Ovaries. It’s something that, if you’re a client of mine, you have most definitely heard me talk about. Perhaps even if you don’t have them, but absolutely if you do. I train a lot of women. Some are pregnant, some are trying to get pregnant, some never want to get pregnant, some are menopausal, some are premenopausal, some use birth control, and some do not. 

When was the last time you openly talked about ovaries on the gym floor? It can be uncomfortable to talk about. It’s usually on the gym floor where I get whispered to “hey, I’m having really bad cramps today because of my period, can we take it easy?” It’s still taboo to talk about ovaires, periods, and vaginas in a public setting, but why does it have to be? There are a lot of signals that your body can send you to let you know how it’s doing, but most of them are how you interpret them. Some people are exhausted, but if it’s their normal they don’t really know. Same thing with pain. But, two major ways that your body can let you know how it’s doing (for people with these reproductive pieces) are periods and poops. If you poop 5x a day and it’s always liquid your body is trying to tell you something. Same thing with periods. If you get your period irregularly and you have heavy or abnormal color and bleeding your body is trying to tell you something. Yet, both poop and periods can only be discussed in appropriate settings, with appropriate people, and in hushed, and sometimes embarrassed tones. 

If we aren’t comfortable talking about these things though it’s hard to get an idea of what is healthy. I will use myself as an anecdote as to why this is so important. Almost a year ago I was diagnosed with “suspected endometriosis.” There are so many reasons as to why this should be kind of absurd. The three major ones would be that:

1. it took over 10 years of periods to realize that mine were considered abnormal 

2. that the only way to officially diagnose me would be to perform an experimental surgery that is basically equivalent to a C-section where they cut through your abdomen to see if you have bleeding on the outside of the uterus, and 

3. without the surgery they couldn’t officially confirm the diagnosis, and that whether or whether not I was diagnosed officially would not change the treatment I would be given, which is supplementing hormones

Why would it take ten years to get diagnosed? Here are the things that were “normal” because it was happening to me every month for ten years. How would I know that it wasn’t “normal?” 

  • I didn’t know that bleeding through a tampon every 30 minutes wasn’t “normal.” 
  • I didn’t know that almost passing out from pain while having a bowel movement wasn’t “normal.” 
  • I didn’t know that having cramps that prevent you from even getting out of bed to go to the bathroom to throw up wasn’t “normal.” I just thought that I had it pretty bad, but not that perhaps my female hormone system was dysfunctional

Now, what does it mean to be dysfunctional? That’s when something is not performing how it should be. This directly ties in to the other population group that I work with the most – autoimmune populations. About 8% of the population in the United States have an autoimmune condition and 78% of that 8% are women. Now let’s look at reproductive health statistics – about 10-20% of American women have endometriosis with another 3-10% of women have polycystic ovary syndrome (PCOS). These percentages will also change from research paper to research paper because diagnostic materials differ and in general we have a very poor understanding of how to diagnose (i.e. I still don’t have an official diagnosis because nothing will change unless I have a major exploratory surgery in order to diagnose me). 

But, there was also a meta-analysis where at least 4 papers have suggested statistically significant associations between endometriosis and at least 1 autoimmune disease. There was also a meta-analysis done that looked at women with PCOS and found that a higher prevalence of patients with PCOS also have a thyroid autoimmune condition. This makes a lot of sense and is not necessarily causative, but if you know anything about PCOS you know that there is a dysfunction of hormones and issues with insulin resistance and obesity with the disease as well. This all points back to dysfunction. And affects millions of people every year, and happens to half of the population – women. 

Women are often under-represented in the fitness industry. And although this is something I have been thinking about a lot as of late (thanks to the book I’m reading, “This Is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences,” by Dr. Sarah Hill) Lucy Hendricks made a very well articulated post about how the fitness industry under-represents many kinds of people, not just women, but it got my wheels turning about how there needs to be more of a conversation about this. Lucy really uses her social media platform well to talk about important issues where I tend to use mine to watch dog videos, plan my future kitchen, and then watch videos made by Lucy. 

We must have these conversations. Why did no coach or doctor ever talk to me about how the birth control I was taking was made? How it derives from testosterone, and although it is a synthetic progesterone, it still mimicked testosterone and could still bind to my T receptors. How does this affect the rest of a female system? It can be enough to cause weight gain and unwanted hair growth so I imagine there can be effects to training and athletic performance as well. 

I just learned this from reading and diving into research because I’m curious, but your average female client will not be privy to this information. If we work with females isn’t it our responsibility to understand what they are taking and how it can be affecting our bodies and function? I can’t even find research that discusses training with the female cycle, but it sounds like something that should at least be explored in our industry. Female reproductive health and hormones are very understudied though, especially in the fitness industry because the majority of people in our industry are not female. And that’s okay, but if we don’t bring awareness to how this topic and group is underrepresented we cannot improve and learn more to help 50% of the population as best we can. I don’t expect the average male coach to understand why a woman on the second day of her period would want to take it easy that day, but they at least need to make an environment where the woman can tell him that she isn’t feeling well and he should be able to adapt based off of his knowledge of the female system. Learn about the female system, talk to female coaches to see what we know and observe and can understand. We just need to open up the communication between the genders and make it okay to discuss. 

For starters, and this will be the last piece I leave you with to get you thinking about these differences, is that women have different bodies and needs than men. This is highlighted frequently by one specific exercise that I would like all men to stop programming their female clients: chest supported rows. Just don’t. It hurts. And it’s uncomfortable. We have breasts and it’s not comfortable to lay on a bench and try to row 60 lbs. I see male coaches give this to women all of the time and I’ve never seen a female client give it to another female. There’s a reason for that. So if you get one thing out of this article let it be that #stopthechestsupportedrow. And start the conversation. If not with your female clients then at least with female peers so that you can better understand what is going on with your female clients. You might find out that the cyclical back pain she gets while deadlifting might be directly related to her period cramps…

Some sources that I used:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266413/
  3. https://academic.oup.com/humupd/article/25/4/486/5518352
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215798/