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It’s time to talk about periods in sport

Linda Pearce looks at a new education program from the AIS, the Female Performance and Health Initiative that addresses how periods and pregnancy impact performance.

It started with a confession. A light-hearted one. Sitting with Olympic diver Anabelle Smith at the Melbourne Sports and Aquatic Centre, this 35-year veteran of sportswriting admitted to a personal first: an interview about menstruation.

Nor was it familiar territory for Smith, although—just as the world is awakening to the importance of women’s health in optimising performance and avoiding injury—the Rio bronze medallist is becoming more accustomed to discussing what has, until recently, been a subject mentioned only sparingly.

Just as mental health is no longer taboo, it’s time to talk about periods in sport.

When they stop and why. How commonly they are managed with hormonal contraception, and how necessary that is, or isn’t. The risks involved. The myths. The pain and whether it should be tolerated—the answer is no, for it may be a symptom of other conditions. The impact of the monthly cycle on performance, which is a work in progress. And the potential longer-term implications.

Period talk beneficial for Australian sport

The education process is being led by the Australian Institute of Sport through its Female Performance and Health Initiative. Launched this month, it is designed to provide information about an area that has been chronically under-researched and discussed.

“Every female goes through the same challenges; as much as we’re all different and our bodies are all different and we’re never going to look the same we all go through similar things,’’ says Smith, also a triple Commonwealth Games and former world championships medallist. 

“So people who are fearful of having conversations don’t realise the person next to them is probably having the exact same thoughts, and if we can open those channels and reduce the stigma around talking about female health issues, I feel there’ll be a lot more success in avoiding problems down the road.

“The more everyone is on the same page and athletes can feel safe and comfortable in that space and talk about anything, then I think it’s just going to be very beneficial for Australian sport.’’

The project lead is Dr Rachel Harris, the Chief Medical Officer for the Australian Paralympic and national water polo teams, who has helped to develop seven menstrual health education modules to assist athletes, coaches, parents and support staff.

Part of the aim is to make what have often been hard conversations a lot easier—especially when one considers that around 90 per cent of Australian high performance coaches are male. “That’s just the state of play in Australia and the world at the present time,” says Dr Harris.  “But having said that, a lot of our female coaches also need education in this space, too, around what is normal and what isn’t.

“We absolutely know that things like menstrual dysfunction can impact people from a psychological perspective. But also, say, if you have endometriosis and you’ve got lots of pain, or if you have heavy bleeding and it interrupts how you’re training and competing, it’s going to have an impact on performance.’’

The phase one modules cover the truths and fallacies around the menstrual cycle—including an explanation of RED-S syndrome, which is the mismatch of the amount of fuel coming in with the energy being expended, which increases both the incidence of injury and illness, and the likelihood of longer-term consequences such as bone strength and fertility. Other subjects include hormonal contraception options and puberty. 

The second phase, coming later in the year, delves into areas such as breast and pelvic floor health, plus returning to sport after pregnancy, with Dr Harris noting approvingly that even the fact that the latter is increasingly relevant is a positive sign of the times and a nod to the greater support contributing to lengthening elite careers.

Potential for performance improvements

The word is already spreading: here and abroad. Following the lead of the world champion US national soccer team, Chelsea Football Club and the English national team have been tracking menstrual cycles and adapting training and diet accordingly, taking into account issues that can contribute to soft tissue injuries—the link with ACL tears is already well-documented—in what has been described as a “bespoke” approach to tailoring individual programs. Closer to home, the Brisbane Lions AFLW team is also on board, monitoring recovery and cycle-related data, and seeing the potential for improvement in performance and injury-prevention.

Among teens, anything that can assist with maintaining participation rates—especially in these Covid-impacted times—is important, too. Body-hugging leotards and swimsuits may be part of the issue, or the fear of wearing cricket whites during heavy menstrual bleeding. 

“It’s such a hard time for anyone, going through adolescence, but there’s a lot of other factors going into it as well, and if you’re also worried about how your body looks or you’re worried about your uniform, it can be a real challenge,’’ says Dr Harris.

Netballer Beryl Friday recently added another element—the Indigenous kind. She tweeted in early April after a disappointing post-period gym session and a conversation with a teammate that she would be interested to know if there was indeed a link between menstruation and training performance. 

A long Twitter discussion followed, to which an appreciative Friday added: “Periods can be such a shame topic in our mob, it’s often not discussed openly and contraceptive use can even be frowned [upon]. I myself don’t even feel openly comfortable talking about periods with my own mother and sisters in the vicinity of my brothers and dad. Let’s remember this before we treat our Indigenous girls the same as everyone else.”

A long overdue conversation

On a personal note, being involved in writing three AIS athlete case studies provided some fascinating insights. Not just from Smith, who ended up in hospital with blood clots as a side-effect of the contraceptive pill, and now opts to deal organically with the regular mood swings, fatigue and other impacts of her monthly cycle rather than trying to manage it with artificial hormones.

There is also four-time world champion para-cyclist Emily Petricola, who is balancing severe PMS with Multiple Sclerosis and thus requires methods of contraception that assist with the former while not exacerbating the symptoms of the latter, and notes wryly that sometimes it’s tempting just to wish for an early menopause.

Yet the most dramatic story is that of Laura Harding, the 2018 world junior sailing champion who kept asking her doctor why she was not menstruating despite being in her late teens. Tired of being fobbed off, she eventually sought an ultrasound. It revealed she had been born without a uterus—due to a condition called Mayer-Rokitansky-Küster-Hauser syndrome that affects just one in 5000 females. 

With the help of the Victorian Institute of Sport’s medical team, 21-year-old Harding Is now trying to use this recent knowledge of her condition to best advantage as an athlete building towards a potential Olympic debut in Paris in 2024.

Time to talk about women’s health? Clearly, the conversation is long overdue.

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