Annabelle White [00:00:04] Hello and welcome to the Coaching and Officiating podcast series. My name is at Annabelle White. I am joining you from Eora country, and I am the coaching advisor for coaching and officiating at the Australian Sports Commission. Over this series, we will look at what it takes to modernise Australia's coaching and officiating system. Each podcast we will be joined by a special guest or guests who will share experiences and practical tips on their topics. Today we will be discussing the role of menstruation and hormonal contraception in community sport. We will be discussing the impacts of menstruation and hormonal contraception on participation in sport, how we as coaches can create a culture of openness and transparency, and how we can leverage the lived experience of those around us to create this culture within our team and participant groups. To support coaches working with women and girls in community sport, the Australian Sports Commission is developing a series of resources to support coaches to enhance their practice. We are lucky today to welcome Noella Green and Doctor Briana Larsen to the podcast. Noella is a retired rugby union athlete. During her career as an athlete, she personally experienced the transition of planning pre-conception training while pregnant and returning to sport postpartum. Noella is a practising accredited exercise physiologist and scientist working in the clinical space of female health at all stages of life. She is actively involved in researching female athlete health, and is currently contributing to two projects returning to sport postpartum and sports bra protection in contact sports. Brianna is a senior lecturer of sport and exercise at the University of Southern Queensland. Her research at the moment is focussed on the menstrual cycle, hormonal contraception and educating athletes on these topics. She is actively involved in supporting sports to better support athletes to understand these topics and their impacts. Briana and Noella, I am thrilled to welcome you both today. Thank you so much for joining me.

Dr Brianna Larsen [00:01:54] Thanks so much, Annabelle, for having me on the podcast. And I do just want to first, before we get into our chat, acknowledge the traditional owners of the Ipswich region where I'm recording today, the Jagera, Yuggera and Ugarapul people.

Noella Green [00:02:05] Thank you so much for having us. It's really exciting to be here.

Annabelle White [00:02:09] So, Brianna, what should coaches know about menstruation?

Dr Brianna Larsen [00:02:13] That's such a big question and I could answer it so many ways, but I, I think if I can split it into two broad areas, one being practical aspects and the other being creating an open and positive culture when it comes to discussing these topics. So when I say practical aspects, that covers things like having solid knowledge of the menstrual cycle and hormonal contraception, and not expecting coaches to be doctors, but just having a good basic knowledge of how these things may affect the athletes. Encouraging menstrual cycle tracking for athletes because, you know, data is power and we can apply that to our training. And also having pathways in place for athletes who might come to with, with issues with their cycle. So those sorts of practical things I think some big takeaways. But also the second part of that, creating a culture where athletes actually do feel comfortable having these discussions, if they're having issues with their cycle that may potentially be impacting their training or even just, you know, their overall health and wellbeing, they should be able to feel comfortable coming to their coaches or other support staff with those issues in the same way that they would, for example, an injury. And at the moment, the data suggests that athletes don't feel comfortable having these conversations with their coaches. So I think creating that, that culture is the second takeaway that I'd like to, to really impart today.

Annabelle White [00:03:38] Yeah, brilliant. And you've kind of spoken to it a little bit there. Women and girls necessarily don't feel comfortable having those conversations. There's a statistic at the moment that seven out of ten young girls avoid being active while on their period. So why is it important for community coaches to understand the effects of menstruation.

Dr Brianna Larsen [00:03:59] Using that example that you just provided Annabelle we know that young girls in particular do often avoid physical activity altogether, and that may be in part because the culture within the sport isn't that inviting or open to be able to say, hey, I'm just feeling a bit off today. Can I, you know, train at a seven out of ten instead of a nine out of ten. And maybe if there was that culture within sport, maybe we'd have girls and women continue participating and not feeling like they need to bow out.

Annabelle White [00:04:29] Listening to Brianna, there Noella, when you reflect on your experience in sport, did menstruation impact your participation?

Noella Green [00:04:37] Yeah. So for me it was at quite a young age for, for me, I was very I was always running around crazy as a kid. I had three big brothers. Once I got my period, I was in high school. And, so, I mean, I just had a very abnormal cycle, pretty much every two weeks I get my period. And then it'd be quite heavy for 2 to 3 days. So from a confidence perspective, and it was confidence in relation to, like, if I was doing something in sports, I'd be worried about leaking. I'd be worried that somebody could see the wings on my pad because we had these big basketball shorts. And if you're sitting on the ground, people could see stuff I'd be wearing. And there were times that I actually leaked through. So for me, that was really the that was where the mental block was for me participating in sport. And my dad saw that quite early. My mom is from the highlands of Papua New Guinea so when you talk about menstrual cycle and periods and all that kind of stuff, it's, it's a whole different culture and a whole other conversation. So my support came through my father, and the only way my father knew was to take me to the doctor's and say help my daughter, the response to which was to put her on a hormonal contraceptive. So as I progressed through life and even to the the elite sporting side of things, for me there was less of an impact in sports because I was on hormonal contraceptives.

Annabelle White [00:06:13] You spoke about normal, and I want to dive into normal menstruation because I'm sure any women listening to this, or even men who have had those conversations with their partners or friends, know that the experiences of menstruation are so diverse. So when you were growing up, or even just going through sport, was that a regular conversation that you had with your team-mates, with coaches on what does normal menstruation look like?

Noella Green [00:06:41] Never. No. Oh, not at all. And I think the only thing that was kind of normal, when I was younger, was I'd see friends that would feel very unwell or I've got my period, then would step away from sports at school. If I go to the the dressing rooms in rugby, you know, we would basically shout does anyone have a pad? Anyone got a tampon? Anyone got this? I just got my period. You know, sometimes, the athletes would talk about some of the symptoms that they were feeling at the time or that I was feeling off, but it was never conversation, with the coaches. And I'm in a male dominated sport as well.

Annabelle White [00:07:30] Brianna, I might come to you and ask a similar question. I guess understanding our bodies and understanding how we may differently, experience menstruation to the person standing next to us. It's very humanising and it's very, I guess, calming to know that what you're experiencing in your body may be different from someone else, but is still normal. So what's the benefit of, I guess, athletes or participants in sport and coaches, to an extent, to understand that the experiences of menstruation are going to vary.

Dr Brianna Larsen [00:08:03] I think that's really important to get across, and I think we're still not doing a good enough job with educating young people who are going through that experience. I know I think it's gotten better than, you know, when I was growing up and going through that, but I know that I was someone who didn't have what was considered normal menstruation. I got my period very late, ended up much, much later down the track being diagnosed with PCOS or polycystic ovarian syndrome. But it it wasn't something I felt comfortable talking about. You know, I was doing not high level, but I was doing, you know, recreational level training a lot with gymnastics. And certainly it wasn't something I felt comfortable saying, oh, I don't have my period yet to other people. I was aware that it wasn't normal, but I certainly was not comfortable to have those conversations.

Annabelle White [00:08:53] What does the research tell us about, experiences of menstruation, particularly as it's relevant to sport? Are athletes regularly experiencing what's classified as normal menstrual patterns or are they varying? Do people have a good understanding of what normal looks like?

Dr Brianna Larsen [00:09:16] I can speak to that one. Athletes have higher rates of menstrual cycle dysfunction than the general population. They also tend to have, although this is a little bit specific on the region and sport that you study, they tend to have higher rates of hormonal contraceptive use, which might not be surprising if you think about having higher rates of menstrual cycle dysfunction and oftentimes one of the sort of treatment options or ways that that might be managed is through hormonal contraception. We also know that athletes use hormonal contraception to manipulate their cycle. So, you know, taking the oral contraceptive pill so you can then choose when to take those sugar pills and time that around aligns with training. Although a lot of the, the, the issues that we see, in athletes, you could certainly extrapolate out into the general public as well. But in terms of the knowledge, we certainly say that that is still very low.

Noella Green [00:10:21] And I guess I guess from my side, you know, what I absolutely love is the wonderful people like Brianna doing this research, because there is a lot of research out there. But I also like to, I guess from being an athlete and then having a clinical exercise background, it's also that research application to practice component that comes into it. So, you know, Brianna mentioned the the lack of knowledge, absolutely huge. And that's just across the board. And I think no matter what it is in life, if you don't know about something, it can be overwhelming. As soon as you start to talk about the menstrual cycle and female athletes are like, oh, okay. So I think that definitely yes, there is a lack of knowledge there on just the bare minimum of what you need to know, you know, what are the hormones? how are they important to you as a female? How can you actually work with them rather than against them to make people sick with illness scale. So that's kind of the normal. And then understanding that you as an individual, to the person who's on the left and right of you is that could be different. They could be similar. But I think when we talk about normal, when I talk about normal, I'm like, what's your normal? You need to know what your normal is. Because once you know what your normal is, then you can start adapting and changing to make sure you're getting the best health outcomes, but also the best sporting performance outcomes.

Annabelle White [00:11:51] Yeah. And it's interesting because we have to recognise the, the critical role of clinical practitioners in this conversation. We're not expecting our community coaches to be the fountains of knowledge. We understand that they're pulled in a million different directions and they're doing incredible work. But what kind of support, from your coaches, would have made managing your menstruation more tolerable?

Noella Green [00:12:15] I think I look at it as. You're working with female athletes. You learn about strength and conditioning skills, drills, whatever it may be. The reality of working with female athletes is we have different nuances than the male counterpart. Too often I see programs cookie cut to be like, okay, this works. And it might not necessarily. You know, it's a little bit different in in netball. If there's a female dominated sport. But because, you know, my bias is with rugby union. So you know, that's where it comes from for me. But I kind of say programs are picked up. This is what the men do. The women can do this as well. You do all the same strength and conditioning sort of things. And we'll get the same outcome, you know. So for me, I think it's. If coaches lent in to going, okay, I'm working with female athletes. They have boobs, they have vaginas, they have a period that will turn up at some point, whatever that normal is. So having some awareness of that, becoming familiar potentially with the terminology that the group is using and then understanding how they can support that athlete.

Annabelle White [00:13:33] We're going to move on to discussing hormonal contraception. So, Brianna, what should community coaches know about hormonal contraception?

Dr Brianna Larsen [00:13:41] I think this topic can be really overwhelming because there's a lot in it. You know, there's a lot of medications, there's a lot of physiology. So I understand that it is really overwhelming. And of course, we don't expect coaches to be doctors and understand, you know, the ins and outs of every one of these medications. But I think having a basic understanding of the different types and that like the menstrual cycle itself, they will affect people differently. So from person to person, some people go on a hormonal contraception and it it might, you know, really help them. And obviously maybe it depends obviously what their reason is for taking it. Obviously if the reason is pregnancy prevention then, you know, that's very helpful. People take it for other reasons as well. But I think having an understanding that there are there is oral contraceptive pills. Everyone knows that, that there are 30 plus types available in Australia with different hormonal makeups. And there are, you know, potential different adverse side effects. But in general, the adverse side effects associated with hormonal contraception are often quite similar to the adverse side effects that people might experience as a part of their cycle, particularly if they have menstrual cycle dysfunction. So having a broad understanding of things like, you know, breast tenderness, mood changes, weight changes, you know, heavy, heavy bleeding, these sorts of things can really impact, obviously, how someone feels and also potentially their ability to train. And if we take the heavy bleeding example and someone ends up anaemic, you know, that that's obviously something that can impact training. So I do think it's worth having a basic understanding that these medications can cause side effects, and that some people will have to go through quite a process to find one that works for them if they do, in fact, you know, need to be want need to be on one.

Annabelle White [00:15:32] Noella speaking to your experience, you started on hormonal contraception, basically to control your experiences of your menstrual cycle and symptoms associated with it. And it almost. Yeah, it created some regularity with your menstrual cycle. So can you speak to a little bit more about your experiences in sport and how the hormonal contraceptive pill impacted your experiences in sport?

Noella Green [00:16:01] For me, it was. It just it made it easier. Like. It made it easier. I knew if I, since it if I was training on the weekend, if I had to perform on the weekend for a competition, I had every confidence that I was not going to be impacted by my menstrual cycle. So for me, as I said, that was really the only thing for me as an athlete, because I actually had confidence on a weekend that I was able to perform with minimal distraction about having my period or worrying about, you know, blood seeping through my shorts. And the other great thing about the sports is we also had, we had dark shorts, which was fabulous.

Annabelle White [00:16:45] Brianna, I'll come to you. Noella kind of explained there how taking hormonal contraceptive gave her confidence in sport. It gave her a sense of security that she wasn't going to bleed through her shorts, that she could manage her symptoms appropriately so that she could show up in the way that she knew she was capable of. And I'm sure those experiences will resonate with a lot of young women and young girls as well. She also mentioned that she started hormonal contraceptive at quite a young age, adolescence, being prescribed hormonal contraception, often at this age.

Dr Brianna Larsen [00:17:20] Yeah, it's very, very common in, in young people. And it's a medication that young people can go in and get, you know, without their parents as well.

Annabelle White [00:17:28] So when we think when we think about incredible community coaches in our community sport environments, mom or dad may have picked up the local cricket team just because they were the the last one to step back, the last one to not necessarily say that they can't coach, they're doing their best. They want their girls to have a great time in the sport that they're coaching. Why is it important for these community coaches to understand some of the symptoms associated with hormonal contraception? Some of the reasons why participants may be on hormonal contraception and maybe the impacts that this medication may have on their experiences in sport.

Dr Brianna Larsen [00:18:11] I think, you know, like we said earlier, we don't expect coaches, community coaches to be doctors and to know every single thing about this stuff.

But the data does show us that these medications can have an impact on how people feel and their well-being. The, you know, ability to, to exercise, especially if they're potentially trying a new medication and experiencing some side effects, maybe the one they're taking hasn't been the best fit for them. So I think anything that has the potential to affect your athletes or your participants like that is worth coaches knowing. But I think I really do think the biggest part, especially at that community level sport, I think the biggest part is creating the culture. And, you know, maybe it's if you've got a window of time where you can find one of these, you know, half an hour, a little online modules work on that. These are on the Female Performance and Health Initiative website. Have a look at an infographic. Just so these terms aren't a complete novelty, sort of a bit across the terminology. Although of course, you know, the scientific terminology and the terminology people use are often quite different as well. But I think having a basic understanding and then above and beyond that, it's just about saying to the athletes, making it known to them, if you're working with athletes of that age or participants of that age, hey, if you're having a bad day, if you're having any sort of menstruation related symptoms, or if you're trying any sort of new medications, feel free to let me know. We can tailor your training. Just come and have a chat. And then being open to those conversations when they happen.

Annabelle White [00:19:41] Noella, do you think an open culture and more transparency around these conversations would have improved your experience if there was less taboo around those kind of conversations?

Noella Green [00:19:55] Yes, I think it would actually help to support and change the environment for for athletes. And I when I look, you know, when I refer to athletes, if I look at my clinical space, you know, if you're somebody who just likes to walk every single day, like you're an athlete in your own space. You're working with female athletes, we have a different hormonal profile to to males. No ifs or buts about that, right. So I think being open to that and being okay to lean into an uncomfortable conversation, that will be what will start to change this space for females to feel comfortable, to feel confident, to have these conversations. You know, I think sometimes people can get caught up in how complex it is or how big it is. But I think through our conversations and through our actions, that can be really powerful in creating an environment where. Your group. Your supporting group can be unstoppable in what they're doing. I think for me, it's find the language that resonates with the group but also be adaptable to it, bringing the tempo down for that particular person, not necessarily for the entire group.

Annabelle White [00:21:16] Thank you. Brianna, in your research, you found there's a real lack of understanding amongst women and girls who use hormonal contraception. And also, their understanding of their own menstruation. What are the impacts of this?

Dr Brianna Larsen [00:21:33] I think it's about we want to do everything we can to get people out exercising at a baseline level. And I'm, you know, same as I slip into athlete language. But I'm talking about anyone who's out exercising. And we want to give people the best opportunity to do that. And I think while people don't have a really good understanding of their bodies or the medication they're taking and how that might impact them, it can mean people opt out or even, you know, maybe retire from their sport early all of those sorts of things. So I think being able to work with our own body through, you know, menstrual cycle tracking in a practical sense, that could be like I've referred to earlier, it could be about speaking to someone early because you notice changes early. So I guess if you're thinking, you know, worst case scenario, a lack of understanding means you think that losing your period is a normal thing that happens when you train hard. Maybe you even think it's a positive thing. There's a lot of misconceptions out there, and that goes on for years and years and years. And you never get a diagnosis, you know, or you never get appropriate education around what might that be potentially causing that? And, you know, things like if we're talking about things like relative energy deficiency in sport that have really, you know, quite devastating health consequences sometimes. So it's really important to be aware of this stuff. And that sort of worst case scenario is about we want to catch people who are experiencing issues and help them, early, but also it's about being able to harness your own power. I always feel really good this this week of my cycle. I'm going to absolutely smash it at training. I'm going to whatever that is. Or, you know, I know that this is a week where I tend to to get a little bit, you know, a little bit sluggish or, I tend to get a bit of a bad back and some cramps on those couple of days. So I'm going to take some Panadol to training and make sure I've got, you know, a couple extra water bottles. And just having that, you know, that knowledge of your own body can make the whole process much more enjoyable. And I think, you know, without having specific numbers and data, I think you can keep people participating in sport where they might not otherwise. So I think that's why it's important.

Annabelle White [00:23:39] Thank you. Look, and you've spoken to it a little bit there. Sport can be a really positive place where we learn more about our bodies, we learn more about what we're capable of as women. How can coaches empower the participants that they're working with to better understand their body?

Dr Brianna Larsen [00:23:58] I think by having this be part of the conversation is the first step and sort of following on from, you know, when know time before about using a bit of humor. And I think that's really important, particularly when you're communicating this stuff to to younger people. But I also think consistency is key. And just this making it part of the conversation. I've seen a lot of very well-meaning, you know, organisations or coaches get people like me in to do a workshop, but I don't know how impactful that is unless the conversations flow on from that. And I say in these workshops how awkward it is at the start and how, you know, you've got to work, you've got to work on it a little bit. There's a lot of taboo even in society with these topics as well. So I think having that consistency in the conversation and then through that, people get curious about their own bodies, you know, about what they're capable of, about when they feel best, and perhaps when they don't feel their best. And what support do I need? So I think that's the power. I think sport can be a real conduit. And, you know, if we can educate people through sport and then they go see a doctor and get, you know, get diagnosed with a health issue that that might have taken them longer. Well that’s great, that’s sport acting as a conduit to better health. So I think there's a real opportunity here for that as well.

Annabelle White [00:25:18] Thank you. Noella listening to Brianna, what is the importance to you as an athlete in understanding your body?

Noella Green [00:25:27] Its your body. Your body is your temple. Your body is what's going to get you the outcomes that you want. In relation to moving and moving right. So if you're not aware of what your body needs to move well or move at its optimal level, you're basically doing yourself a disservice. So to me, your body is your temple. Know what you need to do to fuel and perform well and do what you can to support that.

Annabelle White [00:26:01] And you've already spoken about some of the things that coaches can do to better empower the women and girls that they work with and create a culture of openness. But do you have anything to add on how coaches can create those positive environments?

Noella Green [00:26:15] Yeah. Look, I know we've probably mentioned this a couple of times already. And, Brianna, actually the word that really stood out with me is, is consistency when you're working with female athletes. You do have to do things a little bit different.

Annabelle White [00:26:31] Brianna, some coaches won't be able to relate with their athletes. With regards to their experiences of hormonal contraception or menstruation or whatever it is, whether they're male or personally, haven't had any issues with their cycle or for a range of other reasons. How can coaches leverage the experiences of people around them to create an open culture with their participants?

Dr Brianna Larsen [00:26:54] Yeah, I mean, that is a really good point, and it's something that I've seen a lot of coaches say when they've been maybe nervous to have these conversations with the athletes or participants, as I just don't know about that. I, understand you know, that sort of push back. But I think. I think most coaches would agree that there's probably a lot of whether it's health issues, personal issues, things that the athletes that will experience, that they might not personally. And this is just another one of those. And you can still be empathetic and open and supportive of that, even if you haven't personally gone through that yourself. So I think it's important for coaches to feel, to realise I don't need to have gone through it. I don't need to have, you know, doctor level knowledge just to be able to be supportive. But I do think there is still power in leveraging people that can speak to these issues more intimately, those with lived experience. And in my experience, coming in and doing a lot of these educational workshops with different sports teams, the ones that have worked the best in terms of creating open conversations, you know, and getting athletes to feel comfortable asking questions, have had a lot of involvement from the more senior athletes and really having them lead some conversations potentially, if they're comfortable, obviously share some of their own experiences, and that just really sets the scene in the room or, you know, whatever the case may be, to just that, this is an okay thing to talk about. It kind of takes the pressure out of it. So I think that's another way of coaches are maybe feeling a little bit tentative on their own. They can maybe have some conversations with some of the older athletes, or the more senior athletes who who have maybe been comfortable and showed that comfort in speaking about these topics before and, and sort of use them as a way to make some of the other people feel more comfy.

Annabelle White [00:28:41] Why is lived experience so important when discussing these topics?

Dr Brianna Larsen [00:28:47] I think it's important because when you hear someone else describing an experience that maybe you thought was something that only you had gone through or you you know, I think people do have a lot of often shame about these things or concern that something isn't normal for them. And so I think it's very, very powerful to have someone speak to their own personal experience, but to be able to relate and resonate with that. And I think it makes people feel a lot, a lot less alone in what they're going through. So I think having those conversations and we do say in terms of I'm a scientist, I always go back to the research, sorry if that's boring, but we certainly say, you know, some studies show that there's not a lot of conversations between team-mates around the menstrual cycle. And it might be, like you said, not maybe it's around the level of athlete where they don't know or the sport might be specific to, but it does seem to be a bit of a mixed bag in terms of whether athletes or, you know, even recreational level sport participants feel comfortable having these conversations in a sport environment, the reasons why they report not talking to their coaches. And then that's a good place for coaches to sort of break down those barriers. And those often times are they don't know anything about it. They're not going to be able to help anyway. Or it's too awkward. So the three things that I think, okay, if, if, if you put yourself in, you know, we're talking to coaches here. If you're a coach, how can you break down those barriers and create that environment for that conversation even if you can't personally relate? So I think the awkwardness thing that comes down to consistency, just making this a part of the conversation, all the things that we've sort of talked about already that, oh, they're not going to be able to help anyway. Okay. Have some pathways, have some people that, you know, some referral pathways so that the athlete knows if they bring it to you. It's not just, okay. It's what can we do about this, you know, and, and there's, there's a pathway of support. And I think that is an issue that that's something that's not done well pretty much across the board. And I think, you know, it's probably another big thing we need to tackle as well as the education piece.

Annabelle White [00:30:52] Thank you Noella and Brianna both for sharing your personal stories, but also your valuable insights and knowledge today. Thanks for listening. To learn more about community coaching and officiating, head to the ASC Community Coaching and Officiating web pages. My name is Annabelle White and I look forward to you joining me for the next podcast in the Coaching and Officiating series. If you like today's podcast, please follow us wherever you get your podcasts and share this with your Team-mates, fellow coaches and officials and friends. This podcast was produced on the lands of the Ngunnawal people. I wish to pay my respects to the traditional custodians and recognise any other people or families with connection to the lands of the ACT and region. I wish to pay my respects to their elders, past and present, and acknowledge and respect their continuing connection to country.