Menstruation is not a taboo in women's sport, period
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Menstruation is often called the “last great taboo” in women’s sport. But periods are the media’s taboo, not sportswomen’s. Our new research showed that elite athletes are not afraid to talk about their menstrual cycle and how it affects them. We also found that half of the 430 athletes we interviewed are using some kind of hormonal contraceptive, which affected their menstrual cycle.The menstrual cycle is a repeating pattern of hormones, designed to allow pregnancy to occur. Each phase produces different concentrations of the hormones oestrogen and progesterone. On the other hand, hormonal contraceptives aim to prevent pregnancy by removing the menstrual cycle and creating a new hormonal environment, with low levels of oestrogen and progesterone almost all of the time. These hormonal differences, between women with and without a menstrual cycle, mean that not all female athletes are the same. As oestrogen and progesterone have the potential to affect many aspects of health and sports performance, it’s important to know the hormonal profile of each athlete, so that training and performance can be optimised. Up until now, it was unknown how many elite sportswomen in the UK used hormonal contraceptives, such as the oral contraceptive pill, the contraceptive injection, a patch or implant. My colleagues and I surveyed 430 elite athletes, from 24 different sports including hockey, football and rowing, to determine how many used a hormonal contraceptive or not. As contraceptives can have other roles outside of preventing pregnancy, we asked them about any other effects they experienced as a result of taking them – such as easing painful periods, heaving bleeding and acne. We also asked the athletes who didn’t use a hormonal contraceptive to tell us about their experiences with the menstrual cycle. This meant that we could compare those athletes who had a menstrual cycle – with variable hormone concentrations – versus those who used hormonal contraceptives and had a more stable hormonal profile.
Managing periods with contraceptivesOut of 430 sportswomen, 213 (49.5%) used some type of contraceptive and 217 (50.5%) did not. The oral contraceptive pill was the most popular type of hormonal contraceptive – used by 78.4% of contraceptive users. Contraceptive users reported 19 negative side effects, with weight gain, irregular periods and poor skin being the most common. In contrast to the negative side effects reported, 12.7% of contraceptive users told us they liked the regularity of the pill and knowing when they would experience their withdrawal bleed – not the same as a period – which happens during the seven pill-free days of an oral contraceptive pill cycle. In addition, 12.2% of the athletes using a hormonal contraceptive said they liked having a reduced number of bleeds per year, which can be achieved by skipping the pill-free days. Knowing when the withdrawal bleed would occur allows athletes to avoid bleeding during an important competition, such as the Olympics. Athletes not using any type of hormonal contraceptive had menstrual cycles of different lengths, usually between 21 and 35 days. Just over three-quarters of these athletes reported negative side effects that usually occurred during the first day or two of the cycle, when they were having their period. The most common side effects were cramps, back pain, headaches and bloating.
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