The physical and social changes teenage girls go through can often push them away from sport. So we need to change the way we talk about puberty and periods, says women's health in sport working group, WHISPA.
With so much attention last week to Lydia Ko’s casual mention of the menstrual cycle, it's a good time to ask how we're talking about the body with our young women in sport.
The playing field is a place where a young woman’s body is on display, where her performance, capabilities, appearance and physiological changes are regularly judged and commented on by others.
Yet the teenage years are a time when a young female athlete will be experiencing a lot of physical and social changes, and how we talk about the changing body (like puberty and menstruation) matters.
International and New Zealand-based research has consistently shown that young women are dropping out of sport and physical activity at much higher rates than young men. Recent research by Sport New Zealand shows that by the age of 17, young women are spending 28 percent less time being physically active than their male counterparts.
But why are young women turning away from sport at such high numbers? What's going on in their lives to turn them away from sport and physical activity at such high rates?
In answering these questions, we must avoid blaming young women themselves. Research has shown the high levels of pressure on young women in male-dominated and defined elite sport environments are a major ‘push’ factor, prompting many to turn away from the sports they once loved.
While we recognise the importance of changes to the sporting environment towards more gender inclusive and supportive spaces for young women, our focus here is the complex hormonal, physical and social changes affecting girls during this critical time in their lives.
When considered alongside changes to the sporting culture, such knowledge can better support young women through their teenage years and help them continue to build positive relationships with their changing bodies through sport and fitness.
Hormones, periods and more
The teenage years are a time of constant change for young women’s bodies both hormonally and physically. For example, breast budding is the first sign of true puberty and while this typically occurs around nine to 11 years old, there's wide variation of timing.
This start of puberty signifies the growth spurt is starting, and girls' growing bodies need appropriate calories and nutrient availability during this time. Acne can also appear, which can lead to embarrassment and discomfort with sweating potentially making acne worse.
Further change that can influence girls' feelings about sport is menstruation. The average age for the first period is 12 years old, but again, there's wide variation. If a woman hasn't had her first period by the age of 15, a medical assessment should be sought. This can be a sign of insufficient nutrition for a growing and physically active young woman.
As a young woman starts to have regular periods, they can be at first quite unpredictable - with rate of flow, timing, and discomfort all having implications for embarrassment in sporting participation. Periods that are particularly painful and/or heavy can again be discouraging.
We encourage girls and parents to record periods (such as using a menstrual tracking app) because regularity of periods is an important sign of a healthy body.
It's also important young women know where to go to get support and trustworthy information about their menstrual cycle and menstruation in sport, as o. For young women of different cultural and religious backgrounds, it's important that culturally-specific information and support is available.
Self-consciousness of the changing body - breast and hip development, weight change, menstruation - can be heightened in sporting contexts where the body is on display (like gymnastics leotards, lycra outfits, swimming togs, short skirts, wearing white or light-coloured uniforms). Girls frequently report feeling uncomfortable in sporting uniforms that reveal their bodies.
Sports organisations who listen and respond to such concerns tend to see an increase in participation.
Fuelling the teenage body
Adequate nutrition is needed through adolescence to not only fuel the active muscles, but to also support the development of bone, the reproductive system and other important systems within the body.
Without making the required fuelling adjustments for the active teenager, or if restricted eating patterns occur, this can impair development in a process known as low energy availability (LEA). One key symptom of LEA is delayed or disrupted periods, but fatigue, mood changes, recurrent illness and injury rates and recovery can also be signs. This condition can have long lasting impacts, including bone and menstrual health. Adequate nutrition — properly fuelling exercise and day-to-day energy expenditure — is the best way to avoid LEA.
Nutrition can also impact girls' energy levels and overall feelings of health. For example, iron deficiency anemia (low iron levels or low blood count) has been shown to be more common in adolescent girls compared with boys of the same age. This can be easily diagnosed and treated if parents are aware of this possibility, but if it goes undetected, it may leave young women feeling lethargic, unmotivated and/or exhausted from sporting participation.
Physical changes and injury risks
Physical changes during puberty mean there can be changes in athletic ability with coordination, balance and speed. Such physical changes include a change in the center of gravity and knee stability affecting training and performance.
If young women and their families are not aware of the reason for these changes, they can feel like they are “no longer good at” their chosen sports and give up. Yet, with understanding, patience and support, young women can learn to love the power in their developing bodies.
While adolescent males’ strength and control typically increases post-puberty, adolescent female strength lags behind and motor control reduces for a period of time. Not only can young women feel gangly and uncoordinated for their chosen sport, this lack of strength and control increases the risk of injury in this population.
At this stage in development, we see the injury type and incidence in our young women varies from young men. Significant injuries such as ligament rupture of the knee increase to four to six times the rate of males. This is a serious injury that often requires surgery to return to sport, takes a prolonged period of time (up to 12 months post-surgery), dedicated rehab and comes at a significant cost to families and the health system in the short and long term.
Yet 50-70 percent of these injuries are preventable with the application of basic injury prevention programmes as part of sport warm-ups. Access to prevention programmes are available for our primary sports where this injury is common (particularly football, rugby and netball). But such programmes are not common practice across all sports.
In addition to serious injuries such as knee ligament rupture, less severe but more chronic injuries that commonly occur in this teenage population are anterior knee pain and shin pain. Ongoing pain, reduction in their ability to complete training without limitations and subsequent reduction in performance, unfortunately commonly result in sport drop-out.
Changing Relationships and Social Pressures
The teenage years are an important time for renegotiating social relationships and forging an identity as a young adult. For many, this means a shift from the parents to the peer group as the most important social influence in their lives.
While some negotiate this transition well, for others it can be a time of much disruption to relationships and sense of identity and belonging. For many young women, the social pressures, expectations and judgements to ‘look’ a particular way can feel overwhelming, as if coming from everywhere and nowhere simultaneously.
Medical studies show two-fold higher rates of depression and anxiety in adolescent girls compared with boys. International research is also showing the pandemic is making mental health issues among young women worse.
As boys move through the pubertal journey, their self-esteem and body satisfaction tend to improve, whereas these scores worsen for adolescent girls. Early maturing girls can be more vulnerable to these concerns, again further complicated in sporting contexts where the body is on display, being judged and commented on by others.
Given such sensitivities, parents and providers should always take utmost care at the language used when commenting on young women’s changing bodies. Such comments can be easily misinterpreted, and can contribute to body image issues and disordered eating practices.
These changing social dynamics and growing social pressures can influence young women’s participation in sport. As identified in the new Sport New Zealand campaign focused on young women, #ItsMyMove, the primary motives for girls and young women's participation in sport and physical activity are fun, friendship and fitness, and the pressures of competitive sport (to achieve, to perform, to win) can feel too much as their motives shift and change.
They are also trying to balance school, family and new social roles and responsibilities, so competitive sport can feel like it's adding to the stressors of life as a teenager, rather than helping them through this tumultuous time. Of course, for others, the relationships, identity and sense of confidence gained through sporting achievements help them carve a path through the teenage years.
Social media and body image
Teenage girls are highly digitally savvy. They use social media on a daily basis for a range of purposes - to communicate with friends and peers, to forge new relationships, and to communicate aspects of their everyday lives and identities. However, research is also demonstrating the increasingly powerful role that social media plays in impacting young women’s relationships with their bodies.
Social media can increase social comparisons and exacerbate social anxieties, including social physique anxiety. Comparing oneself to others can prompt young women to feel that their own lives are inadequate, somehow ‘lesser than’ those they follow. This can lead to negative feelings about their bodies, as well as other aspects of their social lives, including their sport and fitness participation.
A recent study done by the WHISPA (Healthy Women in Sport: A Performance Advantage) group in the elite female athlete population highlighted social media as a primary source of pressure to look a certain way and it's very likely this is more influential in this teenage age group.
For parents, opening conversations with daughters about their social media usage and how it makes them feel about themselves can be helpful. Sports and fitness providers would also do well to consider how they are using social media and digital technologies to connect, support and inspire young women.
Supporting healthy young women in sport
The reasons for young women’s high levels of disengagement from sport and physical activity are complex. In many cases, the sporting context (ie too serious, feelings of judgement, lack of fun) may prompt their withdrawal.
However, this is also a time of significant personal changes for young women. The teenage years are a critical time for young women in building habits, routines and relationships with their bodies that will continue into adulthood.
It's also important to acknowledge that teenage girls are a diverse group, and the rates and reasons for participation will vary depending on socio-economic and cultural reasons. With better understanding of these changes and differences, however, we can find new strategies to support girls and young women during and through this important chapter of their lives.
As part of the High Performance Sport New Zealand WHISPA working group, we recognise the importance of these issues. Educating young women, parents and providers is a key focus of the work we've been doing over recent years. We've offered multiple national conferences, a series of online educational resources, and regularly visit high schools.
Our website also offers a range of resources for athletes, parents and coaches to better understand the menstrual cycle and a range of other important factors influencing women’s performances and wellbeing (ie ACL, body image, social media).
Other organisations are doing important mahi in this area too. For example, Education Outdoors New Zealand recently launched an amazing resource ‘Going with the Flow: Menstruation and rainbow inclusive practices in the outdoors’, providing a range of resources for outdoor education teachers to better support young people who menstruate in the participation in outdoor activities (like hiking and kayaking).
Sometimes these topics can be uncomfortable at first, but we believe that open, safe and supportive conversations with young women about their bodies are important for building lifelong relationships with body image, nutrition, sport and physical activity.
Sport and physical activity providers and parents have key roles to play in supporting and enabling young women’s current and lifelong sport participation. We need to provide space for the voices of young women, to listen to their concerns, and support them, even if their motivations are changing.
Sports organisations listening to and responding to young women’s concerns and suggestions are seeing a positive upswing in ongoing participation. Better yet, we can work together towards co-designing sport and fitness programmes that meet young women where they are at.
