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

• Anne van Eijk

  editor NOS Sport

“It’s a taboo,” says Emma Paternotte, a gynecologist in training, without a doubt. She answers the question why top athletes only rarely talk about menstrual problems, while it can really affect their performance.

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

Tennis player Zheng Qinwen and swimmer Fu Yuanhui, among others, preceded her and said during Roland Garros and the Olympic Games in Rio respectively that they struggled with health problems during their menstruation.

There is still a lot to be gained in that area, know Paternotte and trainee sports doctor Merel Wielink. Paternotte: “What strikes us is that about 80 percent of the studies are done among male athletes, while during the Games in Tokyo (for the first time) half of the participants were women. So why don’t we know more about that? Why aren’t more studies on this?

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

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

Watch the interview in which Jutta Leerdam staggers below.

Wielink, for example, issued a questionnaire in 2020 and 1,328 athletes responded to it, including professional, competitive and recreational athletes. “It showed that a large proportion have complaints during menstruation and therefore perform less, but a part also performs better.”

Leontien van Moorsel, for example, once said that she had deliberately planned her – successful – attack on the world hour record during her menstrual period, because her pain threshold is then, according to her own words, higher.

According to Paternotte and Wielink, there are also many top athletes who do not menstruate. “Athletes see that as nice, 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, that’s bad,” says Paternotte, a gynecologist in training.

Paternotte: “Because menstruating is part of your cycle and in many cases, for example, reduces the risk of cardiovascular disease, no bone decalcification and faster recovery. And if you no longer menstruate, that is a result of more processes in your body that are not function properly and eventually you will stop menstruating.”

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

“We know that if you have too little energy intake, certain body processes go into a low-power mode,” explains Wielink. “Just like when you haven’t charged your phone battery properly. Then some apps start to work slower. That also happens to your body. One of the things that can happen is that your periods become erratic or stop altogether. That’s a sign that your energy balance is going in the wrong direction.”

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

About half of the athletes use the contraceptive pill, says Wielink. “Some do that to get a grip on the time of menstruation.” With the pill you can, among other things, ensure that you do not have your period during an important match.

Still, according to both Paternotte and Wielink, that is not the holy grail. “With the pill, you can create a period, create a bleed, whether or not you are right in your hormones,” said Paternotte. “You then no longer have an idea of ​​whether someone also has a cycle of their own accord. Then you mask any problems.”

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

With the Sport & Gyn knowledge centre, Paternotte, Wielink – together with Floor Sibrandi and fellow gynecologists and sports physicians – try to make athletes aware of possible gynecological problems and help them achieve better performance.

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 no longer menstruates, we can help with that. And you can imagine: if you have enough energy again, it will benefit your health and performance.”