Cramp cocktails and apps - how rugby tracks 'fifth vital sign'

If you scan the drinks menu at your local bar, you're very unlikely to see 'Sylvia's Cramp Cocktail'.

But if you're Erica Jarrell-Searcy from the USA women's rugby team and you're on your period, you might want to order one.

This is among the ways teams have been trying to ensure their players are able to perform at the highest level throughout their menstrual cycle.

As the Women's Rugby World Cup takes place over five weeks, the female athletes that reach the final will have competed while managing one or two menstrual cycles.

From encouraging players to fill out daily questionnaires to logging their cycles in an app, BBC Sport looks at how rugby has been tracking periods and why?

Period symptoms such as fatigue, cramps, hormonal fluctuations, and digestive issues can have an impact on strength, endurance, focus and recovery.

According to the BBC's Elite British Sportswomen's Study 2024, 88 out of the 143 athletes who responded said their performance had been affected by their period, while the same number missed training or a competition because of it.

By keeping track of a player's menstrual cycle, teams can make adaptations to training or nutrition if necessary and it is also a key indicator of overall health.

"A lot of people describe our cycle or our period as the fifth vital sign of a female," said Abi Okell, a former player and now lead rugby physio of Sale Sharks Women.

The other four vital signs for a female are temperature, blood pressure, pulse and respiratory rate.

"If you know you're having a regular menstrual cycle, then essentially you are healthy, your body is willing to be able to procreate because it knows you can grow a human," added Okell.

"The main things that we look for is that they are tracking day one of their bleed."

Okell said she prefers players not to use contraception that takes away a natural period, such as the contraceptive pill, because players lose the fifth vital sign as they are getting a withdrawal bleed, rather than a menstrual period.

England winger Abby Dow said her team normally sit down once or twice a year to discuss periods, especially when they have a big tournament, or when new players join the squad.

"Rugby as a sport isn't going to wait for you if you are on your period and no-one is going to tackle you easier because you are bleeding," the 27-year-old told BBC Sport.

"We recap and talk about how we handle it (a period) as an England team and what we can expect.

"The talk will normally be broken up into the stages of the cycle and our physios and doctors will go through and explain what physical symptoms we could be feeling."

There are four main stages of a menstrual cycle; menstrual phase (period), the follicular phase (egg follicle growth), ovulation (egg release), and the luteal phase (preparation for pregnancy).

England's Red Roses also have a wellness monitoring form that players are encouraged to fill in and Dow added: "I think a lot of us also personally track.

"We also went through a stage of having ovulation tests, so we were peeing on sticks to work out how consistent our ovulation is."

In her team, USA second row Jerrell-Searcy said: "Every morning you fill out a form saying, 'I'm this sore, I'm in a great mood or a bad mood'."

A saliva test is also a reliable way to show a rise in oestrogen levels, which happens before ovulation. This is vital sign to show a women's body is healthy.

Other teams adopt different tracking methods, with Wales using Vodafone's Connect app which has GPS trackers - placed in the players' shirts - combined with data collected on their performance, menstrual cycle phases and mental and physical wellbeing.

Their players also get daily monitoring questions on the app.

After the physios and doctors have looked at the data, adaptations can be made in training, which could include a reduction of intensity, taking out extra conditioning or in a lot of cases adding extra mobility sessions in the warm-up.

"It's about working out how can we maximise ourselves and when you are not feeling so great [bleeding], how can we adjust things like the gym to suit you," explained Dow.

"You are not going to get PBs [personal bests] and that is OK.

"The coaches are not going to go, 'can you push?', because we know that that isn't going to happen and that isn't something to be frowned upon."

Jarrell-Searcy, 26, said her team's coaches are "very careful with our numbers and pushing into what they call, the red zone".

The red zone can be seen where a player is in a state where they are fatigued and more at risk of injury through tiredness.

"It's cycle informed, but it's not as cycle mediated," added Jarrell-Searcy.

This means the menstrual cycle doesn't control what adaptations are made, it just influences decisions made by the professionals.

The menstrual cycle is personal, so often the physios will monitor the player during the sessions and games, but it is unlikely they will sit out training or a game.

"The perception of a period can take over, but when the players have their rugby head on, they tend to be focused and pretty involved," said Okell.

Regardless of periods, Jarrell-Searcy added the game schedule stayed the same and a bleed was "not going to make or break you as an athlete".

There are other things to aid players during stages of their menstrual cycle.

Clubs have nutritionists who can use the tracking data from players to help prepare the body for the bleed and ensure they get enough nutrients before, during and after sessions.

For example, an athlete will eat more carbohydrates to give them the energy stores they need.

"Some athletes will have a heavier bleed than others and we have to look at whether they will need some medical intervention in terms of adding in tablets." added Okell.

This would give athletes more vitamins and minerals they might lose during a bleed.

She added: "We're not men's athletes, so we need to more so than just 40g of protein a day every day."

"It's not like this like 24-hour cycle that they (men) get to have," said Jarell-Searcy. "We do need to be aware that you have to increase your intake of certain things and your behaviour around recovery to accommodate your hormonal fluctuations."

Players also take things to try to minimise the pain of cramping in the stomach so they can continue to perform.

This includes 'Sylvia's Cramp Cocktail' - named after a former member of the USA medical and physio team - which is a mixture of vitamins and minerals designed to replace those lost during a bleed.

"You just take it and then tough it out for the the next 20 minutes until it kicks in and then you're OK to train," revealed Jarrell-Searcy.

No research shows there is any particular time a player is more at risk of injury during the menstrual cycle.

"We can injure ourselves on every day of the menstrual cycle," said Okell.

"It's really hard to say that players are getting injured in the phases without the specific hormonal testing."

According to a study conducted by the National Library of Medicine, 'a causal relationship has not yet been established', to whether a menstrual cycle is related to injuries.

However, Okell said there may be a link between injury and the lack of confidence to move freely for fear of leaking on their shorts.

She explained players "change their movement patterns and the way they do things that can potentially cause an injury risk".

"We would promote this is something we don't need to be fearful [of] and hold yourself back or not do a particular training," added Okell.