While a change in diet, medication, exercise and stress can all affect a girl’s menstrual flow, doctors say cycle irregularities don’t affect their ability to play sports and are raising privacy concerns over a state board proposing to mandate that information for Florida students to play high school sports.
The Florida High School Athletic Association’s 16-member board of directors— made up of 14 men and two women — had scheduled a vote on this issue later this month.
The board, however, will hold an emergency meeting Thursday to discuss the proposal, which has drawn criticism from medical professionals, students, parents, coaches and others over student athlete medical privacy issues. The association’s executive director is now recommending that students submit only one page to schools, where a doctor would stipulate that an athlete is healthy enough to compete, or only able to participate partially. Details about a player’s health would not be included on that form.
The initial proposal called for a mandatory series of questions related to a girl’s menstrual cycle. If the student did not answer them, they could have potentially been banned from playing high school sports. Previously, menstrual questions were optional on the form, which is filled out by both a physician and a student and asks a variety of health questions, such as whether a student has ever had a seizure or heart problems.
The board’s proposed mandatory questions about a female athlete’s menstruation had doctors wary, along with some students and parents and political leaders.
“This is private information. It’s not necessary and should not be included in the school physical,” said Washington Hill, a high-risk pregnancy and maternal fetal medicine doctor in Sarasota and a member of the National Medical Association, which represents more than 50,000 Black physicians. He’s helped fill out the physical evaluation forms at gyms, schools and churches through free events hosted by the Gulf Coast Medical Society.
“Nobody should know if I’m on my period unless I tell them,” Mallory McDonald, a Miami Beach High softball player, told the Herald on Friday.
Fentrice Driskell, the Florida House Democratic leader, on Monday called the proposal a “gross invasion of privacy” and said she plans to send a letter to the association, pressuring them to discard the measure. And while doctors the Herald spoke with agree menstrual history is important, they don’t believe schools should have access to the information due to student privacy concerns.
The Florida Chapter of the American Academy of Pediatrics has reached out to the high school sports association to discuss its concerns with the proposed form, Thresia Gambon, a Miami-Dade pediatrician and president of the state pediatric group, told the Herald.
Why is menstrual history important?
There are many reasons why a girl might have an irregular period, which is why tracking changes to her menstrual cycle can help doctors ensure she is staying healthy, said Judith Simms-Cendan, division director of pediatric adolescent gynecology at the University of Miami Middle School of Medicine and the president-elect of the North American Society for Pediatric and Adolescent Gynecology. She’s also a member of the American College of Obstetricians and Gynecologists.
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A patient who reports very heavy periods, for example, might get screened to see if she has iron deficiency resulting from anemia, caused by a lack of red blood cells in the body. She can also have a bleeding disorder, Simms-Cendan said. During the pandemic, she said, many girls saw their periods affected from stress and sleep cycle changes. Some women may be diagnosed with policystic ovary syndrome, or PCOS.
Some girls and young women may have their menstrual cycle altered due a medication or other medical reason.
“I think that being forced to disclose this kind of information to a school, not a clinician, really puts adolescents at risk for shame and stigma and judgment from people who really don’t understand the medical reasons why,” she added.
Athletes can also experience relative energy deficiency in sport, or RED-S, which can affect performance, their ability to concentrate and recover from workouts, said Kathryn Ackerman, director of the female athlete program at Boston Children’s Hospital, the primary pediatric program of Harvard Medical School. A subset of this is female athlete triad, which is often caused by exercising a lot and not eating enough calories. Symptoms include no periods or irregular periods, weight loss, stress fractures and other broken bones or sports injuries.
“It’s not that somebody can’t play a sport at all if they’re missing their menstrual cycle. It’s what are the other risk factors? Did they drop weight suddenly? Are they restricting their diet now? Have they had multiple bone stress injuries?” asked Ackerman. “We know that there’s this correlation between relative energy deficiency, menstrual dysfunction, and a risk for low-bone density and for fractures. That component — female athlete triad — is something we’ve known about for a long time but we also know that there are other health and performance consequences if that goes on for a long time.”
In boys, physical signs of relative energy deficiency in sports include low testosterone levels or decreased libido, Ackerman said, while in women, it’s often a lack of a normal menstrual cycle.
If the Florida High School Athletic Association’s board were to make menstrual questions mandatory in the physical evaluation form, students would have to answer if they’ve had a menstrual cycle, and if so, at what age they had their first period, when was their most recent period and how many periods they’ve had in the past 12 months.
Advocates in the LGBTQ community ascribe the menstrual cycle question as a means to ban transgender athletes playing in high school sports in the state. In 2021, Gov. Ron DeSantis signed a bill passed by the Florida Legislature that banned transgender athletes in girls’ and women’s scholastic sports in Florida.
The form, which is filled out by both a physician and the student athlete, also now asks students about their “sex assigned at birth.” Previous forms just asked about their sex.
Hill, like Simms-Cendan and Ackerman, believes the period information should stay confidential between the doctor and the patient and that parents should have the choice to decide whether to share the information or not with the school.
All three doctors agree Florida should follow the recommendations of the American Academy of Pediatrics and sports medicine organizations and only submit an eligibility form to the school, stating whether the student is fit or not to play. This way, the medical information stays private.
The Florida High School Athletic Association has not responded to numerous requests from the Herald to discuss this subject.
Times/Herald Tallahassee bureau reporter Ana Ceballos and Miami Herald reporter Clara-Sophia Daly contributed to this article.