‘Losing your period is not healthy’: Athletes want more understanding of women’s health

‘Losing your period is not healthy’: Athletes want more understanding of women’s health

When Ironwoman Carla Papac stopped getting her period, she wore it as a badge of honour.

“The attitude towards it was, ‘I don’t want my period because it means that I’m an elite athlete’,” she told ABC Sport.

“So imagine the effect it has when you’re talking to your role models and people who are achieving really good things in their sport and them telling you that they don’t have proper menstrual health.

“You are going to take that on board and want to be the same.”

Papac was a strong surf ski paddler but wanted to “look” like an ironwoman.

To her, that meant getting “lean”, which led to not eating enough.

Ironwoman Carla Papac sits and paddles in the water during a race
Papac says she realised something was wrong when the surf ski became her weakest leg.(AAP Image/Coolangatta Gold)

And what was once her best leg in races turned into her worst.

“I lost all my strength, all my muscle,” she said.

“I looked really fit; I had a lot of people telling me that I looked good, which is also damaging because you look fit on the outside.

“But that year, I didn’t make any finals of nationals except one, and before that, I used to make every final and be up there in every final too.”

It took Papac some time to finally realise the real reasons behind her drop in performance, and it inspired her to educate herself and others.

The cost of striving for perfection

Ironwoman Carla Papac smiles as she holds the finishing tape in her hands, raising her arms
Papac won the prestigious Coolangatta Gold Ironwoman series last year. (AAP Image/Coolangatta Gold)

Papac still competes and is now an exercise physiologist who helps run Woman Performance, which provides workshops and education to athletes, coaches, and families about women’s health.

She wants sportswomen to understand their periods and the importance of menstrual health — in particular, conditions which can affect them, including amenorrhoea (loss of periods) and Relative Energy Deficiency in Sport (RED-S).

RED-S means energy intake isn’t matching energy output – basically, not eating enough for the amount of exercise you’re doing.

It’s most common in sports where weight/leanness are important, like long-distance running/cycling, aesthetic sports like gymnastics, or where you need to meet a weight category, like boxing and combat sports.

A graphic chart with RED-S in the middle and descriptions of health outcomes in breakout boxes
RED-S can lead to a number of poor health outcomes.(Supplied: AIS Female Performance & Health Initiative)

Symptoms include weight loss, disordered eating or eating disorders, menstrual dysfunction, drop in performance, mood changes, and recurrent injuries and illnesses, including stress fractures.

“Losing your period is not healthy,” Papac said.

“Especially for people that haven’t had that period for a long time, that’s when I would be urgently encouraging that person to be making some serious changes in their training and reaching out to qualified nutritionists, talking with their coach about it.”

Runner Lauren Fleshman has her arms raised in the air after a race
American Lauren Fleshman is author of Good For A Girl: A Woman Running In A Man’s World.(Action Images: Andrew Boyers/Livepic)

American former distance runner Lauren Fleshman can relate — she had RED-S during her career.

She’s the author of Good for A Girl, which details her own experiences in the running world, as well as more broadly exploring women’s fight for a place in a sporting system “created by men, for men and boys”.

“I think that I had been through my own stage of disordered eating,” she told ABC RN’s The Drawing Room.

“I had broken bones; I had missed opportunities in pursuit of this idea of looking like the image of excellence, of fighting for every per cent of body fat, just trying to be perfect.

“There was a huge cost. I couldn’t even be good because most of the time, I was hurt in this effort to be perfect.”

Fleshman realised she needed to listen to her body and forget about any “number on the scale” to be in a position to stay healthy.

“[Eating more] would lower my stress levels enough where I could actually train consistently every day, show up and race at all the big races and not be sidelined,” she said.

As Fleshman explores in her book, female athletes have higher rates of menstrual dysfunction, bone loss, and disordered eating, while many think losing their period is a normal outcome of heavy training loads. 

“Monitoring menstrual health is the first line of defence against all of this harm. And again, nobody talks about it,” she writes.

Puberty is a ‘power not a weakness’

Runner Lauren Fleshman crosses the finish line with her arms raised
Fleshman says there needs to be more understanding of what girls experience through puberty.(Action Images: Lee Mills/Livepic)

Girls drop out of sport at higher numbers than boys and are more likely to experience body image concerns.

Fleshman believes a lot of this comes down to a lack of understanding of girls’ and women’s bodies.

“Puberty is framed as a career ender for a lot of developing female athletes,” she said.

“We’re looking at puberty and the changing female body to something softer, like something we need to draw conclusions about now, that it means they can’t continue to improve.

“It’s just way too premature to be creating these kinds of messages.