Periods Have a Purpose. Dr Keesha interviews Anna Nieboer.

Periods Have a Purpose. Let’s Stop Fearing/Ignoring this Part of the Female Body in Youth Sports.

Girls, be proud of your beautiful body. The female body is complex and honestly, so amazing. It’s time to better understand what makes you special and how you can harness the workings of your body to maximize your success in sports. I am so excited to share with you my recent interview with Anna Nieboer.

Anna Nieboer is a certified Nurse-Midwife Practitioner and Reproductive Health Research Institute (RHRI) Fellow. Her scope of practice includes women’s primary healthcare, gynecological care, menstrual cycle care, adolescent education/care, prenatal/intrapartum/postpartum care and newborn primary care. She has her Masters in Science of Nursing (MSN), with licenses as a Registered Nurse and Certified Nurse Midwife.

She has also completed a medical fellowship with the RHRI that focuses on using reproductive endocrinology to solve women’s health issues without the use of hormonal birth control. She is a specialist in understanding female hormones and how they affect girls. Her goal is to help you better understand your cycle and understand how your cycle interacts with the rest of your body. I learned so much from the interview and hope you do as well!

Anna, how did you get into this field?

I pursued my MSN in midwifery after becoming a foster parent and feeling that young girls were not being educated and celebrated for the amazing abilities of their bodies. When I graduated, I was given the opportunity to work side by side with a pediatrician in the community who introduced me to Fertility Education and Medical Management (FEMM) Health. FEMM gives girls a tangible way to measure their health and tools to correct hormonal issues by treating the underlying cause.

Do you have any personal history of sports involvement?

I played basketball, softball, and ran track in high school. In my junior and senior year, I was an assistant athletic trainer. This gave me a good look at the physical, mental, and emotional health of young athletes.

Why is it important for girls in sports to understand their menstrual cycle?

A regular menstrual cycle is a marker of good health and tells us that the body is working as it is meant to. It is important to understand that a regular menstrual cycle is 24-36 days apart, 3-7 days long, and 1 day of medium/heavy flow with minimal pain. If during a 3 month period you are not having regular periods, your period is painful, or super heavy (you should not lose more than 80 mL for a whole period, 1 super tampon holds 10 mLs) something in the body is not working optimally. Any of these symptoms could be due to a lack of good nutrition, over exercising, or stress in young athletes.

What are common hormone/menstrual related conditions that affect girls in sports?

The two most common menstrual related conditions that young athletes struggle with are amenorrhea and dysmenorrhea.

Amenorrhea (not getting a period) is a big one. If girls exercise too hard and under eat, the menstrual cycle disappears. This can lead to an irritable mood and compromise bone health because of the lack of hormones, especially if it goes on for more than 3 months. Good fats (from foods like fish, nuts, avocado) are necessary to make hormones and can help restore lost periods.

Dysmenorrhea (very painful periods) is another condition seen in athletes who use a sugary diet (sports drinks, simple carbs, granola bars) to compensate for their frequent exercise. Sugar is an inflammatory food and it also drives up insulin levels. This leads to a thicker uterine lining and more prostaglandins (inflammatory fat compounds), which can feel like firecrackers when it breaks down each period.

Can you explain how hormones impact the musculoskeletal system?

Hormones impact the musculoskeletal system in so many ways! The two main hormones that we look at with the menstrual cycle are estrogen and progesterone. Estrogen tones and contracts the uterus, progesterone relaxes it. Estrogen proliferates breast tissue, progesterone normalizes it. Estrogen promotes bone formation, progesterone maintains bones. A balance between estrogen and progesterone each month is an important factor for optimal body health.

How can we as physical therapists work with you to provide the best possible care for girls in sports?

We can work together to promote better care by improving access to education on the female body and menstrual cycle. By teaching young girls in sports to monitor their biomarkers (cervical mucus in their underwear, mood changes, breast changes, etc), they will better connect to their body. When girls are able to pick up on irregularities early, a collaborative treatment plan to address the issues may be able to prevent injuries from occurring. Besides the ability to prevent injuries in sport now, early care can help to minimize the risk of bigger hormonal health issues, such as possibly infertility later in life.

How amazing was all this information?! I am so grateful to have had the opportunity to learn more about this essential part of the female body. We have been created to do big things and I hope that you find this information helpful. Early in the interview, Anna spoke about FEMM.

This is a free app that you can download to help track your cycle and start to better understand your hormonal health. I hope that you will check it out. Also, if you think that you are having any symptoms related to your menstrual cycle please reach out. We would love to help you in collaboration with Anna, to solve any issues and help you feel stronger and move better.

Anna has also kindly provided her contact information if you would like to contact her for further information.

Anna Nieboer, CNM, MSN, RHRI Fellow

Women's Health

Holy Family Healthcare

Kalamazoo Office: 1441 South Westnedge

anieboer@holyfamilyhealthcare.org

Office: 269-621-0011

FB: A.Marie Midwifery

IG: A.Marie_Midwifery