Hi Hazel, my name's Ruth. I have been a long-term fan of the podcast and Everything Food Medic.

My question is around the increase in discussion and emerging research related to the menstrual cycle and how this interacts with training, with nutrition, with recovery, etc., etc., which I think is fantastic. I think it's brilliant that

there is more conversation and more research in this area. However, as someone who is on the pill,

sometimes this can all feel a little bit unrelatable. So my question is around how the pill

interacts with training, recovery and whether this completely writes off

any impacts that a normal menstrual cycle would have, or whether there are other impacts that

the pill can have on these things. Thank you.

Hey Ruth, great question. And yes, you're correct in that when we do have these conversations,

we're largely discussing naturally cycling women, so women who are not on any form of hormonal

contraception, which obviously leaves out a huge proportion of women. So I absolutely hear you. So, as you know, there are many different types

of hormonal contraception and each work in a slightly different way. So they may have

progesterone and estrogen known as combined contraception such as the pill or progesterine-only

contraception options.

Now, the combined pill works by suppressing the natural estrogen and progesterone in our bodies,

which means that the hormonal fluctuation that would occur with a regular cycle doesn't happen.

And because of this altered hormonal profile, it's likely that hormonal contraception might influence how women perform, train and recover compared to those who are not on hormonal contraception.

But what does the evidence say? Well, basically, what we know is not very much and it's very conflicting.

But that said, a recent systematic review and meta-analysis by Kirsty Elliott-Sale, who has

published lots of papers in this field, found that some women who use oral contraceptives

might see a very small decline in their performance compared to naturally

menstruating women. However, the effect size was small and the studies weren't great quality. So the

authors really did emphasise that the focus should be on the individual's response, as some people

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