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Young female athletes: 'The Pill is not the answer'

Fuseworks Media
Fuseworks Media

She is involved in the third Female Athlete Health Symposium - HPSNZ being organized by the University of Waikato in collaboration with High Performance Sport NZ, happening in Auckland in April. The focus on women is needed because almost everything that people know about female athletes from training mechanisms, internal drive, external motivation, recovery, and nutrition has been based on men, then generalised for women. Dr Sims says that a lot of the information out there is not correct, and consequently many women experience things like low energy availability, which can lead to a lot of common problems.

Up to puberty boys and girls are very similar. But Dr Sims says once they hit puberty there is a major dichotomic change. "Little boys start to lean up and become faster and taller, going through a growth spurt. They also might might become unusually aggressive as that is what is happening hormonally. Society’s view is ‘oh he’s just a teenage boy’; promoting bias and stereotypes instead looking through these changes through a hormonal lens. The evident change in young female athletes is more pronounced, and often with a more negative personal impact: I’ve had so many young girls ask if they have to quit sport, because their period has come. The societal idea is that once you get your period you become slow and uncoordinated, gain weight; and the prevailing thought of the young girls is that you shouldn’t exercise or train on your period. It’s a mentality that still exists, because no-one talks about it. The word period is still very taboo in sport."

Parents can be in the same information void. Dr Sims says it is important to know what is going to happen to your girl over the course of a year to 18 months. "From a sporting point of view, it is not about the performance outcomes, it is about gaining skill, technique and strength to carry them on. We break it up, and look at what happens when a girl hits puberty, and what a typical trajectory is. How we can put steps in to support her? And talking about all the things girls go through versus boys, so coaches and parents can have awareness and skills to deal with them."

Research shows that if a girl starts to ovulate before the age of 13 then her periods are going to be very regular, and those who start after are likely to be irregular for a few years. Dr Sims says the response is often to blame the irregularity on sport, take her to a GP, and most suggest putting the young woman on an OCP: Oral Contraceptive Pill. "Parents don’t know how to navigate it, the girl is wondering why her periods are irregular and she is having really bad cramps, and not wanting to talk about. Your GP says that if you put her on an oral contraceptive pill, it will help regulate and modulate the cycles. But that is the worst thing you could do, because then you don’t how she’s progressing. Also, one of the first warning signs of heavy training and heavy stress is endocrine dysfunction, with menstrual cycle irregularity a common first sign. But if you put someone on a pill it masks the problem. We need to make people aware that oral contraceptive pills are not the answer for young girls who are having menstrual disruption or irregularities (unless, of course, there is a larger health issue)."

In endurance and aesthetic-based sports, where body weight is a perceived significant contributor to success, when the young girls start going through puberty facing body composition changes and weight gain, they may start to restrict calories or increase training volume to try to stop that weight gain. "Sometimes they think that if you lose enough weight you can stop your period. If you’re training hard enough and or eating less than your body needs; the periods will stop. I’m getting a lot of worried parents saying their daughter was regular but now she is not. And a visit to the GP will often result in a suggestion of the OCP and to reduce training (or stop exercising). But that’s not really identifying the crux of the problem: Relative Energy Deficiency in Sport (RED-S). My goal with my talk at the symposium is to explain all of this, and give steps for people to be guided by. Let’s have this conversation, and put research-informed practices in place so we don’t end up in the prevalence of pathophysiology."

Dr Sims is the keynote at the upcoming Symposium that her University of Waikato colleague Holly Thorpe is leading. They are also part of the High Performance Sport New Zealand working group WHISPA (Health Women in Sport: A Performance Advantage), and have various collaborative research projects together focused on female athlete health, including work with elite triathletes, rugby players and weightlifters.

Dr Sims and Selene Yeager’s book ROARwas published three years ago, and has been listed as number 11 on book authority's top fitness books.

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