSA: the diva cup is amazing. It’s amazing for running too. Imagine going out for 6hr long run and not having to worry about leaks or bringing supplies. It’s great for working a job or having a life where bathroom breaks are irregular. It’s great for those unfortunate souls (like me, sob) that go through a super plus tampon in less than 30 min. It creates so much less waste too, and just think ladies, you only have to pay that pesky “female tax” once instead of every month. Once you try it, you’ll wonder why you waited so long

      1. Katherine

        I use a Luna Cup. I’ve worn it for running and races and it’s much easier than carrying tampons. Cups last for 15 years, although I’ve only had mine for 2, I couldn’t imagine wearing tampons again. They are so much better for running that I’ve contacted the company and suggested that they get a booth for marathon expos. Keep in mind that if you are one of the heavy flow 1-hour tampon changers, you will have to empty your cup every 2 hours or so. Light days are the 12 hour days. Cups make more sense; I don’t understand why they aren’t more popular, especially with ultra runners.

        1. Liza

          Thanks, Katherine. My guess is some of it’s squeamishness — women not wanting to have to deal with cleaning the cup — but mostly it’s being unfamiliar with it, not knowing anybody who uses it and feeling awkward about asking.

      2. Amanda

        Holy cow. I switched to using the Diva Cup 6 years ago and it has changed my life. Yes, it seems more gross to deal with, but honestly it is just as gross as tampons, there’s absolutely NO trash involved, and you can leave it in for days. Literally. My friend told me about it, and I’ve told my sister, sister-in-law, other girl friends… and they use it too. It costs $40 (ish) but lasts years. As someone who travels a lot internationally (on the back of pick up trucks for 12 hours, or on 20 hour bus rides), and does long multi-pitch rock/mountaineering routes, it is a total no-brainer. The same is true for ultras. And you honestly don’t feel it at all. I don’t mean to sound insulting, but using a tampon instead of a Diva cup is like using a Fred Flintstone car when you could drive… a real car… It is totally worth trying out.

        1. Amanda

          Sorry, it’s early- I can’t think of good analogies right now. The car analogy doesn’t do justice to the fact that the Diva cup is far more environmentally friendly than tampons/pads.

    1. Caroline

      I use a diva cup too and agree with the other commenters – life changing. But am wondering how you do deal with it if needed out on the trail. I haven’t had an ultra during a “flood” but wondering what other people do.

      1. Yitka

        Caroline, my Diva Cup usually works just fine (no leaks!) and doesn’t need any fiddling with if I’m on my period for races 50 miles or less. But if you need to do need to change it while out on the trail, I’d recommend a Ziploc bag or two with a mini bottle of hand sanitizer (for your hands, not the cup, before and after emptying it) and some squares of toilet paper. Like any other kind of human waste in the backcountry, you should dig a 6-inch deep hole in the dirt, away from water sources, and dump out the cup’s “contents” in it. Then bury them, wipe out your Diva cup with toilet paper, re-insert, pack out your toilet paper in the Ziploc, wash your hands with hand sanitizer, and get back to running!

  3. David Nowaczewski

    The Scarlett O’Hara pic is great! I read the whole thing, but don’t have much to add, except to say God bless all women, you are tough as nails.

  4. Mel

    Nice piece ladies! Coming from New Zealand, I am a bit gob smacked than anyone would think it was appropriate to leave any kind of rubbish on the trail, but seriously a sanitary pad! thanks for helping educate folks!

  5. Sarah Lavender Smith

    Great piece! I would add that the ziplock bag should be used for poopy TP too! More runners of both sexes need to get in the habit of packing a ziplock with TP, and if they have to go on the trail, they should bury their poop but be good and pack out the TP.
    It drives me nuts how so many aid station volunteers seem clueless or embarrassed when asked for a tampon by a runner who’s unexpectedly started her period during an ultra. I wish aid stations would stock tampons and hand them out with a smile, not a wince! I got my period unexpectedly in a big way around Mile 15 during my first 50-miler — I looked down and had an “oh shit” moment upon seeing heavy bleeding, and no tampons were available at the aid stations. I had to make do with wiping up with gobs of paper towels. Sorry, now try to erase that image from your mind!

  6. Tovi

    Ok, I’m a guy but I have to chip in about the Diva Cup. My wife decided to test it a few years ago and now swears by it and would never go back to tampons. Safe, reusable, environmentally friendly and would totally solve most issues for ultra and trail running females. You also save a ton of money!

  7. Jessica

    The DivaCup (and Instead Softcups before it) totally changed my life. I basically don’t notice that I’m on my period now except for twice a day (and cramps, of course). But it’s made running WAY more comfortable, especially longer runs and races.

  8. Sarah

    Shout out to Thinxx underwear as well! If you’re gonna wear underwear anyway, I’ve found them to be a good solution for running (or doing anything) during my period.

  9. Amy

    Another menstrual cup user here. I use a lunacup. I was interested in them for a long time but forced to look into other options after I gave birth and tampons were suddenly blindingly uncomfortable. I highly encourage any menstruating person who is interested in them to go for it. It’s not nearly as awkward or messy as you’re imagining it to be. This website is a fantastic resource:

  10. Ellie G

    Thank you ladies for the usual entertaining and informative read. Apparently I might have put at least one Strava follower off when I entitled a recent run ‘Period Pains, P***ing rain and Quads from hell’, my attitude was ‘well ok, but next time you go on a run I don’t want any mention of a headache or food poisoning or anything similar affecting your run – I just want you to get on with it, no grumbling’. I will spare everyone the details of finish line drugs testing pee samples in a bathroom stall with drugs admin watching (why does anyone ever apply for that job posting). Look forward to the next month Trails Sisters column.

  11. Lori

    Ok, so the info about hormonal changes during the cycle is interesting. I personally have not had to deal with the actual menstruation during a run, because I had a hysterectomy approximately 10 years before I began running. However, I still have all the hormonal fluctuations.
    One other thing that is sort of on the topic, that I am wondering, especially from the doctor, is how menopause and perimenopause affects running? It seems like to me, the unpredictability of it is the biggest thing…

    1. Pam

      Yes, unpredictability would certainly be a major issue. In peri-menopause, the cycle can become irregular, which leads to that unpredictability. The reason for this is decreasing ability for hormone spikes. During this time estrogen drops, so perimenopause/menopause would be more like the low estrogen parts of the cycle. But the continuously low estrogen state can lead to estrogen “withdrawal” which comes withers own set of symptoms. By full menopause, estrogen and progesterone should be consistently low. While women’s endurance performances don’t drop off as early as men’s, menopause is often accompanied by some drop in endurance performance.

  12. Lauren

    To get back to the original question I thankfully have nevver ever had my period during an event. Never!

    Recently, the week leading up to my period I felt super energetic and strong. Even the first and second days were ok. I was like, Yeah! The third day I woke up and felt like I hit a bus. What gives? The fourth day was similar but the hitting the bus feeling was much less.

    I will have to look into this cup thing just for day to day use.

  13. Alejandrina

    As a runner who was racing at the Rocky 50, I had the pleasure of “Taking The Rag On The Ride”. Since I have been adjusting my Ketogenic diet a bit, my period was late and therefore it started the night before the race, when it should have started the week before(DAMMMM IITTTTTT!!!) In deciding to register for Rocky 50 the plan was that I would have Great power and a Spiritual ability during my first 50 race. When my period arrived, I figured it is what it is, so suck it up and go Race. As a proud user of the Diva cup, it is well worth the money in the long run, plus easy to use.
    When it came time to empty “the Contents” of the cup around 6 hours into the race, I just found an area off the trail, did my thing, rinsed my hand with water, used a small portable hand sanitizer and went on with the race. Plus the only ones cleaning up after “my contents” is all the bugs or critters out there, I was Thinking of you, LIZA, plus all the other volunteers. Using a Diva Cup is environmentally friendly plus the volunteers would never notice “the contents” on the trails as pads, and tampons do.

    For my Rockhopper Family (LIZA) and any other female out there, I highly suggest to use this product, plus if you order with the link below through Thrive Market, it’s only $24.95. Diva Cup is the best gift to give to a young women to help save her money for all those years of having a Period.

  14. A

    I’ve been using the diva cup for the past 10 years, including backpacking and running. There is still some seepage so I recommend a thin liner. There are also companies that sell underwear designed to snap in a washable pad/liner. This could be a possibility for menstrual cup plus this underwear. Looks like a business opportunity to design a good running brief with a washable pad that can be snapped in.

  15. Jennifer M

    Solution to all of this: the diva cup (or any other type of menstrual cup). They last longer, no evidence is left (pull cup out, dump blood out, put cup back in), and blood is biodegradable ;)

  16. Valeria

    Thanks a lot for covering the issue, I’m definitely getting that book you suggest. My experience is pretty much the same as Gina’s – I know I’ll be getting my period in a week or so when even the easiest run feels like a desert marathon (for the temperature too, I get terribly hot and it kills me!). BTW I use the Moon cup and I’d never go back to using pads/tampons, especially during long runs. I must say though that one of my pre-race anxieties when on my period is not having inserted it properly – so I always have to wait for exhaustion to set in and give me a very liberating “whatever, I’ll bleed all over the place” attitude – luckily this has never happened :) the Moon cup always works its magic

  17. Lynette

    I’ve been using the Diva Cup for about 15 years (2 years before I started ultras). I love it!

    I’ve run several ultras and long training runs while on various phases of my period that being on my period is no longer a concern, issue or fear.

    With the Diva Cup, on my heavier days and/or during a 100 mile race, I will need to empty the contents during a race/run. If this has to occur in the woods, it is super easy to remove, empty and replace. If water isn’t available (from a sream/creek) to rinse my hands, water from my hydration hose of my bladder does the job well. (I always wonder if some male woodland creature will get some sort of pleasure when he discovers the aroma of smells I left behind.)

    The Diva Cup does take some practice, at first. But if carrying pads or tampons (unused and used) seem like a hassle or if you are just worried about possible chaffing from them. I recommend giving a menstrual cup a try.

    Happy running, any time of the month!

  18. Rachel

    And if all else fails, those big soft leaves on plants called lamb’s ears can be stacked in a tidy pile in the undies. They are comfortable, absorbent, affordable, and can be tossed back into the woods from which they came, at a decent distance.

  19. braided

    Sort of late to the party here, but one issue I’ve always had with running and menstruation has been cramp management. I’m extremely leery of taking NSAIDs and other pain pills while running, yet I get killer cramps that literally leave me unable to run comfortably. I’ve popped ibuprofen at a few ultras for this reason, against my better judgment.

  20. sam

    Seriously, ditch the tampons and use a mooncup or softcup instead – not only is it way better for managing things whilst running ultras (for example you can put a mooncup in in advance if you think your period will come on during a run or race…) but it’s also hugely better for the environment all round. Mooncups in particular – you buy one and it lasts…forever (as long as you sterilise it properly).

    ‘Roar’ by Dr Stacy Sims is a very interesting read on female athletic performance (and some hacks for ameliorating troublesome symptoms).

  21. Christine Cozien

    I guess a factor to consider when considering different women’s experiences of performance in relation to their cycle is whether or not they are taking hormonal birth control.

    I stopped taking hormonal birth control 2 years ago (switched to copper IUD and have become much more aware of the physiological changes implied by my changing cycle. I definitely notice that I log my best efforts/ drop the most hammers around mid-cycle/ ovulation. I also know that I experience fatigue and low energy in the 3 days leading up to my period, and I therefor don’t race in the week leading up to my period if it can be avoided, but will race once I’ve started menstruating. I often wonder if other women experience similar things.

    And I must echo those above – change to an M-cup

  22. Moira

    This was great, thanks! I also think the suggestion about lamb’s ears above is brilliant! I see someone else already mentioned: Thinx are great for those who don’t or can’t use cups (they make shorts as well as underwear)! But what I really want to do is sing the wonders of baking soda! If you add a bit to the bag you plan to put your pad or tampon in it will completely cut the smell. This is most useful on overnight backpacking trips but it also really decreases the “ick” factor for shorter distances!

  23. Wren Paige

    Hi Great article! I’ve been waiting awhile for a forum about this topic. As an older 50+ runner I thought the younger women in the sport were all on ‘the shot’ which came after my youth. It’s nice to hear that we’re all still struggling together. I nearly passed out when I ran a half marathon on the 1st day of my cycle a few years ago. Now I’m trying to schedule races so they don’t fall on my period. LOL! I plan for that time of the month, 3-4 days, as a rest ‘period’ (no pun intended) or taper. Kudos to those of you who are stealthy enough to run through it. I too ran through it until my 40’s when the whole thing just caused more wear and tear on my morale and body… some months are less severe and now moving through menopause I have better stores of energy now that my cycles are subsiding. (I thought Chrissy Moehl in her book about ultra running planned tapers every 4 weeks because of the female cycle.) Thanks again for sharing this. It’s good to share how others are coping during moon lodge.

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