• Femme Fitness: Women and Performance

    IMAGE The past 30 years have seen an increase in the number of women participating in sports. Are there special considerations for the female athlete?


    It is no secret that a woman's hormones play a huge role in how she feels, but the effects of hormones go beyond just mood. You can blame estrogen, at least in part, for the fact that women tend to have a higher percentage of body fat and water retention. But this is not in vain. According to Mark Baugh, PharmD, author of Sports Nutrition: The Awful Truth, "This is a natural process which is designed to protect the fetus from the harsh environments humans live in."
    Okay, so women have more estrogen and body fat than men, but why is it seemingly easier for men to lose weight? This can be summed up in one word—metabolism. It is sort of a domino effect in men. They have more testosterone, which allows them a higher percentage of muscle, and because muscle is more metabolically active than fat, it burns more calories and revs up their metabolisms.


    One's "fattern," or pattern of fat distribution, seems to be an issue, too. Men's fattern tends to be highly abdominal, whereas women tend to carry heavier in their lower bodies. According to Robyn Stuhr, MA, an exercise physiologist at the Hospital for Special Surgery in New York, abdominal and visceral fat appears to be more responsive to exercise than the fat on the hips, buttocks, and legs.

    Reproductive Organs

    "Until recently," says Christine Wells, PhD, in her book, Women, Sport, and Performance, "most of the International Olympic committee members believed that sport training and competition were detrimental to proper reproductive functions in women."
    We now know that these beliefs are unfounded. Physical activity—whether during the menstrual period or not—will not harm a woman's reproductive organs. In fact, Constance Lebrun, MD, a physician at the Fowler-Kennedy Sports Medicine Clinic in Ontario, says that men's testes are actually in a more vulnerable state than women's reproductive organs during certain athletic activities. Hence, the need for a cup!

    Menstrual Cycle

    "When I'm PMS-ing," says Yaz Boyum, a professional bodybuilder and online trainer, "I just do not have as much energy and I am hungry all the time!" Cramps and premenstrual headaches can also put a damper on how well you feel. And if you do not feel well, you are going to have to psych yourself up to perform better.
    Apart from these anecdotal experiences, however, research is mixed on this subject. In Lebrun's review of the literature covering this topic, she concluded that "there does not appear to be any conclusive evidence of effects of the menstrual cycle on actual athletic performance."
    Research does show, though, that aerobic exercise (like going for a jog) can help ease many of the symptoms of premenstrual syndrome.


    As more people get involved in athletic activities, there is an increase in sports injuries. Studies show that it is not the gender as much as it is the sport that increases the injury risk.
    The highest risk sports for women appear to be basketball, gymnastics, softball, and field hockey, according to Wells. Most injuries occur in the knee and ankle, whether you are a man or woman. However, women may score higher in knee injuries.
    According to Bert Mandelbaum, MD, of the Santa Monica Orthopaedic and Sports Medicine Research Foundation, young women suffer from anterior cruciate ligament (ACL) tears more than their male counterparts.
    The reason, he feels, is lack of neuromuscular control. "Women tend to run more extended and flatfooted, which puts more pressure on the quadriceps." His solution is prevention: teaching correct form and proprioception (being aware of your position), and increasing strength and flexibility.

    Nutritional Concerns

    One of the top nutritional concerns regarding menstruating women, especially active women, is iron intake. Athletes are at particular risk. Some of the reasons for this include:
    • Inadequate dietary intake of iron
    • Poor absorption of iron due to nonheme iron sources (eg, cereal, beans, lentils)
    • Increased iron losses in urine and sweat
    • Gastrointestinal blood loss (which may be more common in long-distance runners)
    Iron deficiency can cause anemia. And even when it is not severe enough to cause anemia, it may impair performance. "People who have iron deficiency…have a reduced rate of lactic acid clearance from the blood, and they tire earlier during exercise," according to the authors of Women and Exercise. In several studies, iron supplementation improved endurance performance in women with mild iron deficiency.
    The most important point about nutrition, athlete or not, is to make sure you are eating a variety of healthy foods. Do not supplement iron on your own without talking to your doctor, as too much iron can be dangerous, too.

    Learning as We Go

    As more and more women become involved in the sports and fitness scene, more attention will need to be paid to health matters that concern female athletes. While some research has been done in this area, there are still many more avenues to explore.


    American College of Sports Medicine http://www.acsm.org/

    American Council on Exercise http://www.acefitness.org/


    Health Canada http://www.hc-sc.gc.ca/


    Eston RG. The regular menstrual cycle and athletic performance. Sports Med. 1984;1(6):431-445.

    Frankovich RJ, Lebrun CM. Menstrual cycle, contraception, and performance. Clinics in Sports Medicine: The Athletic Woman. 2000;19(2).

    Hinton PS, Giordano C, Brownlie T, et al. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol. 2000;88:1103-1111.

    Iron. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated February 1, 2011. Accessed April 12, 2011.

    Kishali NF, Imamoglu O, Katkat D, Atan T, Akyol P. Effects of menstrual cycle on sport’s performance. Int J Neurosci. 2006;116:1549-1563.

    Klingshirn LA, Pate RR, Bourque SP, et al. Effect of iron supplementation on endurance capacity in iron-depleted female runners. Med Sci Sports Exerc. 1992;24:819-824.

    LaManca JJ, Haymes EM. Effects of iron repletion on VO2max, endurance, and blood lactate in women. Med Sci Sports Exerc. 1993;25:1386-1392.

    Lee CW, et al. Oral contraceptive use impairs muscle gains in young women. Presented at Experimental Biology 09 FASEB 2009; Abstract 4197.

    McCabe ME 3rd, Peura DA, Kadakia SC, Bocek Z, Johnson LF. Gastrointestinal blood loss associated with running a marathon. Dig Dis Sci. 1986;31(11):1229-1232.

    Why are knee injuries common in female athletes? Brigham and Women's Hospital website. Available at: http://www.brighamandwomens.org/Departments%5Fand%5FServices/medicine/services/rheumatology/womensortho/BaimaKneeQA.aspx. Updated February 14, 2011. Accessed April 12, 2011.

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