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yoloaxel · 8 years

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Putting an end to the taboo of menstruation

Impact on the competition, the recovery, the mental... Because they're women before being athletes, they have to deal with menstruation. A sensitive topic that has been silenced for too long but that athletes accept to talk about now. A first for France.

“I don't feel well, because of... you know...” How many times has this kind of words been heard in an athlete's mouth off the court, near a racetrack or near a swimming pool? Sometimes, we have to admit that we did not see it. Or we suppressed this thought. Sometimes, it is a coach who slipped in a little sentence that is a bit more explicit: “Well yeah, it happens once a month...” But above all, how many times an athlete who did not have a good performance did not dare to say this kind of enigmatic sentence? Or chose to hide behind a lie, like a gastroenteritis, as if it was less shameful? And yet, it has always been clear that the vast majority of athletes are of childbearing age and that potentially thousands of them have not been able to explain why they had failed at some point. What if we had to look back at the records on this matter again? The question then becomes abysmal.

In recent years, the society has fortunately been able to hear a few stars come out of the closet, but there is still another taboo left in sport: menstruation, the time of the month, period! Something a bit 'dirty' and so intimate that it would be necessary to silence it or hide it while, according to the study conducted by Insep [National Institute of Sport, expertise, and performance (Institut national du sport, de l'expertise et de la performance)] gynecologist, Carole Maitre (read the interview below), in 2008-2009, 37% of the athletes consider the pain of menstruation as a discomfort to their activity and require treatment, and 64% think that premenstrual syndrome significantly decreases their performance. In January 2015, our British colleagues had fallen out of their chair when tennis player Heather Watson, Great Britain's number one at that time, had dared to explain that her premature defeat at Australian Open had something to do with “a ladies’ thing”. Wow! We thought about this occurrence again when at the last Olympic Games Chinese swimmer Fu Yuanhui apologized for “dropping [her] partners” during the 4x100m (4th) to the mic of national channel CCTV: “It's because my menstruation arrived yesterday and I felt tired.” In a country where tampons are still culturally rarely used, Fu became a heroine.

After that, we thought that time has come for us to break the silence too. Not all the athletes we contacted accepted, but many did not hesitate, with a confusing and reassuring simplicity, because they had suffered, sometimes alone and without any reason, sometimes because of the lack of information. “It's a topic that must absolutely be discussed and that we should study more,” marathon record woman Paula Radcliffe immediately said. “Because this topic is related to all activities of an elite athlete, her training planning, the repercussions on the competitions, the recovery, the mindset. This reflection is essential to reach the highest level possible in her career.”

Radcliffe thus explains how her first world record (2:17:18″') was just a question of hours, in 2002 in Chicago. “I got my period on the morning of the race. It was not ideal but frankly, it was better than if they had started the next day.” First cliché destroyed. In general, athletes suffer more from premenstrual syndrome meaning symptoms occurring the week before (heavy legs, water retention, gastrointestinal problems and loss of energy for Radcliffe), than the pains felt at the start of menstruation, attenuated by the adrenaline during competition. “I had to get up in the morning while thinking that the day was going to be extremely complicated,” reported former international basketball player Emmeline Ndongue. “But you're focusing on something else when you get to the game and you don't feel the pain too much.”

Swimmer Charlotte Bonnet, for example, has sore upper legs, to the point that, she feels “a weight pulls her down” in the water

Through these testimonies, we could see how menstruation can make athletes' life hell with its procession of lack of energy, back pains, migraine, cramps, belly pain that can be terrible, lack of sleep, vomiting... Not to mention personal specifics: swimmer Charlotte Bonnet, for example, suffers from the upper legs, “at the insertion of the thighs”, to the point that in the water, she has the impression that “a weight pulls her down”. Gabriella Papadakis, Ice Dance World Champion, saw girls feeling so much pain that they were unable to skate, despite having swallowed ibuprofen: “After a while, we get used to it. But sometimes I think that if I were a guy and I never had my period, it would be really great!”

Since it is a natural process, we realized that women accept pain and learn how to deal with it... sometimes with a coach who does not take this into account. Or to whom they do not dare to speak to. "This summer, in WNBA (the female equivalent of NBA) in Los Angeles, a teammate suffered so much that, despite the pain-killing pills, she was on the floor and we tried to relieve her pain by putting warm towels on her stomach," remembered Sandrine Gruda, center of France basketball National Team. "Since the coach is a man, she didn't dare to tell him. Would it have been a throat infection, we would've naturally talked about it. This is why, in the staffs, there's usually a woman, a physiotherapist or an assistant coach."

Olivier Krumbholz, France women's handball National Team coach, confirmed: “Things are directly regulated with the doctor. They don't talk to me about it. It's medical. I never had a discussion about it with one of the girls. We try to have complicity with the players, but we have a limit, which is intimacy.” Official team doctor since 1995, Gérard Juin can tell the coach that a player is not well without saying why... And if it is rare that a player feels so bad that it could justify a stop, when it happens, it is he who discusses with the staff: "It's not necessarily spontaneously understood, but it's important because a peripheral disturbance is a source of injury.” The pain distracts the player who can misplace her pelvis for example. “This topic comes up regularly with the girls,” continued June. “But it's rarely disruptive in team sports.” Basketball players revealed how they would count on their teammates who knew they were diminished on these days.

In individual sports, the situation gets more complicated, particularly in sporting disciplines with weight categories. 2016 Karate World Champion in -55 kg category, Emily Thouy revealed: “It's just horrible! There was a time where I had to go running during the competition because I had gained 2 kg whereas, two days later, I was 3 kg below! Feeling like you're dying because of the hot flushes and because your body hurts during the warm-up is hell.” Almost all of them have worries about controlling their weight during this duration: not only because they gain weight, but also because they have more difficulty to lose it. Rio Olympic Games silver medalist in -63 kg category, judoka Clarisse Agbegnenou is one of them. Not those who are making the topic of menstruation with her coaches a taboo but “sometimes they get embarrassed, so I rub it in and add: 'My tampon has slid out, it hurts so I have to go to adjust it back.' They say: 'Yes, it's okay, just go, we don't need to know everything!' It makes me laugh! But I know that not everyone has the same facilities as I to talk about it.” And things can become very serious.

Boxer Sarah Ourahmoune, Rio Olympics silver medalist as well (in -51 kg category), has just retired at age 35 and told us how she endured many problems in a sport then new for women: “You have iron deficiency [which can lead to iron deficiency anemia], you recover less well than usual, you feel asphyxiated when you make lactic efforts, you make water retention and, in addition, in boxing, you take blows in the belly”, listed Ourahmoune. “I remember a France VS Italy where my period arrived earlier than expected. My loins hurt and I was throwing up everywhere during the weigh-in. Since I was fighting the main event, my coach told me that I could not not go.” Not surprising that one of her teammates in the national team was glad that she no longer had had her menstruation for a long time. “She said that she was more than fine with it. She wasn't worried because no one told her it was serious.”

Speaking on condition of anonymity, a gymnast reveals in a thin voice that at twenty, she has never menstruated

However, for Insep gynecologist Carole Maitre, these problems of absence of menstruation (called ‘amenorrhea’) that some athletes have, are in fact a medical concern. She treats them from six months on. Often observed in sports with weight or endurance categories, they are usually a sign of overwork and an alert as for the increased fragility of the body, with consequently stress fractures. The issue gets even trickier with gymnasts, who start competing at a young age, before their first menstruation. Speaking on condition of anonymity, one of them reveals in a thin voice that at 20, she has never menstruated: “Since I was young, I'm under the care of an endocrinologist because I'm too short. I had three stress fractures. I only noticed it because I had pains. I took estrogen and progesterone. I don't know if it's related to gymnastics, but it's possible...”

Aware of the particular problem of her sport on this subject, the freshly retired gymnast Youna Dufournet is delighted that we and athletes speak out about it, convinced that girls are not sufficiently aware of this matter. She had her first menstruation three months before her 20th birthday, a week after London Olympic Games, and is convinced that psychology has played a key role. “The doctors told me that I overtrained and couldn't be relaxed enough to have my period. With the Olympics, I had achieved some of my goals. But after that, I went from feeling the need to have them because I was distressed to see that all my friends had them, to an ordeal because it was really painful.” Youna also remembered a competition where a girl who was younger than her was still lying in her bed one hour before the competition because of the pain and who had to take hot baths. “In addition, menstruation is really irregular for gymnasts and that makes another anxiety for us! Because of that, retiring is a relief.”

The vast majority of athletes we interviewed found an effective remedy to their struggle in the holy pill. Regularity of the cycles, less abundant losses, less pain... and the possibility of using two contraceptive pill packages in a row so this intimate enemy does not come to disturb their biggest competition of the season. “It's so great!” Charlotte Bonnet said. Except that taking the pill may come up against various obstacles. For example, parents do not see their twelve-year-old daughter leave to competitions with pills with in a favorable light. “We should also inform parents to demystify the pill because taking them doesn't necessarily mean that we're sleeping with someone,” Youna Dufournet added with a smile, for who taking the pill went with an important weight gain. It has come to the point that since three years, she chose progestin-only pills (mini-pills) not to have her menstruation. “I'll stop soon because I'm no longer training [she retired last season] and the pain will hinder me less than during my life as an athlete...”

To each woman her own particularity, to each sportsman her way to deal with menstruation. Paula Radcliffe barely used pills, “just for 10 or 15 days, to keep period away from the main goal” of her season, because she felt that pills made her “less aggressive, which is decisive in a race.” Gabriella Papadakis has recently chosen [contraceptive] implant due to her frequent trips and changes of time zones. She does not have “enough distance on the situation” to take pills every day. Skier Anne-Sophie Barthet explained that, on menstrual days, “her legs feel like cotton but she explodes her power scores” and decided to try without contraception and deal with mood swings and a more pronounced stomach ache.

As for Doctor Gérard Juin, he recalled that the endless collective sports calendar makes the idea of delaying menstruation obsolete. A fact that also applies to the very case apart that is tennis. In a sport where tournaments follow one after another for eleven months, the dates of menstruation necessarily coincide with days where they compete. At last season's Roland-Garros, Czech Petra Kvitova [ranking of world no. 10 at that moment] had strangely lost 6-0, 6-7, 6-0 against Shelby Rogers, ranking of world no. 108: “Simply because I had my period, that I couldn't sleep and that I had no energy.” A confession that is still rare two years after British tennis player Heather Watson's words.

Truth is, that over the testimonies we came to the conclusion that athletes have blended so much menstruation into their status as women that, as long as they are not in agony like one of their training partners, they often minimize the consequences on their performances. Former 200m Indoor World Champion Muriel Hurtis talked about how “lucky” she was not to have been too affected by menstruation during her career, but nevertheless mentioned a slight fatigue and a slight weight gain. In short, probably as many hundredths, sprint unit of measurement, gone up in smoke. Not to mention the issue about what she is wearing. “Is it obvious or not?” A stain, a tampon string... “Just thinking about that makes you completely lose focus on competition,” stated Marion Lotout, the current best French pole-vaulter. And yet, they all think of it. And it seems obvious that those old English gentlemen who once imposed white outfits at Wimbledon did not care.

In fencing too, athletes worry about whether they have unsightly stains on their beautiful white pants or not. According to fencer Ysaora Thibus, no girl can escape from it: “Sometimes we ask to each other to look at the other person's pants to see if there’s a stain or not. It already happened to me...” During her menstruation, her partner Anita Blaze admits she “doesn't make certain moves”: “There was a time where it was bleeding more than usual. My pants were dirty and my sister warned me about it. The problem was that I only had one, so I continued my competition this way. I told myself that I didn't want to have that happening to me anymore.” Emmeline Ndongue said something similar: “There's always that day when you play in white and you ask other people to warm you before entering the piste [fencing playing area] if you have a spot. It happened to a teammate once. She got up from the bench and we told her: 'Don’t! Sit down, please' ...”

Did you say embarrassing? The situation can get even worse! Karateka Emily Thouy said she saw a girl lose her sanitary pad during a battle: it fell on the fighting surface. “She clearly wasn't feeling well... We saw the scene, but then the two athletes were saying it belonged to the other... It was something hard to deal with.” To deal with the white outfit, Thouy has her technique: “I'm fully prepared, I wear at least two or three boxers, cycling pants... Everything to make sure nothing happens! I change it every thirty minutes, I'm always panicking...” But others cannot use this technique.

At the swimming pool, it is hell. Charlotte Bonnet: “We're wearing swimsuits so it's the first thing we see. Thinking about changing the tampon, knowing if it will sink or not, it's very tiresome. At the beginning, you're really terrified!” I already had to tell to friends many times: ‘We can see a little bit of the tampon string, there!’ It's really embarrassing. When I have my period, I check it non-stop, I'm a little paranoid.” In ice dance and figure skating, it is hell as well. Gabriella Papadakis: “The short white dresses, the legs up in the air where you see everything... I never had any major issues for the moment, but sometimes there are girls asking in panic in the locker room: 'Does someone has a tampon, please?’” And in gymnastic, it is still hell. Youna Dufournet: “You have to realize that we compete while wearing in leotards, that the French team's attire is white and that we often have legs spread... When you are a top athlete, we already have enough problems to deal with. And if you add period, it's a lot...”

Just when we thought we were done, Marion Lotout interrupted us. “I've been wondering about this for a long time... The coaches as well, and no one has the answers. There aren't enough scientific studies about it. I noticed that during the year where I stopped the pill, my period was delayed in case of important physical activity. Wouldn't it then be necessary to compensate?” According to her, the pill is the easiest solution for them, but it remains a drug which real function is not to regulate period. “So who knows what the body would gain by not using the pill?” As for Paula Radcliffe, this problem has been ignored or treated in a too empirically for years. She limited her dairy product consumption, others used acupuncture... “We are only a handful of elite athletes to think about the best way to deal with. Most sports physicians are men and don't really understand. We need more women and more scientific studies should be done on this matter.” It would be on this condition that we could one day consider this ridiculous taboo as something part of the past.

"Between 50 and 60% of women ask me to shift their menstruation to later"

Insep gynecologist Carole Maitre evoked the different perturbations that motivate the consultations of the athletes. And the risks associated with them, far from being trivial.

Is menstruation part of the concerns mentioned during your consultations?

Yes. Many athletes, even doctors, are not informed about menstruation. There is a two-hour module on female athletes in sports medicine training, but it is not compulsory ... For a long time, being a female coach was an exception, and men sometimes consider stomach ache as an alibi. Menstruation is a topic that we do not talk enough about.

What do athletes consult you for?

20% of them because they do not have their menstruation. Spontaneous amenorrhea [absence of menstruation in a woman of reproductive age] affects between 10 and 40% of women depending on the sport. They end up asking me questions because it is not in the standard. But the most frequent case, between 50 and 60% are the to ask me a one-time menstruation shift.

The absence of menstruation is often considered practical...

But the practical side is nothing compared to the short, medium and long-term risk. It leads to injury. The decrease in estrogen secretions, which are necessary for bones, has an impact on bone mineral density. Taking treatments does not necessarily mean a total recovery of estrogen secretions. I recently had a young woman who, at 22 years old, had suffered from two stress fractures. This is not acceptable! Estrogens are also involved in energy metabolism. They play an important role in the glucose uptake into muscle cells and then the storage of glycogen. In amenorrhea, fatigue is greater.

What is the cause of this amenorrhoea?

With such important amount of training, the nutritional intake does not bring enough calories compared to to the energy expenditure. When this reserve intervenes just to ensure the basic metabolism, the organism has a saving strategy. Inevitably, it does not put to rest the heart or the brain, but a non-vital organism: the ovarian stimulation system.

Is shifting your menstruation repeatedly a problem?

Not if it is for three or four months. In fact, it is not menstruation themselves that are a problem, but the week that precedes them because of the premenstrual syndrome. In the study we conducted on 363 sports at Insep in 2008-2009, 83% of women said that they already had premenstrual syndrome symptoms. During menstruation, estrogens can stimulate the water retention system and cause weight gain. There may also be some joint and ligament instability.

What other problems do athletes face?

Late menstruation or irregular ones. However, very long cycles have the same metabolic effects as amenorrhea. 75% of athletes told us their menstruations are irregular. And for sports started at a very young age, like the gym, there may be primary amenorrhea (the delay of the first menstruation) for the same reasons. Until 17 years, we do not intervene. Afterward, a treatment can be given. First menstruation appearing at 20 can cause a bone density problem. The moment of the end of a growth is delayed but not affected. Our study showed that the average age of first menstruation was 13 years and 2 months, which is very similar to the general population.

How to handle the pain of menstruation in competition?

Studies show that dysmenorrhea (painful menstrual periods) can affect training – it is the case for 65% of athletes in our study – but that pain tends to disappear during competition. The amount of beta-endorphins secreted is so high that the threshold of sensitivity to pain explodes.

Can their trigger be psychological?

Yes, sometimes the athlete is so stressed that her menstruation happens. If it can be blocked for psychological reasons, it can also be triggered for the same reason, when it was not expected, by somatization.

Can some treatments be assimilated to doping?

Nothing that I prescribe is prohibited. Hormonal treatments do not reach proportions that could disturb a biological passport. We might have to need a therapeutic use permit later on for an ovulation stimulation to get pregnant... But that is another topic.

#sports #women in sport #paula radcliffe #charlotte bonnet #gabriella papadakis #sandrine gruda #emily thouy #clarisse agbegnenou #sarah ourahmoune #youna dufournet #marion lotout #.... many sports there #translation

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