Research by Inspire Institute of Sport tracked menstrual cycles of athletes Research by Inspire Institute of Sport tracked menstrual cycles of athletes

In the last one year, Kalaivani Srinivasan has progressed from being on the fringes of Indian boxing to becoming the next big hope. The 19-year-old attributes the rapid strides, in part, to tracking her menstrual cycle. “I have been monitoring my periods since January,” she says. “It has helped me plan my training and diet.”

In an environment where a conversation on this topic is ignored and considered taboo, Kalaivani is among a handful of Indian sportspersons to take this approach. For her, it’s a step not only to remain healthy, but also to prolong her career.

A first-of-its-kind research in the country has shown that an alarming number of Indian athletes miss their periods and are deficient in key minerals, putting them at major risk of suffering career-threatening injuries as well as long-term health consequences, including osteoporosis. In fact, Indian women athletes showed higher deficiencies and health risks when compared to their counterparts worldwide.

Throughout 2019, a multi-disciplinary research team — comprising physiologists, nutritionists, academics and gynecologists — at Inspire Institute of Sport (IIS) tracked the menstrual cycles of the athletes training at the Bellary-based high-performance centre, home to some of India’s top athletes in sports such as athletics, boxing, judo, swimming and wrestling. The institute, founded by the JSW Group, also hosts national camps and is the venue for the selection trials for boxing’s Olympic qualifiers over the weekend.

The data gathered, according to those involved in the process, is worrying.

Twenty per cent of the 51 athletes who were monitored missed their periods, while 90 per cent did not meet the necessary levels of iron. The research further highlighted that the prevalence of nutritional deficiencies among women is “superior almost every time compared to their male counterparts”.

“It is a huge problem,” says Kevin Caillaud, head of exercise physiology and nutrition at IIS. “It’s a worldwide problem, but bigger in India.”

Most of the research on how women athletes should train is based on what has worked for men. According to the Washington Post, only 3 per cent of the studies on sports performances in the first half of this decade involved women.

There has been an increased effort to understand the issues women athletes face because of their cycles, but few of those studies can be applied in the Indian context, says Saumya Khullar, an exercise physiologist at IIS.

“The unfortunate thing is that all of them (researches) use female athletes who are not Indians as subjects. All the data is from foreign athletes,” Khullar says. “Considering the physiology of Indian athletes and their diet preferences… you can’t really generalise. So, when we are talking about Indian athletes, we need to make our own judgement.”

The athletes at IIS — aged between 13 and early 20s, who practice combat sports — were given a printed copy of the calendar, where they marked their period dates and number of training days missed each month due to periods.

The screening led the researchers to find that 39 per cent of the athletes risk developing a condition called Relative Energy Deficiency in Sports (RED-S) syndrome, commonly known as Female Athlete Triad — a combination of conditions that include low calorie intake, missed periods and weakening of bones.

It is caused, in simple terms, by an imbalance between energy intake and energy spent — or, in even simpler terms, when athletes starve themselves to maintain or reduce weight. In combat sports, there is pressure to shed some kilos before bouts so that the athlete can ‘make weight’; in endurance events, there is a general belief among athletes that weight loss will improve performance.

Diet preferences, Caillaud says, is another important factor. “For example, when Indian athletes travel abroad, they eat junk food or are starving because they don’t eat continental food. For 3-4 days before the match, they rarely eat because they don’t like the food,” he says.

The diet restrictions severely impact some of the functions of the body, which can affect both male and female athletes. But in the case of women, not consuming enough calories (not being wide enough in food groups, being restrictive with carbohydrates, etc) to support the exercise demands leads to them missing periods.

“We have data to show that when athletes were missing their periods, their performance was coming down and not evolving. There were some medical concerns as well,” Caillaud says. “We had an issue with a girl who missed her periods for five months. Her parents took her to a couple of specialists and the answer again and again was, ‘it’s normal, she is an athlete’. That is a big, big problem because ultimately, it leads to injuries.”

The potential injuries because of Female Athlete Triad include ACL damage, stress fractures, back and knee injuries in wrestling, and shoulder injuries in case of a boxer.

Kalaivani, who competes in the 48 kg category, is not surprised with the ignorance Caillaud refers to. “I was 9 when I started boxing. My father was my first coach but when I started getting periods, I felt shy to discuss it with him in the beginning,” she says.

At the national camp, where she is surrounded by male coaches and support staff, the conversation surrounding menstrual health is virtually non-existent. It was only at the insistence of Khullar that she started monitoring her periods. “When she told me, my first thought was, ‘for what?’” Kalaivani says. “Even in the India camp, they are not monitoring all this.”

Eventually, she was convinced that the information could make a difference in the way she trained and performed. Today, Kalaivani uses a mobile app to track her periods, an approach made famous in sports by the World Cup-winning USA football team. Kalaivani isn’t the only one — Tokyo Olympics aspirant Nikhat Zareen, too, has bought into the idea, Caillaud says.

Khullar adds: “We have been able to bring down the number of athletes who miss periods. So that would mean there are more athletes who are healthier.”

Kalaivani testifies to this. “I have been feeling healthier than before,” she says. But she also insists on making the conversation on periods ‘normal’ for better health of women athletes. “We should treat it in a normal way and not think it’s taboo,” she says. “We need a normal conversation around this.”

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