Female Athlete Health PDF

FEMALE ATHLETE HEALTH Emma McCrudden, BSc, MSc, RD  LEARNING OBJECTIVES 1. Describe the key phases of the menstrual cycle and their associated hormonal fluctuations 2. Recognize common menstrual irregularities in athletes 3. Increase awareness of the effects of Hormonal Contra...

FEMALE ATHLETE HEALTH Emma McCrudden, BSc, MSc, RD  LEARNING OBJECTIVES 1. Describe the key phases of the menstrual cycle and their associated hormonal fluctuations 2. Recognize common menstrual irregularities in athletes 3. Increase awareness of the effects of Hormonal Contraception on Menstrual Function 4. Be aware of emerging research on macro, micronutrients and supplements in women and limitations to this research 5. Discuss the implications of menstrual-related symptoms (e.g., PMS, cramps, fatigue) on training https://womenandsport.ca/ “Female Athlete” https://www.scopus.com/search/form.uri?display=basic#basic Through the lifecycle  REDs Iron Macros Bone Supplements  Performance considerations Homeostatic Psycho- variation and Cardiovascular sensory- function motor Exercise Metabolism adaptation Considerations related to menstrual cycle Exercise Musculoskeletal recovery Respiratory Cognition function Immune function Slide Credit Dr G Bruinvels, Faculty of Sport, Allied Health and Performance Sciences, St Mary’s University, Twickenham, UK  Menstrual cycle facts Menstruation generally starts around 12-13 years of age Menstrual cycle “time between the first day of bleeding (known as a period, or menstruation) and the day before the next period” Typical duration 28 days - can range from 21 to 35 days Each period has an average length of 2-7 days The brain initiates fluctuations of female sex hormones throughout the cycle Ovulation is when an egg is released from the ovaries. It usually occurs around the middle of the menstrual cycle  Hormones involved Primary Hormones: Estrogen: repairs, thickens and maintains the lining of the uterus Progesterone: maintains the lining of the uterus during the latter part of the menstrual cycle. Additional Hormones of note: Follicle stimulating hormone (FSH) stimulates the growth and development of follicles in the ovary, which produce estrogen Luteinizing hormone (LH) surges in the middle of a menstrual cycle, triggers ovulation. Following ovulation, it aids in the production of progesterone  Female menstrual cycle – what is “normal” pg/ml Bleed day 1-5 Chidi-Ogbolu N and Baar K (2019) Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front. Physiol. 9:1834. doi: 10.3389/fphys.2018.01834 Why do we know so little about it? No-one talked about menstrual cycle openly until more recently Limited education amongst females and degree of acceptance that symptoms / discomfort is normal Viewed as a performance barrier Risk of burnout and UUPS if we treat women like men  Insights 80% of athletes cite performance worsening due to symptoms felt during the menstrual cycle 90% of elite athletes experience symptoms every cycle >1/3 athletes have a history of heavy menstrual bleeding 77% of athletes use meds to treat symptoms 82% of athletes have never discussed their menstrual cycle with their coach Slide Credit Dr G Bruinvels, Faculty of Sport, Allied Health and Performance Sciences, St Mary’s University, Twickenham, UK  Performance considerations Homeostatic Psycho- variation and Cardiovascular sensory- function motor Exercise Metabolism adaptation Considerations related to menstrual cycle Exercise Musculoskeletal recovery Respiratory Cognition function Immune function Slide Credit Dr G Bruinvels, Faculty of Sport, Allied Health and Performance Sciences, St Mary’s University, Twickenham, UK Menstrual-related symptoms  Seek medical advice Primary amenorrhea Have not menstruated by 15 years of age Secondary amenorrhea: No menstruation for 3-11 consecutive menstrual cycles caused by Functional hypothalamic amenorrhea (FHA) - the cessation of the menstrual cycle in the absence of anatomic pathology Oligomenorrhea: No prolonged absence of menses but menstrual cycles >35days Anovulatory – period but no ovulation, no mid cycle peak in estrogen or LH Polymenorrhea: menstrual cycles shorter than 21 days Experience severe symptoms Menorrhagia or Heavy menstrual bleeding (HMB) also a concern Why is “normal” menses important? Good indicator that EA is adequate for repair and adaptation to training That body has a functional immune system and can defend itself from pathogens That it can deal with changes in body temperature to maintain homeostasis That reproduction is possible Natural fluctuations in estrogen have a positive relationship with bone, muscle and tendon health  Hormonal Contraception Combined Pill Contraceptive patch Vaginal riing Progesterone only pill Implant injection Hormonal IUD 70% of female athletes are using some form of hormonal contraception with combined pill being most popular form Bleed experienced while on combined pill is a false bleed / withdrawal bleed - hormones do not fluctuate in the same way as those not taking hormonal contraceptives  Profile on HC pg/ml Chidi-Ogbolu N and Baar K (2019) Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front. Physiol. 9:1834. doi: 10.3389/fphys.2018.01834  Conducted an audit of the literature supporting evidence-based products: β-alanine, caffeine, creatine, glycerol, nitrate/beetroot juice and sodium bicarbonate. Within 1826 studies totalling 34,889 participants, just 23% of participants were women Across different supplements, 0–8% of studies investigated women exclusively, while fewer (0–2%) were specifically designed to compare sex- based responses. The annual publication of female-specific studies was ~8 times fewer than those investigating exclusively male cohorts. Only 14% of studies including women attempted to define menstrual status, with only three studies (~0.5%) implementing best practice methodologies to assess menstrual status Smith et. Al Auditing the Representation of Female Versus Male Athletes in Sports Science and Sports Medicine Research: Evidence- Based Performance Supplements. Nutrients 2022, 14, 953. https://doi.org/ 10.3390/nu14050953  Key Nutrition Recommendations Carbohydrate – small number of studies that women may have lower glycogen storage in the follicular phase of the menstrual cycle and more optimal during the luteal phase especially due to increase in BMR as a result of progesterone increases Many female athletes are not meeting their carbohydrate recommendations Women and men oxidize exogenous carbohydrate at an identical rate during exercise no matter the phase in the cycle Recovery window – females often find it challenging to consume the necessary amounts of protein and carbohydrates for optimal recovery Protein – a small number of studies have suggested that there is a small increase in protein catabolism during the luteal phase of the menstrual cycle due to high progesterone Proinflammatory cytokines are increased in order to shed uterine lining in late luteal phase – whole body inflammation increases and may have a correlation with pre menstrual symptoms – anti-inflammatory foods may help (polyphenols, omega 3 et.c) High incidence of IDA in female athletes Vitamin D Plays a key role in estrogen production IBS can increase during the pre menstrual and menstruation phase – ensure athletes are not underfuelling during this phase Encourage some menstrual cycle tracking Athletes should note: Days of bleeding Bleed amount Symptoms Response to exercise and performance Summary Menstrual cycle is not just the period but the entire month when a woman experiences regular fluctuations in many hormones Typical menstrual cycles last 28 days but they can typically last anywhere from 21 – 35 days Split into the follicular phase (characterized by low progesterone and rising estrogen) and the luteal phase (inverted u shaped curve for progesterone and estrogen) with ovulation occurring with a peak and trough of luteinizing hormone Nutrition rest and recovery are important Encourage athletes to track cycle and monitor symptoms and continue to be involved in research