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. 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 impact 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 natural 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 progesterone 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

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