Effects of menstruation on exercise among women

By Al Gondi

The athlete’s performance is based on physical fitness, (aerobic and anaerobic fitness, muscle strength, flexibility, and body composition) as well as nervous system, cognitive and psychological factors.

There is some evidence that the performance of some athletes is affected negatively before and during menstruation. Some athletes suffer from painful menstruation (dysmenorrhoea), with painful cramps and heavy flow. These symptoms will adversely affect the athletes’ training and competition.

Other factors include symptoms (emotional and or physical) before menstruation, which occur at the same time and disappear with the onset of menstruation.

The symptoms may include depression, mood swings, anxiety, headaches, fluid retention, breast soreness and breast enlargement. However, exercise may reduce the symptoms but level of performance is usually reduced.

Delayed Menarche

Exercise is also associated with disorders of menstrual cycle such as delayed onset of menstruation (menarche), disorders after ovulation and failure to have menstruation.

The onset of periods usually occurs between the ages of 12 and 13 years. Menarche typically occurs one or two years after the pubertal growth in girls. The age of menarche appears to be correlated to that of athletic performance. The athletes with high performance tend to have a delayed menarche compared to women who are sedentary.

The high performance athletes are categorised into two: Those having intense physical training before menarche and those who have intense physical activity after menarche.

Intense training before menarche is mainly found in ballet dancers and gymnasts and is associated with delayed menarche.

This is due to intense physical training in combination with low body fat common in these sports, which affects the hormones that control menarche, thus delaying it.

In addition, breast development is also delayed but the development of pubic hair is not delayed. Delayed menarche is sometimes advantageous to an athlete.

Slow Maturation

An athlete can inherit a tendency for slow maturation rate, leading to prolonged bony growth hence longer legs, narrow hips, less weight per unit height and less relative fat than those who mature early.

These factors increase athletic performance. A later age of menarche may lead to low bone density with risks of bone fractures in later life. Disorders of ovulation (luteal phase) occurs from the time of ovulation to the time when menstruation starts. Abnormal luteal function is commonly found in athletes. It may cause infertility or sub-fertility or spontaneous habitual miscarriage. It is also causes spinal bone density loss of about three per cent in physically active women.

Scanty or complete absence of menstruation occurs mainly in runners and ballet dancers but is rare in swimmers and cyclists. These incidence are also higher in sports that stress leanness.

These symptoms are also associated with lower levels of thyroid hormones and insulin, together with an increase in stress hormones.

— Dr Gondi, a medical practitioner, is a member of National Olympic Committee’s Medical Commission and board member of Regional Anti-Doping Organisation.