Effects of the Menstrual Cycle on Training and Performance
The impact of sportswomen’s menstrual cycle on performance is “the last taboo” in sport, says former British tennis number one Annabel Croft. Croft told BBC Radio 5 live that women “suffer in silence” on the subject.
“I broke the world record (while on my period) so it can’t be that much of a hindrance, but undoubtedly that’s why I had a cramped stomach in the final third of the race and didn’t feel as comfortable as I could’ve done.” Paula Radcliffe, marathon world record holder told the BBC.
Some females dread competitions falling on particular days of their menstrual cycle because they feel it has such a significant impact upon their performance. More than half of all females surveyed in our initial research (700 responses) feel that their training and performance are affected by their menstrual cycle. This may discourage them from exercising all together and impact upon their quality of life. As recently highlighted in the media however, research around the effects of the menstrual cycle in exercising females is limited and inconclusive.
Initially by surveying as many exercising females as possible we hope to gain an indication of the impact that females across the whole spectrum (recreational to elite) feel their menstrual cycle has on training and performance. We are particularly keen to identify the prevalence of heavy menstrual bleeding (HMB) within this population because this specifically has been shown to impact upon energy levels and reduce quality of life. Affecting more than a quarter of the reproductive population, awareness of this condition is poor with approximately only 6% seeking medical treatment annually. The increased blood loss in addition to exercise will increase the susceptibility to iron deficiency and anaemia within this group. Therefore we are looking at the impact that iron deficiency has on females both by their perceived fatigue levels and also functional performance outcome measures. Further we will investigate the impact of the latest treatment for iron deficiency where we can give a 12-month equivalent dose of iron safely in just a 30 minute injection. Potentially rapidly restoring their iron levels, reducing fatigue and improving sports performance.
- To asses the impact that females feel their menstrual cycle has on training and performance.
- To gain an indication of the prevalence of HMB within the exercising population.
- To assess in females with HMB how many have iron deficiency or anaemia.
- To assess in females with iron deficiency anaemia if treatment with intravenous iron improves quality of life and also exercise performance.
- To raise awareness of iron deficiency as a problem in healthy females and to promote further research as well as providing a possible treatment mechanism.
What we are doing..
Firstly we are using the survey to assess the issue by identifying the prevalence of females with menstrual cycle issues and who meet the criteria for HMB. We will then identify those who have given consent to be contacted further, and invite them for a simple blood test to see if they have iron deficiency or anaemia. Those with iron deficiency anaemia will then be asked if they want to partake further by evaluating how their performance and well-being may be impacted upon by restoration of their iron status. As part of this they will receive a full physiological (exercise test) and haematological profile (blood test).
Many females feel that their menstrual cycle acts as a barrier to exercise. However the lack of conclusive research, likely exacerbated by the taboo around this subject has meant that little has been done to help these individuals and awareness is poor.
Heavy Menstrual Bleeding
A recent study has shown that 27% of women experience HMB at some point in their lives, yet with only 6% seeking treatment annually, many are suffering in silence. To worsen this issue, approximately only one fifth of those who have received treatment feel that their symptoms are under control, highlighting the need for more research and better treatment options.
To date, research evaluating HMB prevalence within the exercising population and the effects that this may have on iron status, motivation to exercise and performance during exercise is lacking. While it is often thought that many elite athletes are amenorrhoeic, initial results from the first 700 responses of our survey have shown that although it is more common in the recreational population, 47.2% elite athletes met the HMB criteria, therefore indicating that this it likely to be an issue across the whole performance spectrum. Despite this, our initial data has shown that of those who met the HMB criteria, only 36.8% have actually sought medical advice.
Approximately one third of athletes are thought to be iron deficient. Endurance exercise is well known to increase iron losses, and this combined with menstrual blood loss increases the likelihood of iron deficiency. When left untreated iron deficiency will cause anaemia, resulting in fatigue, weakness, psychological morbidity and impaired cognition amongst other problems. Iron deficiency affects around one in five women but is often unrecognized or regarded as normal associated with menstrual losses. Consequently many females may be suffering in silence. New treatments are available but we need to assess the true impact and value of these in health and performance.
In recent years there have been new developments in treatment for iron deficiency. Traditionally patients have been given iron tablets. These are slow to work taking up to 6 months to restore a person back to normal. Further, many do not take these tablets due to the side effects of constipation or abdominal discomfort. In the last 5 years new preparations have been effectively utilised. Iron can be given as an injection over 30 minutes at a dose to restore the whole body’s iron stores. Clinically results are apparent within just 5 days and sustained. Indeed in females there is strong evidence that intravenous iron improves quality of life and reduces fatigue. It is not known if it will improve and functional performance however. Therefore we plan to replicate this within the exercising population in those identified as having both HMB and iron deficiency anaemia to determine if this could offer a new treatment.
Our research team..
Having completed studies looking at both iron deficiency in athletes and addressing breast issues as a barrier to exercise I feel that my research team is well placed to conduct this study. Dr Charlie Pedlar and Dr Richard Burden have enormous experience working with many Olympic and Paralympic athletes (many of whom are iron deficient), and have both published in the field of iron deficiency. Nicola Brown has done extensive research into the barriers to exercise for females, particularly focusing on breast health. Mr Toby Richards is an international expert in iron therapy and clinical trials with a particular interest in Patient Blood Management. He leads trials on intravenous iron therapy in Australia and the UK. Being just over a year into my PhD in addition to working as a physiologist in the lab I have done much research around iron deficiency and the menstrual cycle in athletes. Also being a elite runner myself, I feel very particularly passionate about this research.
Help us succeed.. What can you do..and where will the money go?
Firstly if you are a pre-menopausal women aged 18 or over and partake in exercise we would be really grateful if you could please complete this survey and share it with your friends and family. We need all women who regularly exercise to answer this because if only those with a problem (HMB or anaemia) reply then we will not gain a true representation of how big a problem this is. The link for the survey is here –https://stmarys.onlinesurveys.ac.uk/female-health-questionnaire
The success of this research is dependent upon getting as good a representation of the issue as possible and therefore by obtaining as many responses as we can.
In order to cover the costs of this research we would love anyone who is interested to please donate. Any contributions are very welcome and really gratefully received. Money will go towards undertaking this research, the analysis of samples and physiological testing.
We are delighted that we have matched funding. So for every £5 you give we will be able to receive £10 of funding.
WHAT CAN WE DO FOR YOU?
Females with HMB will be contacted and given feedback if they have provided email addresses. If they meet the inclusion criteria they will be invited to partake in our trial which will include free physiological and haematological assessments (exercise and blood tests).
We will regularly keep all donors up to date. There will be a frequent newsletter of our progress and ultimately you will be directly advised of the findings from the research so you can then see how you have helped to make a difference. You will be invited to join our female exercise and well-being research community, and if relevant will also be invited to participate in future research that may offer information and free of charge physiology testing.
why is this research so important to me..
Being a female athlete myself I feel extremely passionate about this area of research. I can and have seen first hand how athletes across all levels are affected by their menstrual cycle and feel frustrated myself by the lack of research in this area. I think it catastrophic that the menstrual cycle is actually stopping some females from exercising, particularly as more and more research is concluding on the health benefits gained from exercise. I am therefore really keen to initially gain a better indication of the issue, then identify whether a possible treatment may be effective. Through the work we have done around iron status I feel that we are well placed to pursue this further.
As a result of this study I aim to raise awareness, increasing understanding across all levels, contributing to and encouraging more research in this field as evidently iron deficiency is only one of the many likely issues around the menstrual cycle.
Find out more..
A link to our research page can be found here http://www.stmarys.ac.uk/chases/female-health-and-well-being.htm