Sports injuries and female hormones

Elegant Point · Satellite level

Sports injuries and female hormones

emmsie69 · Top national player

It was probably me that mentioned it as I have a real bugbear about the lack of medical research specifically aimed at Women, even the lab rats are Male. I think England Hockey have been the trail blazers, Football is miles behind but will push things forward now. Training has to be tailored to the menstrual cycle to help prevent injuries.

caringmedical.com/prolotherapy-news/estrogen-ligament-laxity/~:text=Female%20athletes%20on%20containing%20high%20doses%20estrogen%20and,to%20stimulate%20collagenase%20enzyme%20responsible%20for%20collagen%20breakdown.
It's also not just about our bodies but also the equipment in use, often just a smaller version of the Male equipment. There was an article on the BBC last week about the issues Women have.

Tanaqui · Club Coach

Thanks for posting this, EP. It was a really interesting and quite disturbing read.

Elegant Point wrote:
Katy, 26, had fairly regular periods until she was about 14, when she started eating less, on top of competing in junior tennis tournaments. As she grew older, her periods became increasingly sporadic, until they stopped completely. A turning point came in her early 20s, when Katys coaches noticed that she wasnt gaining any strength, even though she was training hard. They kind of put two and two together and had a conversation with me about my fuelling, and whether I wasnt eating enough, she said.

I'm pretty horrified apparently no one questioned this or investigated it at the time! Amenorrhea/dysmenorrhea in a teenager who's been having regular periods is, I believe, generally a sign of something very, very wrong physically.

Coup Droit · Tennis legend

There is also a big issue about training at different times during the menstrual cycle (i.e. first half as opposed to second half)

"Some research has found that strength training during the follicular phase results in greater increases in muscle strength compared to training in the luteal phase. Estrogen is highest in the follicular phase."

Equally, proper medical studies show that:

"Peak estradiol is associated with increased laxity, strength, and poor use of neuromuscular control. Thus, the ovulatory phase is associated with an increased risk of injury".

www.ncbi.nlm.nih.gov/pmc/articles/PMC9958828/~:text=Thus%2C%20the%20ovulatory%20phase%20is,and%20neuromuscular%20control%2C%20among%20others.

Far more injuries have been logged for women doing hard training during the wrong phase, and savvy coaches know to schedule the training accordingly

Like you, Emmsie, I find it mindblowing that this is not A1 standard stuff

Coup Droit · Tennis legend

As a separate issue, I was involved (very obliquely) in a case that looked at sleeping pills and their effects

The problems was that ALL the studies for dosages etc had been done on men (men are used for nearly all trials because they don't have 'pesky' monthly hormonal changes that mess up the trials - so just ignore women, and just test the men, what could go wrong?)

And hence men of 65 kg, say, were used as the dosing measure for women of 65 kg

But sleeping pills are prescribed very frequently for women, and these particular pills (maybe all sleeping pills?) were stored rather than broken down, by fat, and women have a higher percentage of body fat

The net effect was that the prescribed advice, based on the men, was that the pill will clear your system in 8 hours

BUT for women of the same weight, because of the higher fat, it took more like 11-12 hours

And the problem was that women were waking up and driving to work at 7 am in the morning, having been told they were safe, the drug would not be in their systems any longer, and - guess what - there was a higher number of car accidents - and then some drivers, and third parties, got killed - and they found that the female drivers still had quite a high level of sleeping drug in their system ....

Utterly dreadful .... what's to say.....

-- Edited by Coup Droit on Saturday 6th of April 2024 06:00:52 PM

Elegant Point · Satellite level

Thanks all for replies - hopefully the more widely the topic is discussed and awareness raised, the more it will be investigated. The increase in popularity of womens sports such as football should also be a driver.

CDs comment on sleeping pills and the link with increased number of car accidents was shocking! Its not just women, many medicines prescribed to children have also not been formally evaluated for them.

Tanaqui · Club Coach

Thanks for the information on sleeping pills and the inadequacy of the testing, CD. I'd not heard about that particular example before.

Coup Droit wrote:
The problems was that ALL the studies for dosages etc had been done on men (men are used for nearly all trials because they don't have 'pesky' monthly hormonal changes that mess up the trials - so just ignore women, and just test the men, what could go wrong?)

Because it's not as if pharma companies haven't known about the absolute importance of testing on women (or, indeed, any kind of properly representative population, including children) since, oh... at least 1961. (That's when thalidomide was withdrawn from the market.)

Also, while I don't have links to any studies to hand, I've read in the past that there's quite a bit of evidence the medical profession is more dismissive of reports of pain from women than men. (And racism factors into it, too: there's even more discounting of black women's reported pain compared to white women.) So there may be an element of coaches and medical staff not taking complaints of e.g. joint pain seriously enough, especially in younger players.

paulisi · Tennis legend

It is quite common in lots of sports.
Athletics is very prominent especially with girls doing Endurance events and their increased training and attempts to maintain their weight. This can delay or restrict their body changing and cause problems in later life.

Generally called REDS syndrome

-- Edited by paulisi on Friday 12th of April 2024 08:41:30 PM

emmsie69 · Top national player

paulisi wrote:
It is quite common in lots of sports.
Athletics is very prominent especially with girls doing Endurance events and their increased training and attempts to maintain their weight. This can delay or restrict their body changing and cause problems in later life.
Generally called REDS syndrome

-- Edited by paulisi on Friday 12th of April 2024 08:41:30 PM

The problem occurs when they try to lose weight in the misguided idea that being thinner will make them quicker and look like an athlete. If endurance athletes ate enough to maintain their weight during training they wouldn't get REDS.

Some 74% of the survey group agreed that they had "felt as though they did not look like an athlete", while half said they had consciously restricted their food intake in order to improve their performance.

Just over half (52%) said they restricted food in order "to fit in or look the part in their sport".

The report found 91% had worried about how many calories they were eating, with 19% admitting these worries occurred "all the time".

More than half (53%) of athletes said they had received comments about their bodies, with athletes receiving those comments four times more likely to restrict their food intake.

What is really concerning is how many GPs think that periods stopping during training is 'normal' which returns to the point that there is an appalling lack of knowledge generally about the Female physiology.

Coup Droit · Tennis legend

One of the respected journals published a 'secondary' study recently i.e. one that doesn't do it's own research but compiles all the results of other specifc research studies, and tries to find a generalised takeway

The study found that, based on all the other studies, it's clear that the ovulatory phase of the cycle creates "increased laxity, strength, and poor use of neuromuscular control" and that it's proven that "the ovulatory phase is associated with an increased risk of injury".

But another takeaway which is rather shocking was that in trying to find all the literature and studies on the subject, they looked at 134 papers about the menstrual cycle, hormones, training and injury - their selection criteria were "scientific articles in English or Spanish that analysed healthy female athletes. Specifically, only articles published in 2011 or later were included to achieve up-to-date information".
And they only found 8 that qualified. (A lot were basically looking at the effect of the pill or something else and obliquely covered the area but you couldn't extrapolate the data they wanted as it wasn't focused enough)

So, in the last decade only 8 studies (small, big, whatever, anywhere in the world, only 8) have been done that actually address the question.

www.ncbi.nlm.nih.gov/pmc/articles/PMC9958828/~:text=In%20conclusion%2C%20it%20seems%20that,a%20higher%20risk%20of%20injury.

paulisi · Tennis legend

Some of it is down to coaches as they use power to weight ratios and they shouldn't

Coup Droit · Tennis legend

Well, it's ALL down to the coaches
They should know about all this if they are coaching young female athletes - it's their job

emmsie69 · Top national player

I think it's unfair to blame the coaches when every aspect of sport (Society) is designed for Men. Bottom line is that there has never been the money or the exposure in Female sport to make it worth doing any research and you can't blame them when all of Medicine has been designed around Men. It's only since the awarding of the London Olympics that there has been any real research and it's still in it's infancy.
The article on the BBC is about equipment.
www.bbc.co.uk/sport/68542035

Coup Droit · Tennis legend

emmsie69 wrote:
I think it's unfair to blame the coaches when every aspect of sport (Society) is designed for Men. Bottom line is that there has never been the money or the exposure in Female sport to make it worth doing any research and you can't blame them when all of Medicine has been designed around Men. It's only since the awarding of the London Olympics that there has been any real research and it's still in it's infancy.
The article on the BBC is about equipment.
www.bbc.co.uk/sport/68542035

Partly agree.

Yes, as above, the number of suitable studies on the subject in the collective study is ridiculously low

But they're not non-existent

There's quite a few - as cited on this forum

Coaches have to know that - it's their job