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Why are sportswomen excluded from scientific studies?

Juliana Antero
Juliana Antero
Epidemiological researcher at the Institut national du sport de l'expertise et de la performance
Key takeaways
  • Women are under-represented and overlooked in sport research, making up just 35% of participants in sports science studies.
  • The menstrual and hormonal cycle can have an impact on results, so a better understanding of women’s physiology is needed.
  • Oestrogens are thought to have anabolic properties that are beneficial to muscle building and recovery.
  • Training needs to be adapted to each woman’s individual profile and cycle.
  • To achieve this, research programmes are being set up to help sportswomen improve their performance by taking into account the menstrual cycle.

Women are still under-rep­re­sent­ed in sports per­for­mance stud­ies. For­mer sports­woman Juliana Antero has long been affect­ed by the stress of irreg­u­lar men­stru­al cycles. In order to help spread aware­ness and com­bat this inequal­i­ty, she has launched the EMPOW’HER research pro­gramme to sup­port all sports­women1.

Why are women under-represented in scientific studies on sports performance? 

Women account for only 35% of par­tic­i­pants in sports sci­ence stud­ies. Most of the med­ical, nutri­tion­al and train­ing pro­to­cols that sports­women fol­low are devel­oped for male ath­letes. Some sci­en­tists jus­ti­fy this absence by the influ­ence that the men­stru­al cycle can have on women’s sci­en­tif­ic results and per­for­mance. But that’s pre­cise­ly why these stud­ies are nec­es­sary! If we want to opti­mise women’s sport­ing results, we need to know more about the impact of female phys­i­ol­o­gy on their performance.

What is the aim of your EMPOW’HER project?

The main aim of EMPOW’HER (Explor­ing Men­stru­al Peri­ods Of Women ath­letes to Esca­late Rank­ing) is to max­imise the per­for­mance of female ath­letes by opti­mis­ing their train­ing respons­es through adapt­ed train­ing loads, in syn­er­gy with their phys­i­ol­o­gy and men­stru­al cycle. Since 2020, we have mon­i­tored around a hun­dred top-lev­el sports­women who took part in the Tokyo Sum­mer Olympics, the Bei­jing Win­ter Olympics and/or are prepar­ing to take part in the Paris Olympics. Almost a dozen dis­ci­plines are cov­ered: row­ing, cycling, swim­ming, ski­ing, wrestling, gym­nas­tics, and triathlon. 

Every day for a peri­od of six months, these women record their data on an appli­ca­tion: the qual­i­ty of their sleep, mus­cu­lar pains if they feel any, pains linked to their men­stru­a­tion, their state of stress, etc. In this way, we can observe the influ­ence of hor­mon­al fluc­tu­a­tions on the well-being and train­ing of these sports­women. In this way, we can observe the influ­ence of hor­mon­al fluc­tu­a­tions on the well-being and train­ing of these sports­women. The ini­tial results show that even mild symp­toms reduce the qual­i­ty of their train­ing, and that they are more or less fit at dif­fer­ent times of the cycle. In par­tic­u­lar, there are sig­nif­i­cant inter-indi­vid­ual differences

A US decree to adapt sports train­ing to the men­stru­al cycle

In 2019, the Amer­i­can women’s foot­ball team won the World Cup for the fourth time. How can we explain the dom­i­nance of the Unit­ed States in a sport tra­di­tion­al­ly dom­i­nat­ed by Euro­pean nations in the men’s game? In 1972, a decree was passed ban­ning all dis­crim­i­na­tion based on gen­der in schools and uni­ver­si­ties in the Unit­ed States. This was the cat­a­lyst that gave women access to bet­ter oppor­tu­ni­ties in sport. The team is now advised by Amer­i­can researcher Georgie Bru­in­vels, who holds a doc­tor­ate on the impact of iron defi­cien­cy and men­stru­al cycles on sport­ing per­for­mance. The researcher has adapt­ed the team’s train­ing accord­ing­ly. An approach that has clear­ly proved effec­tive with female footballers.

Is it possible to choose the date of competitions according to your menstrual cycle?

No, but you can adapt your train­ing sched­ule to the dif­fer­ent phas­es of your cycle and antic­i­pate cer­tain con­straints. For exam­ple, increas­ing the over­all vol­ume of exer­cise over the month by reduc­ing the inten­si­ty on cer­tain days. If you take these issues into account before­hand, you can even take advan­tage of cer­tain hor­mones. For exam­ple, the quan­ti­ty of oestro­gen is high­er dur­ing ovu­la­tion. Often per­ceived as an obsta­cle to per­for­mance, this hor­mone has inter­est­ing ana­bol­ic prop­er­ties for mus­cle build­ing and recov­ery. Our hypoth­e­sis is that it may be pos­si­ble to take advan­tage of hor­mon­al fluctuations.

How do sportswomen approach the subject of menstruation and possible pain?

It’s still a bit of a taboo sub­ject. The major­i­ty of coach­es are male. Sports­women feel allowed to talk about their injuries and mus­cle pain, but not always about their hor­mon­al cycle.

When it comes to peri­od pains, there is usu­al­ly an expla­na­tion. To begin with, it’s impor­tant to seek a doctor’s advice to find the cause. Is it linked to a cycle dis­or­der such as endometrio­sis? Could med­ica­tion be effec­tive in reliev­ing the pain? Final­ly, are there any non-med­i­c­i­nal meth­ods – although not sci­en­tif­i­cal­ly proven – that can relieve men­stru­al pain? Sports­women need to be per­suad­ed to con­sult a doc­tor, a gynae­col­o­gist or an endocri­nol­o­gist if they are to over­come these pains and be able to train normally.

How were you able to objectively assess performance in your study?

For non-timed sports such as row­ing and fenc­ing, it was dif­fi­cult to mea­sure an objec­tive per­for­mance, so we had to rely on the ath­letes’ own com­ments. But with cycling or foot­ball, we have pow­er or move­ment sen­sors and we can cal­cu­late the effort pro­duced by the ath­lete. So, we’ve been able to link this data with women’s hor­mon­al profiles.

We are now try­ing to mea­sure the effect of train­ing adapt­ed to women’s indi­vid­ual pro­files and cycles. That’s the aim of our next research projects. There’s still a lot to be done, for exam­ple, sup­port­ing sports­women on issues relat­ed to the pelvic floor to pre­vent uri­nary incon­ti­nence dur­ing exercise.

Marina Julienne

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