In medicine and science, little attention has been paid to the female anatomy. However, it is essential to know the differences between the sexes in order to optimally address their needs during training.
The most important facts in a nutshell:
- Women's health has received too little attention in the sports & health sector.
- There are major differences between the requirements for efficient and effective training between the sexes.
- In order to achieve efficient training success as a woman, the female physiology must be taken into account, which means, among other things, training in harmony with the menstrual cycle.
According to key data from the DSSV, women make up the larger proportion of gym members, 53.3%. Overall, 26% of all women in Germany are registered in fitness studios - and the trend is rising. The age group between 20 and 29 is the most frequently represented. The aim is to win over this target group and, above all, to retain them as members in the long term. In doing so, they try as best they can to stay up to date and constantly expand their range of offerings.
You don't have to follow every trend! What you should do, however, is know your members, their training goals and their indications, and cater to their needs.
And this is where the problem begins. Because understanding the customer means, above all, being familiar with the female anatomy and physiology. As a trainer, you know exactly what each muscle is called in German as well as in Latin, where its insertion and origin is, and its function.
But in which training/study courses are the physiological differences between the sexes addressed? On the peculiarities of female biology? On the effects of the menstrual cycle? Exactly, so far in NONE! Even in medical school, important basics of female physiology are not taught. But why is that? And why does less knowledge exist to date about women's biology than men's?
The Gender-Health-Gap
The most recent meta-analysis by Cowley et al. (2021) shows, shockingly, that just 6% of studies in sport & exercise science have been conducted exclusively on women. "That's because it's too expensive and too time-consuming to survey with female subjects." Hormonal fluctuations during the menstrual cycle affect many parameters that affect athletic performance and also nutrient requirements.
Designing good studies is complex because there are several things to consider about research with female participants. What menstrual phase is the subject in? Is she taking hormonal contraceptives? Is she pre-/post-menopausal?
As a result, women are often excluded from scientific studies. This is also referred to as the "gender data gap," because there is a data gap here (to the disadvantage of women), which has decidedly many and serious consequences.
In science, it is argued that general human physiology, with the exception of reproductive function, has traditionally been defined in terms of responses of the "typical 70-kg male" (Miller, 2005)1 Ever notice that almost all covers of anatomy books feature male bodies?!
The gender-health gap encompasses not only the menstrual cycle, but women's health in general, which has received too little attention in the sports & health field.
Many women are affected by severe menstrual cramps, amenorrhea (absence of periods), endometriosis and other gynecological conditions. These complaints naturally affect well-being, but also athletic performance.
To summarize: Studies have been too complex, elaborate and expensive, which is why training and nutrition recommendations are mainly suited to male physiology and simply inferred to women. Even in studies on women only, little attention has been paid to hormonal fluctuations due to the menstrual cycle.
But to disregard our hormones would be like a car without a steering wheel. After all, these chemical messengers transmit information and control numerous vital bodily processes, such as metabolism and energy production, development and reproduction, respiration, blood pressure and much more.
During the menstrual cycle, hormone levels change, which affects, for example, energy levels, basal metabolic rate, mood, susceptibility to injury, infection, etc., and thus influences athletic performance on the one hand and the ability to adapt to certain stimuli on the other.
Cycle-based training is not a trend, but a MUST!
If you think "cycle-based training" is just a trend, you are definitely wrong! But is it the fitness and sports industry's job to educate and raise awareness about the menstrual cycle? Isn't that the responsibility of school education or gynecologists, for example?
Gyms serve the purpose of "keeping fit" and achieving individually defined athletic goals. The fact that many women wear themselves out in the process, both physically and psychologically, is known to very few. According to estimates and various studies, about 70 to 98% of menstruating women are affected by various menstrual cramps or cycle disorders.
According to a survey (2020) conducted by the menstrual platform "Strawberry Week", in which more than 2,000 women participated, 98% reported suffering from various forms of menstrual cramps, such as abdominal pain (63%), heavy menstrual bleeding (30%) and cycle irregularities (23%). Some women are affected by pain so severe that they are unable to work for one to three days. In Spain, the so-called "menstrual leave" has therefore been introduced.
In addition, approximately 85% of women are affected by the so-called premenstrual syndrome (PMS) during the premenstrual phase (Steiner & Born, 2000)2, which is characterized by emotional and physical symptoms (such as headaches/migraines, breast tenderness, water retention, lack of energy, depression, mood lability, etc.).
If there is no underlying organic, pathological cause, these disorders are related to hormonal imbalance. And this hormonal imbalance is in turn related to lifestyle factors - especially physical and psychological stress.
And this is where the fitness industry comes in. Because hopefully you're aware that eating the "wrong" diet and exercising the "wrong" way means physical stress. So you don't have to be an expert to realize that menstrual cramps and cycle disturbances affect well-being, health, physical fitness and performance.
However, some female athletes, especially those in the competitive field, are not even affected by the menstrual cramps mentioned here because they have long since lost their periods. "How?" - Lose your period? That's right! Many female athletes suffer from amenorrhea, which is the absence of periods. Amenorrhea is one of the symptoms of the clinical syndrome "RED-S" (= "Relative Energy Deficit Syndrome in Sports") (still too little known among female athletes and coaches).
This phenomenon is a globally recognized disorder and was first recorded in the International Olympic Committee (IOC) consensus statement3 in 2014. It is a syndrome in female athletes that results from a relative lack of energy, which affects many aspects of physiological function. These include, for example, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular and mental health.
The consequential health effects, both short and long term, include osteoporosis, fractures/stress fractures, impaired growth and development, increased susceptibility to infection, infertility, etc. In order not to go beyond the scope here - the following is a case study of the American middle-distance runner Mary Cain: "I got caught in a system designed by and for men, which destroys the bodies of young girls."
The Case of Mary Cain
The seventeen-year-old "miracle runner" joined the Nike Oregon Project (NOP) in 2013 and made major headlines around the world when, in November 2019, in a New York Times op-ed and shocking video, she recounted the alleged abuse she was subjected to at the long-distance training center. "I was the victim of abuse by a system and a man."
In it, Mary Cain recounts how her all-male coaching staff became obsessed with her weight. She was publicly weighed and, according to her accounts, brutally berated when the results on the scale did not match her expectations. She followed the strict instructions of her coaches, who had no regard for her physiology or well-being.
Many female athletes share the idea that they have to sacrifice everything - including their health - to achieve their goals. They believe they can only succeed athletically by enduring things that others cannot. Overuse injuries and subsequent health problems are accepted by many female athletes, both inside and outside of elite sports, as normal steps on the road to success.
Period loss is seen by many female athletes not as a warning sign, but as a successful validation of hard training.
Mary Cain's health suffered greatly from overtraining and malnutrition. Her estrogen levels dropped, she didn't get her menstrual period for three years, and her bone density was severely compromised, causing her to break five bones. Her ability to recover was also severely affected because she was not taking in enough calories and her body could not recover from the hard training.
So doing without and the hard training didn't pay off - on the contrary, it harmed her performance and health. According to reports, she even had suicidal thoughts at the end.
At this point, you may be asking yourself: why aren't cases like this more widely known? Why have I never heard about them? And why isn't anything changing? An interesting study by Ryterska et al (2021) asked about the reasons for not reporting amenorrhea. The following five main reasons of the female athletes were collected: (1) lack of normalization of the topic, (2) the absence of menstruation is not perceived as a problem by the athletes themselves, (3) experienced shame and taboo, (4) prioritization of athletic performance, (5) denial.
So the lessons learned are: de-tabooize & educate! Sure, the case of Mary Cain is a pretty drastic example. However, not only competitive athletes, but also many active gym-goers are affected by amenorrhea or RED-S. In a survey4 of 500 athletic women, half reported having suffered from amenorrhea at some point in the past few years.
Many women have goals of losing weight, building muscle, improving endurance, and in some cases are overly motivated and very disciplined in their approach to their goals. Most women quickly end up in a (chronic) calorie or energy deficit and torture themselves through tough training sessions without sufficiently regenerating.
It may seem that women can't work out hard and reach their desired weight without getting cycle irregularities. This is definitely not the case.
"I have the feeling that men often achieve their training and nutrition goals faster and easier than women. I notice this especially when I train couples."
Micha Haase, Founder CityBootCamp & Personal Coach from Leipzig, Germany.
Of course, as a woman it is possible to reduce weight and build muscle without suffering harmful consequences. The "simple" solution here is to take female physiology into account, which means, among other things, training in harmony with the menstrual cycle.
Cain also recognized the source of the problem, which was that her training and nutrition plans were not designed for her physiology, but for that of a male athlete, and that these vast physical differences were not taken into account. Neglecting these differences not only limits the progress, development, and opportunities of female athletes, but also jeopardizes their long-term health.
The menstrual cycle, or female physiology, must therefore find its consideration in everyday (training) life - it is not enough to open women's gyms in pink design.
Source: BODYMEDIA
Image source: BODYMEDIA, #122061087 dbunn / stock.adobe.com
Published on: 28 June 2023