Heavy menstrual bleeding in athletes

Despite the fact that female athletes are becoming more prevalent, the ongoing issue of menstruation is rarely studied in the context of athletics.

Heavy menstrual bleeding (HMB), which affects around a quarter of the female population and can have a severe impact on physical performance and overall quality of life, is seldom publicly acknowledged.

Due to a lack of standardized and reliable diagnostic methods, determining the real impact of HMB is challenging. Blood loss of more than 80 mL each monthly cycle, or subjective measurements such as excessive menstrual blood loss that interferes with a woman’s physical, social, or emotional quality of life, are examples of possible definitions. According to various studies, the condition includes two or more of the following criteria: large blood clots, the need for double sanitary protection, frequent (every two hours or less) tampon and towel changes, the need for 12 or more sanitary items per period, and flooding through clothes or bedding.

Increased menstrual blood loss, regardless of definition, increases a woman’s risk of iron deficiency and, as a result, iron deficiency anemia. Iron is a vital mineral that plays a part in a variety of biological activities, including the transfer of oxygen and the generation of energy. The most prevalent cause of iron deficiency anemia in women of reproductive age is menstrual bleeding, especially when it is heavier than usual. As a result, 63 percent of women with HMB reported being iron deficient at some time, according to a recent observational research.

Poor iron status can have a significant influence on endurance exercise performance due to its critical functions in oxygen transport and energy generation. Exercise-related variables, such as increased iron loss through the GI tract, perspiration, and foot strike hemolysis, enhance the risk of anemia in menstrual athletes (destruction of red blood cells from the repeated shock and impact of long distance running).

Heavy menstrual bleeding affects around a quarter of women, and it can have a negative impact on iron levels and, as a result, endurance performance.