Menstrual disorders in top athletes ‘taboo and gap in medical knowledge’

• Anna van Eijk

  NOS Sport publisher

“It’s taboo,” no doubt says Emma Paternotte, a gynecologist in training. She answers the question why top athletes only rarely talk about menstrual problems, when it can really affect their performance.

Jutta Leerdam, on the other hand, was frankly two weeks ago following her World Cup gold medal in the 1,000 meters in Calgary. The 23-year-old figure skater explained why she nearly fainted during an interview shortly after her competition. “I had a very bad time on Saturday and lost a lot of blood. I was so sick of it this time.”

Tennis player, among others Zheng Qinwen and swimmer Fu Yuanhui preceded her and said during Roland Garros and the Rio Olympics, respectively, that they struggled with health issues during menstruation.

There’s still a lot to gain in that area, get to know Paternotte and sports doctor apprentice Merel Wielink. Paternotte: “What strikes us is that about 80 percent of the studies are done among male athletes, while at the Tokyo Games (for the first time) half of the participants were women. Why don’t we know more? Are there other studies on this?”

“Women are a bit behind in this respect and menstruation is therefore still taboo, so even less is known about it,” adds Wielink. “So yes, this is a gap in medical knowledge.”

For Paternotte and Wielink, this was one of the motivations for establishing a knowledge center where female athletes with gynecological problems, including menstrual disorders, can go. At the same time, they are conducting research on this topic.

Check out the interview Jutta Leerdam reels in below.

Wielink, for example, released a questionnaire in 2020 and 1,328 athletes responded, including professional, competitive and recreational athletes. “He has shown that a large percentage have disturbances during menstruation and therefore underperform, but a proportion also perform better.”

Leontien van Moorsel, for example, once said that he deliberately planned his – successful – attack on the world hour record during his menstrual period, because his pain threshold is then, in his own words, higher .

According to Paternotte and Wielink, there are also many elite athletes who don’t use contraception and who don’t menstruate. “Athletes consider it beautiful, because then you don’t have a period and you don’t have to take it into account. But from a hormonal point of view, it’s ugly,” says Paternotte, a gynecologist in training.

Paternotte: “Because menstruation is part of your cycle and in many cases, for example, they reduce the risk of cardiovascular disease, no bone decalcification and faster recovery. And if you no longer have menstruation, this is the result of multiple processes in your body that don’t work properly and you’ll eventually stop menstruating.”

The lack of menstruation is partly due to the weight of the athlete and the intensity of the training. Paternotte: “The more intensely you train, the greater the possibilities.”

“We know that if you have insufficient energy intake, some processes in the body go into a low-energy mode,” explains Wielink. “Just like when you don’t charge your phone’s battery properly. Then some apps start running slower. It also happens to your body. One of the things that can happen is that your period becomes irregular or stops completely. This is a sign that your energy balance is going in the wrong direction.”

“This can have negative effects on health, but also on sports performance,” says Wielink. “We can help athletes with this by making them aware that the menstrual cycle is really important.”

About half of athletes use the contraceptive pill, Wielink says. “Some do it to check the timing of their periods.” With the pill you can, among other things, make sure that you don’t get your period during an important game.

However, according to Paternotte and Wielink, this is not the holy grail. “With the pill, you can create a period, create a bleed, whether or not you’re okay with your hormones,” Paternotte said. “So you no longer have any idea whether anyone even gets a period of their own. So you mask any problems.”

Wielink: “I would prefer if an athlete simply had a normal cycle, so that he could keep an eye on the energy balance. In other words, whether menstruation is present or disappears.”

With the Sport & Gyn knowledge center, Paternotte, Wielink – together with Floor Sibrandi and fellow gynecologists and sports doctors – try to raise awareness among female athletes about possible gynecological problems and help them perform better.

Several (top) athletes have now knocked on the door of the knowledge center. “For example, if we notice that someone has a negative energy balance and is no longer menstruating, we can help them. And you can imagine: If you have enough energy again, health and performance will benefit.”