2019 has been somewhat of a turning point for women's sport with successful global tournaments, higher engagement and an increase in coverage, but despite these achievements, sportswomen are still suffering when it comes to their menstrual health.
Earlier this year we learnt of a link between the menstrual cycle and susceptibility to ACL injuries, a risk so threatening that Chelsea Women tailor their training to players' periods. However, the dialogue doesn't just surround footballers. Talking to Give Me Sport Women in October, England netballer Rachel Dunn expressed the need for more research into women's bodies and the effects of sport and now, female runners have joined in with the conversation.
Last month, track runner Mary Cain bravely revealed the awful treatment she received when training under Alberto Salazar as part of the Nike Oregon Project. During the project, Cain suffered from the absence of menstrual periods, which is medically known as amenorrhea and, despite the lack of public knowledge, affects a significant 69% of athletic women. Amenorrhea is an issue that forms the Female Athlete Triad Syndrome - a medical condition seen in physically active females that involves three components: menstrual function, and bone mineral density and energy availability.
Alongside Cain, runners Tina Muir and Jess Piasecki have openly talked about their battles with amenorrhea and triad syndrome. In 2017, Muir announced she was quitting running. At 28-years-old, she hadn't had a period in nine years and desperately wanted to start a family. "I love to run, but having a family is something I’ve always wanted. I knew the logistics. If you’re not having your cycle, you can’t get pregnant," she explained to OutsideOnline.
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Jess Piasecki trained and competed throughout her childhood, but by the age of 18, she still hadn't had a menstrual cycle. Although she was training well and had a good diet, Piasecki was also diagnosed with amenorrhea as a result of the Female Athlete Triad Syndrome.
What, how and why?
Menstrual disturbances, or a lack of periods, are often caused by a shortage of energy in the body which can be induced by several different factors and is often linked to a woman's diet. Eating disorders, for example, will cause the body to lack sufficient energy but something as simple as calorie counting to help lose weight can also affect energy levels. Running is such a high-intensity sport and due to the huge amount of energy needed when running, some women won't even realise that they're not intaking enough calories which, ultimately, can result in health issues like amenorrhea.
The obvious effect of amenorrhea on the body is reduced fertility, but missing your period won't just mess with your reproductive system. Research has found that your cardiovascular, bone and hormone health can all be influenced by the condition.
Estrogen and other hormones are vital to ensure strong bone health which develops most between the ages of 20 and 30. If a woman doesn't menstruate during this time, estrogen won't be released which could cause her to never reach the maximum bone mass, ultimately putting her at a higher risk of fractures. Research has also shown that amenorrhea can cause higher cholesterol levels which contribute to further medical issues such as hypertension and diabetes.
Jess Piasecki suffered several compression fractures as well as osteoporosis which could have been caused by the fact she didn't menstruate during early adulthood. Talking to RunnersWorld after winning this year's Florence marathon, she described the pain of her fractures as "unbelievable."
Unlike menstruation's link with ACL injuries, amenorrhea in female athletes seems well researched, with several studies confidentially finding that the condition is a real and true one. However, despite the volume of research readily available, amenorrhea and the Female Athlete Triad Syndrome is one that seems to be continually ignored by the media as well as sporting professionals.
We are living in a world where women find themselves too often in the situations of Jess Piasecki or Tina Muir, having to choose between a successful career or good health. Active women are being silenced and left feeling shamed, led to believe that talking about their periods is too taboo for the sporting world. A continued lack of communication surrounding amenorrhea and the health issues that come with it will only lead to increased injury and decreased participation - it is the job of medical professionals, trainers and athletes to help stop that.
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For more information on amenorrhea and the Female Athlete Triad, visit the Lane 9 Project.