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'Completely overlooked': UNC researcher explores how menstrual cycles affect sports science

DTH Photo Illustration. Emergency contraceptives, birth control, and a pregnancy test are pictured on Oct. 9, 2022. These can be accessed both on and off campus.

UNC professor of exercise physiology Abbie Smith-Ryan said she thinks "estrogen is a superpower."

Director of UNC's Applied Physiology Laboratory, Smith-Ryan currently researches practical applications for exercise, performance, recovery and nutritional strategies for women and men. Her research has revealed key differences in the health needs of female athletes, who often require specific consideration due to their menstrual cycles, hormonal contraception and other factors that can impact performance. 

She said there should be more investment into understanding and applying these gendered differences in the sports field.

According to the National Library of Medicine, there are major gaps in research dedicated to women’s health in sports. And according to a 2021 study in the Women in Sport and Physical Activity Journal, Six percent of sports and exercise science research published between 2014 and 2020 centered on women specifically.

"If you think about coaching and education and support, there's not a lot of conversations or people are afraid to talk about periods, which is not a good thing," she said.

Smith-Ryan was selected alongside colleague Anthony Hackney, professor of exercise physiology and nutrition, to participate in the FIFA Female Health Project as part of the 2023 FIFA Women’s World Cup this past summer, where she helped develop a framework for combating inequalities in women's health in sports.

"It's always pretty incredible when your research can have some sort of impact. And the most exciting part is that this is just the beginning," she said.

Sam Moore, a third-year doctoral student in UNC's Human Movement Science curriculum and a student of Smith-Ryan's, said she has enjoyed the opportunity to present similar findings to different strength and conditioning staff and other sports exercise professionals. 

However, she said she has been surprised by the responses her work has received.

"I think what was really shocking to me is there's actually quite a bit of resistance against changing training across the menstrual cycle for female athletes or changing it based on different birth controls," Moore said. 

She said she has observed discomfort from male strength coaches who must adapt to gendered training, in addition to the larger research community. Despite the reactions Moore received, she said female athletes have responded to her efforts "incredibly positively." 

Before coming to UNC in 2021, Moore worked at NC State as an assistant strength and conditioning coach where she helped design training programs around aspects of the female hormonal landscape regarding factors like birth control and the menstrual cycle. 

She said for many of her athletes, it was their first time having a female strength coach, which she suspected was a source of doubt at first.

"When you have these experiences across the menstrual cycle at whatever point, sometimes the feedback that you can hear from former female athletes or other women is like, 'Well, I went through it, and I was fine, and so you need to just buck up and get through it,'" she said.

Grace Saccone, a former soccer player at Indiana University, said if everyone on her team had discussed their period cycle openly, she would have felt more compelled to work to understand her period health.

Saccone said she struggled with amenorrhea, a condition resulting in the absence of a regular menstrual period, while entering college. She added that because of their physical activity levels, many of her teammates experienced a similar condition, which was regularly considered a "badge of honor" rather than a cause for concern.

Hormone pills prescribed to her by nutritionists were only "band-aids" on a much larger issue, Saccone said. It was not until a doctor questioned her about her physical activity levels and restrictions she had placed on her eating that she realized she needed to make changes in her behavior.

"There are so many things we can leverage about female physiology to make us better athletes that are completely overlooked either because they're cliche or uncomfortable," she said.

Smith-Ryan said in an email that while practical applications have been "slow to integrate" at UNC, many women's teams at the University have begun tracking and comparing menstrual cycles and hormonal contraceptive use to athlete performance. She also said her department has made efforts to qualify these observations as research, and has initiated conversations with UNC athletics about the unique support needed by female athletes.

Moore said female health evaluations and collaborations between UNC's academic and athletic community can be difficult due to a lack of enforcement. She said these partnerships can often be individualized, such as when she approached UNC women's teams about developing a universal female athletic questionnaire.

"I think making it this systematic collaboration and [having] clear expectations and clear roles, I think will help in the future of consistency of data collection and consistency of implementation and [ensure] everyone's on the same page,” Moore said. 

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She added that UNC staff have been "super open" to implementing research, which is not very common at every university.

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