Dealing with the First Menstrual Cycle
by Dr. Becky Morgan
Are you a coach with young girls on your team who will experience their first menses this season?
Do you have swimmers who do not swim during their menstrual cycle?
Do you have girls quitting swimming because of the fear of having to deal with menstrual issues?
If you answered YES to any of these questions, you may find the following information useful in dealing with the concerns that many young female swimmers and their parents have regarding training and menstruation.
Step One: Talk to the parents. Many times a mom or an older sister can help dispel myths and explain the whole menstrual “thing” so that a younger girl will not be so horrified.
About the tampon issue... It’s not always easy to solve. First, identify someone with whom the athlete is comfortable (i.e. a parent or a close teammate) to make sure they instruct the athlete in the proper use of tampons, starting with the most slender model. Some girls have issues with the applicator being a bit painful, so the OB brand is recommended because they are small and don't require an applicator. However, the athlete might not like having to insert the tampon manually. If this doesn't work, a visit to the family doctor for an exam is recommended to ensure that there are anatomical problems. Having a male coach deal with this issue is not recommended, as this often magnifies the embarassment factor.
About cramps... Cramps are often accompanied by symptoms such as nausea, vomiting, excessive fatigue and general malaise. Treating these symptoms with medications (anti-inflammatory or oral contraceptive, depending on how severe the symptoms are) often improves participation and performance in affected athletes. There is also value in listening to the athlete and addressing/treating PMS symptoms. Preventing heavy bleeding by regulating periods with oral contraceptives proves especially helpful in swimmers.
About Irregular Bleeding... There are many reasons for irregular bleeding. Some young ladies have irregular bleeding regardless of their activity level. Most of these folks have anovulatory cycles (meaning they don't ovulate every cycle because of some disturbance in the hormone secretion). Others have abnormal cycles when they are most active because the activity causes irregularity in the hormone secretions. Every individual responds differently to changes in the hormonal patterns--some will just quit having periods, and others will just have wacky, unpredictable cycles. If these cycles continue to be really unpredictable, the uterus will have mixed messages and may just bleed all the time (how lucky can one be?). So, the moral of this story is--if those cycles are really irregular (too frequent or not frequent enough), the young lady needs to see a good primary care or ob/gyn and have an exam, have some labs done to check thyroid and some other hormones, and then consider regulation of the period with contraceptives if all else is ok and the bleeding (or lack thereof) is a problem.
About Performance... There is no strong evidence to show that the menstrual cycle affects athletic performance. Typically, it is the symptoms related to the cycle that interfere with training. Addressing these issues first may be a tremendous help in the long run.
Dr. Rebecca "Becky" Morgan is in her fourth year as the team physician for the University of Tennessee Lady Vols. She is board certified in Family Practice and has a Certificate of Added Qualifications in Sports Medicine. Dr. Morgan received her Medical Doctorate from the University of South Alabama and completed her Family Practice Residency Training at the University of Alabama School of Medicine in Huntsville. She also served her Sports Medicine Fellowship at UASOM-Huntsville in 1996. Dr. Morgan completed a volunteer physician internship at the Olympic Training Center in Chula Vista, Calif., and also has experience with international competition through her work with the USA Swimming Program. She is a former member of the USA Swimming Sports Medicine/Science Committee.