Run Well by Juliet McGrattan (reading books for 5 year olds .TXT) 📕

6 At the top and back of each testicle, you will feel a soft, stringy, lumpy area called the epididymis and a firmer, longer, thinner spermatic cord. These are a normal part of the anatomy.

7 If you notice any lumps, changes in size or consistency of the testicle, or any painful areas, then see your doctor.

Q My menstrual cycle really seems to affect my ­running performance. Is this possible?

A There is an under-representation of women when it comes to sports medicine research so questions like this are difficult to answer. A review in the British Journal of Sports Medicine in 2017 found that over 6 million people were included in exercise research studies between 2011 and 2013 and women made up only 39 per cent of that total. Most studies looking at the effect of the menstrual cycle on performance have been carried out with elite athletes as the participants. Measurements such as their oxygen consumption, heart rate and lactic acid production have been monitored, and there’s little convincing evidence that performance alters at different times of the cycle. However, if we look at different measures, such as energy levels and motivation, you’ll be hard pushed to find a menstruating woman who doesn’t report that at certain times of the month running is harder than at others. A study of over 1000 women running the London Marathon in 2015 found that nearly one third of them felt that their menstrual cycle affected their performance and training. With the increasing number of women running and the topic of periods thankfully becoming less taboo, there’s more research going on in this area and in non-elite athletes too. Hopefully we’ll soon have a much clearer picture of the possible effects and how to counteract them.

Generally, most women report they can run well from the second or third day of their period through until mid-cycle. This seems to be a good time to do high intensity interval and sprint work. Around mid-cycle there is an increased risk of injury, particularly the cruciate ligaments in the knee, probably due to hormonal softening of ligaments. The second half of the cycle seems to be better for endurance runs, but towards the end of this, when pre-menstrual symptoms kick in, motivation and speed take a downturn and body temperature rises. This is a good time for easier runs and cross training. It is a very individual thing and finding what works for you takes time.

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Tracking your menstrual cycle

If you’re interested in seeing how your menstrual cycle affects your running and training, then start keeping a record of your activity. You can use a simple written diary of your runs. Note down how you felt and any problems you encountered. You could also rate your energy levels, average heart rate and pace. Tally this with your periods and see if there is any pattern throughout the month. There are several menstrual cycle tracking apps available which offer advice on what changes you can make to work with your cycle.

Q My period is due on marathon day! Is there a way I can stop it coming?

A How frustrating! It is possible to delay menstruation using hormonal medications. If you already use the combined oral contraceptive pill and the marathon is falling during your usual pill-free break, then it’s easy. Miss the break and carry straight onto the next packet. Be aware that if you use a pill which has seven inactive pills instead of a pill-free break, then you will need to miss out the dummy pills and go straight onto the active pills in a new packet. If you take a pill that has different hormone content on different days (known as a phasic pill) then you should get advice from your practice nurse or a family planning clinic to make sure your contraceptive cover is maintained.

If you aren’t on the pill and simply want to delay this period as a one-off, then there is only one drug licensed for this purpose in the UK. It’s a progesterone called norethisterone. This is available from your GP and some pharmacies offer it too. You will be asked questions to check it is suitable for you and the possible risks of deep vein thrombosis should be assessed and discussed. Norethisterone needs to be started three days before you expect your period to begin and taken three times a day until after your marathon. You can expect a bleed within three days of stopping it. However, it might not help you perform at your best as it can cause bloating, sluggishness and tender breasts in some women. You could look at using the combined oral contraceptive to control and delay this period, but ideally you would need to start it at least a month or two before the marathon, because irregular bleeding is common in the first few months.

Remember that no method is guaranteed to stop your period and there’s no evidence that athletic performance is affected during menstruation, so unless your bleeding is heavy and unmanageable then you may prefer to pad up and run. If heavy periods are frequently affecting your running and racing plans, and you aren’t planning to get pregnant, then have a chat with your practice nurse about contraceptive options that might reduce or eliminate your heavy periods.

Q My periods are really heavy, but I don’t want to take hormonal contraception. What can I do to stop them affecting my running?

A Many runners have heavy periods. A survey of over 1000 women at the London Marathon in 2015 found that 35.5 per cent of them met the criteria for heavy menstrual bleeding (HMB) and less than half of them had sought medical help for the issue. Interestingly, elite marathon runners were included in this study and 36.7 per cent of them had HMB and just over half said their cycle has