Women are not just smaller men – they differ significantly in their physiology. While this does not make women less sporty, some aspects play an important role in sports medicine.
The modern Olympics took place for the first time in 1896, when Pierre de Coubertin reintroduced the ancient Greek tradition, but it was not until 1900 that women were allowed to participate. For a long time, women were excluded from sports competitions. But female athletes always existed and women like Alfonsina Strada and Kathrine Switzer participated anyway – with tricks. Alfonsina for example signed up for the Giro d’Italia as “Alfonsin”. The organizers considered it a spelling mistake and registered Alfonsino Strada as a participant. She became the only woman who has ever participated in cyclings’s three major stage races but faced a lot of criticism due to her gender.
Much has changed since then: Olympia is no longer exclusive to men, and a female Tour de France was established in 2021. The perception of women in society and sports has changed. Although equality is being sought, we are not quite there yet. Female athletes still encounter disparities when compared to men. Their events receive less media attention and thus fewer sponsors, promoting a gender pay gap.
Apart from social discrepancies between the sexes there are also physical challenges which especially women have to face in sports. Their physique, hormones and psyche display individual and sex-specific peculiarities. Regarding athletes these different traits play an important role as they might affect performance, metabolism, injury risks and mental health. Therefore, it is crucial to be aware of the gender-specific and individual blueprints of the body and to exercise in unison with it. But what to look out for?
When it comes to sex-specific differences, the most striking one might be the menstrual cycle (MC). These regular fluctuations in female sex hormone concentrations can be categorized into different stages. Research shows that the current stage of the MC impacts athletic performance. For example, in the follicular phase – lasting from day one until the 12th to 13th day of the MC – muscle stiffness is increased, which has to be taken into consideration when calculating the risk of injuries. The late follicular phase – starting after menstruation – is also associated with increased estrogen. It comes with enhanced energy levels and motivation. Thus, it is a good time for high-intensity sessions such as muscle-building and strength training.
The physical and mental peak of the MC is reached during ovulation, which in theory marks the middle of the MC. After ovulation, the body enters the luteal stage. Here shape maintaining and aerobic training is recommended. Also, in the luteal stage, the metabolism might rely more on fat when compared to the follicular stage. MC-oriented training is therefore a useful approach to address these changes and to adapt the training schedule to the athlete's needs.
Performing physical activity on an excessive level can result in loss of menstruation over time. This can happen to professional athletes but also hobby athletes. Excessive sport and low energy intake combined can lead to chronic energy deficiency, inducing a disease named Female Athlete Triad or Relative Energy Deficiency Syndrome (RED-S). Reduced body fat, missed periods, and decreased bone density are resulting consequences. Most cases of RED-S remain undetected. The disease is often recognized when it comes to fatigue fractures. Although men can also be affected, the disease is more often found in women. There might be unreported cases among men as they lack the symptoms of menstruation loss. However, it is vital to raise awareness for this disease among coaches and athletes. The absence of menstruation can be seen as an important indicator of health and should be considered when training.
Because of their different anthropometry women have other injury risks than men. Female athletes are, for example, more prone to experience anterior cruciate ligament rupture. It is particularly noticeable in female soccer players that they tend to encounter this injury two to three times more often than men. The dominance of the quadriceps muscle over the hamstrings is thought to be the main cause. Thus, an intensive neuromuscular training of the hamstrings could serve as a preventive measure.
Non-physical factors provide additional stressors for athletes, where further disparities between the sexes become apparent. For example, eating disorders and the harmful effects of social media affect men and women differently. For many female athletes, talking to their coach about menstruation is also a hurdle. Although they are not the same stressors that Alfonsina Strada faced, there is still a lot of pressure on female athletes.
Eventually, it is important to create awareness of gender-specific differences to meet the athlete’s individual needs. Physical, as well as psychological aspects, must be taken into consideration to create healthy conditions for everyone in sports.
Hackney AC, Koltun KJ, Williett HN. Menstrual cycle hormonal changes: estradiol-beta-17 and progesterone interactions on exercise fat oxidation. Endocrine. 2022; 76: 240-242. doi:10.1007/s12020-022-02998-w
Khowailed IA, Lee Y, Lee H. Assessing the differences in muscle stiffness measured with shear wave elastography and myotonometer during the menstrual cycle in young women. Clin Physiol Funct Imaging. 2022; 42: 320-326. doi:10.1111/cpf.12763
Königstein F, Königstein K. The female athlete – Sex matters in sports medicine and science. Dtsch Z Sportmed. 2022; 73: 223-224. doi:10.5960/dzsm.2022.548
Herrero CP, Jejurikar N, Carter CW. The psychology of the female athlete: how mental health and wellness mediate sports performance, injury and recovery. Ann Joint. 2021; 6: 38. doi:10.21037/aoj-20-53
Image source: Jonathan Chng, Unsplash
