October 2022, Articles

Normalising an important women's health conversation

Six months ago Lydia Ko stunned a sports journalist In California with her matter of fact response to a question about on-course treatment for back pain with the simple rejoinder "it's that time of the month".

The reaction highlighted that while Ko has been celebrated for talking about the topic, conversations around women’s menstrual cycles, especially for elite female athletes, are still not considered ‘normal’ or easy in many situations and sports.

A group of HPSNZ Athlete Performance Support (APS) team members across a range of disciplines are on something of a mission to educate and normalise the topic for men and women coaches, high performance directors and support staff, due to its importance for female athlete health and wellbeing, and therefore performance.

Research conducted by the HPSNZ WHISPA (Healthy Women in Sport: A Performance Advantage) group in 2021 with 219 female athletes revealed a concerningly high number identified difficulty communicating with coaches and support staff who may be poorly informed on women’s health issues.

HPSNZ female health doctor Helen Fulcher, physiologist Anna Skipper and nutritionist Christel Dunshea-Mooij came together to formulate a programme that would get the topic of menstrual cycles onto the agenda and into conversations.

“It is very evident that while there is still a lot that is not known about the menstrual cycle we do know there are a lot of myths about the benefits or detriments of the cycle and its impacts on athletes”, says Christel.  “From my standpoint, for example, it is clear there is little understanding of the role nutrition can play during the different phases of the cycle.”

A presentation to participants at the recent Te Hāpaitanga residential course for female coaches focused on information about the menstrual cycle and the physiological, performance and nutrition features of each phase.

“This was a starting point for us and a key message we wanted to convey was the menstrual cycle, if managed correctly, can be an aid, not a disadvantage for an elite athlete,” says Christel.  “What is critical for them, their coaches and support staff to understand is that having a cycle is most important for the health of all bodily processes and wellbeing.”

Helen Fulcher adds to the story with a startling fact from an Australian 2020 research study of elite female athletes that demonstrated that fewer than 20% of respondents to the survey understood the importance and role of the two key hormones, oestrogen and progesterone, which affect women’s health.  (Athletes’ knowledge on the menstrual cycle – read full report here).

“From the physician’s perspective there are significant health consequences from no menstrual cycle that go far beyond  performance.  It can have huge impacts on mental health and, physically, it can have a major effect on an individual’s entire endocrinological system,” says Helen.

Physiologist Anna Skipper says gaining an understanding of the different phases of the menstrual cycle is key to allowing training programmes to be modified and adapted accordingly.

“There’s a lot of stigma around menstrual cycles and when women are on their period, but many are pleasantly surprised that there are phases in the cycle which can be a performance enabler.   For example, the first phase which is a low hormone phase can allow for an increase in training volume and/or intensity. During this phase athletes can see increased power and coordination and can push hard during training, ” she says.

Yachting NZ is one NSO making the subject of menstrual cycles and their management and impacts on performance critical to its strategy to attract, support and retain female sailors.

Ian Stewart, YNZ high performance director, is the first to admit the organisation is at the very start of the journey on what is an incredibly important women’s health topic for elite and developing athletes.

“Sailing as a sport has a raft of challenges that can impact women’s menstrual cycle management.  We can have venues with limited on shore facilities, sailors spend long hours racing on the water, weight requirements mean female athletes have traditionally over focused on losing or being a specific target weight, and so on,” says Ian.

“Key for us is to start the journey, change our language, normalise conversations and ensure awareness of the topic throughout the sport.  The next phase is one of education and the appointment of Jenny Armstrong as YNZ’s Women’s Coaching Lead is key to that process.”

Jenny has been tasked with delivering a programme that on the one hand doesn’t over egg the issue, rather normalises it, and secondly, ensures it is embedded within the sport’s development and high performance programme.

Education workshops with female sailors and coaches were held by Jenny’s predecessor.

“The next step is a continuing education programme with junior, youth and senior female athletes that is age and stage specific and helps normalise conversations about the menstrual cycle between coaches, parents, athletes and sailing administrators,” says Jenny.

As lead sailing physiologist, Anna agrees it is a sport that certainly presents some challenges for women around their menstrual cycle.  “Regattas can be at any time so there is no opportunity to plan around the cycle.  Therefore we need to ensure athletes know they may have to compete at any stage of the cycle and provide them with the support and necessary information around things like nutrition and recovery.

“There is also the challenge in a number of sports including sailing where you have say two women In a crew who are at different stages in their cycle.  The key in this situation is for women to be comfortable talking about it and aware of what happens for each other during different phases.  For example, some athletes have noticed they lose some coordination at different stages and have acknowledged that previously they felt unable to talk about it with their crew members,” says Anna.

“This is increasingly important for the growing number of mixed sailing crews who need to feel comfortable talking about what’s happening with their bodies on any given day just as they need to talk about the day’s water and weather conditions.”

Helen Fulcher sums the topic up neatly.

“What is critical for athletes and their support teams to understand is what we call body literacy.  The need to understand why it is important for women athletes to have a natural menstrual cycle, what hormones do, not just for the cycle but for all parts of the body’s health – bones, brain, heart, gut, immune system.

“An athlete’s cycle is a window into her health, so if it is not thriving then not just performance but overall physical and mental health and wellbeing will be adversely affected.”

There is a clear consensus among HPSNZ APS team members and from a growing number of NSOs that the topic Lydia Ko put on the front pages needs to be a conversation that continues across the broad spectrum of women’s health for elite and recreational athletes.


Credit: Sailing Energy/World Sailing