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.

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.

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.

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 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.

REFERENCES:

1. 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

2. 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

3. 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.

4. 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.

5. Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence guideline [NG88]; 2018.

6. Heavy menstrual overview: National Institute for Health and Care Excellence. 2018