Run&Bee Week #34: This is a longer version of my Hindustan Times column ‘Exercising & Running with Heavy Menstrual Bleeding’ published on 19th January 2019.
The society repeatedly reminds girls from a young age how unladylike it is to be active and sporty. Most of them oblige and become inactive and from then on even a simple act of conscious walking is tricky. With drooping shoulders and slumped forward posture, even that doesn’t come naturally, leave alone running and doing any kinds of acrobatic stuff in gyms and fitness classes that is all over social media.
As if that wasn’t enough harm done, young ladies in their early teens across cultures are told how impure they are during their menstrual periods and what all they need to be avoiding. This royally messes up their quality of life and self worth, reinforced by monthly reminders.
Monthly cyclical bleeding is normal for healthy ladies of reproductive age groups. A quarter of them are affected by heavy menstrual bleeding along with period pains for as long as a week every four weeks. That adds up to a quarter of their time over three decades, which happen to be their prime years. Since there is such a taboo talking about this, it becomes tricky to know what is normal or not. It then is helpful to define heavy menstrual bleeding as ‘the women’s perception of increased menstrual volume regardless of regularity, frequency or duration’, as done by International Federation of Gynaecology and Obstetrics. Dr Anjali Kumar, Director, Department of Gynaecology & Obstetrics, Artemis hospitals, Gurugram, adds to the definition as, ‘excessive menstrual blood loss which interferes with the physical, social, emotional or material quality of life’.
Besides emotional and psychological strains, there are some very practical issues as well of having heavy menstrual bleeding and trying to be physically active and sporty. During periods, passing large clots, frequent need for changing sanitary napkins and staining clothes can be disturbing for even the most confident ladies even having normal bleeding during periods. This affects sports performance and fitness activities in almost all the ladies.
There is a physical impact too. Ladies who experience heavy menstrual bleeding, are usually low on Haemoglobin (Anaemia) and Iron, leading to fatigue, sluggishness and tiredness not only limited to their periods but throughout. This is accompanied by mood swings and anxiety. Somehow they are not able to make the connect and get injured, as they then overdo in their eagerness to cover up for the lost days of running or training in the gym.
I feel extremely bloated and dehydrated two days prior and the first day. But yes I drink a lot of water and go for my run. Running reduces the pain.
Most today rediscover physical exercises and running after 30 years, and at that age, having bleeding even in between periods shouldn’t be ignored. If it’s been there for more than three months, please do meet your Gynaecologist. If ladies above the age of 45 years start to experience heavy menstrual bleeding or it starts getting worse, it’s something to be paid attention to. Dr Kumar adds that new onset of heavy menstrual bleeding, consistently heavy and prolonged periods, with pain, any associated abnormal vaginal discharge, any mass or lump abdomen and any associated medical conditions like diabetes, needs medical attention.
Dr Anjali Kumar
“Heavy bloody flow can be managed by using large sanitary pads, tampons or menstrual cups. Chaffing because of continuously using a pad can be reduced by using cotton pads and by frequently changing them.”
This also plays a havoc in lives of young active girls at the very onset of periods when they experience painful heavy bleeding. Some of them get in to their cocoon and are never able to come out of it. There is a need for Psychologist to be engaged as well as the taboo makes underreporting the norm.
Some would argue what would I know about the problems ladies face. You are spot on. Nothing first hand. But I have been involved with a getting a lot of ladies to get moving, literally up from the couch, a program I headed in 2013, to pushing them when most sane people would have not even let them start.
Most have to come to terms with heavy bleeding, but pain is what bothers them a lot. Large number of ladies report that when they run and exercise during periods, as much as they can, it helps them to have lesser periods pain and cramps during, before and after periods. It also starts reducing their bleeding days.
Sometimes if you run hard, tampons might slip. But its not often.
My heartbeat is higher during periods.
Sensitive stomach on first 2 days definitely forces one to reduce their miles.
Taking an off seems like the best thing to do.
Higher pulse rate during menstruation does make sense. That would lead to breathlessness sooner at even a lower intensity workout. Long deep breathing would be really useful. Also, keep your speed a low. Listen to your breathing and you’ll do well.
I attempted my first 90km run at Vagamon Ultrail in January. I got my periods night before the race day. After running approx 60kms, I decided to drop out since cramps from period caused too much pain. As someone who is finding ways to be environment-friendly, I am happy that I was able to run that distance with a reusable menstrual cup.
I bleed for 7 long days & being physically active on those has been more of a mental challenge for me than a physical challenge. I have just turned 40 & have noticed that the hormonal changes are wreaking havoc more now than ever.
I will share Jyotsana’s detailed story at La Ultra - The High in a blog to come soon.
In the mean time, please get moving and run like a girl.
I have only quoted ladies if they have responded back openly on social media or agreed to be quoted.
Simon Tarsha S and Sheridan C. Heavy menstrual bleeding (HMB) in female athletes [Part 1: Recognition and diagnosis] British Journal of Sports Medicine Blog. 31 Dec 2018
Simon Tarsha S and Sheridan C. Heavy menstrual bleeding (HMB) in female athletes [Part 2: Investigation and Management] British Journal of Sports Medicine Blog. 14 Jan 2019
Bruinvels G, Burden R, Brown N, Richards T, Pedlar C. The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 London Marathon. British Journal of Sports Medicine. May 2016, 50 (9) 566.
Bruinvels G, Burden RJ, Cushway T, Brown N, Pedlar C, Richards T. The Impact Of Heavy Menstrual Bleeding (menorrhagia) And Iron Status In Exercising Females. British Journal of Sports Medicine. 2017;51(4):304.
Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence guideline [NG88]; 2018.
Heavy menstrual overview: National Institute for Health and Care Excellence. 2018