We’re exploring the intersection of elite athletics and women's health with author and former professional soccer player Georgia Cloepfil and Mayo Clinic women's health expert Dr. Chrisandra Shufelt. Using Georgia’s book The Striker and the Clock: On Being in the Game as our lens, we delve into the emotional and physical toll of high-level sports, particularly the underrecognized condition of functional hypothalamic amenorrhea (FHA), a type of absence of menstruation. We discuss the cultural silence around menstruation in sports, the physiological consequences of FHA, and the need for more research, awareness and support for women navigating intense physical demands in both sports and professional life.
We’re exploring the intersection of elite athletics and women's health with author and former professional soccer player Georgia Cloepfil and Mayo Clinic women's health expert Dr. Chrisandra Shufelt. Using Georgia’s book The Striker and the Clock: On Being in the Game as our lens, we delve into the emotional and physical toll of high-level sports, particularly the underrecognized condition of functional hypothalamic amenorrhea (FHA), a type of absence of menstruation. We discuss the cultural silence around menstruation in sports, the physiological consequences of FHA, and the need for more research, awareness and support for women navigating intense physical demands in both sports and professional life.
This episode was made possible with the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is hypothalamic amenorrhea, which I promise we'll tell you what that means. And our book is “The Striker and the Clock: On Being in the Game” by Georgia Cloepfil. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Georgia Cloepfil, who played professional soccer for six years on six teams in six countries. Her writing can be found in the “Yale Review,” “The New York Times Magazine,” and “The Washington Post,” among other places. She holds an MFA from the University of Idaho and works at Whitman College. “The Striker and the Clock” is her nonfiction debut. Georgia, welcome to the show.
Georgia Cloepfil
Thank you so much for having me.
Dr. Denise Millstine
Our expert guest today is Dr. Chrisandra Shufelt, who's a professor of medicine and the chair of the Division of General Internal Medicine at Mayo Clinic in Jacksonville, Florida. She's the associate director of the Women's Health Research Center for all of Mayo Clinic. Dr. Shufelt is a women's health internist with fellowship training in vascular biology and women's health, and the former president of the Menopause Society.
Her NIH-funded research focuses on young women with hypothalamic amenorrhea, which will be our topic and focus for today. Chrisandra, welcome to the show.
Dr. Chrisandra Shufelt
Thank you, Dr. Millstine, and thank you for having both Georgia and myself on for this really important topic, not just about discussing it above and beyond the book, but I really do appreciate us talking about a really unrecognized and understudied condition.
Dr. Denise Millstine
I'm excited to dive into that and talk more about it. OK, you both know how “Read. Talk. Grow.” works. We're going to talk about the book “The Striker and the Clock,” which is a collection of essays examining the joy and pain of serious athletics, particularly the world of professional women's soccer. Written in 90 short passages reflecting the 90 minutes of a soccer match, the book is a reflection on the ways soccer has shaped George's life.
Georgia, you're a writer and have been even as a professional soccer player. Tell us how you decided to create this book.
Georgia Cloepfil
You know, I'm a very writerly person. I was always taking notes as I played. I was in very unique situations throughout my 20s as I followed this passion around the world and eventually wrote an essay and was really looking for books that spoke in a literary sort of like grand and thematically broad way about sports. And I didn't find a lot of those books. Right.
We have like very traditional memoirs of I worked hard, I got hurt, I came back and I, you know, won the game. And that was just like, not at all the way I was experiencing my story. And so I just put it together and I kept writing in it, you know, and to graduate school and it kept sort of accumulating. And I got to revisit all the notes that I had taken was and then it became a book.
Dr. Denise Millstine
I love an interesting structure. So was it your idea to do the 90 passages after the 90 minutes in a match?
Georgia Cloepfil
It took a long time to find its form, but I think I was looking for a way to sort of contain the book that didn't make it, you know, but I could move throughout time. I wanted to go forward and back, talk about childhood and structure more based on themes of, you know, gender and pain and time and beginnings and endings, but not have to move chronologically. So I feel like the minutes sort of allow a reader to move through time in a way that makes sense and is connected to, like the whole idea of what is coming next, where is the ending? And the game certainly ends, the career ends. And that's sort of what I was working towards. So it just came to me, I wish I knew how because it's the hardest part of writing, I think.
Dr. Denise Millstine
Well, I think it's brilliant. And anybody who's watched a soccer match knows every minute is different from the next. Then it does go forward and back. So I just thought it was really well done.
Chrisandra, tell us your reaction to the book and also what it's like to work as a women's health physician who's trained in vascular medicine.
Dr. Chrisandra Shufelt
Well, it's a great question. And I was just commenting that you're writing Georgia so engaging and I usually don't listen to books, but this is a book that I happen to listen to. I like to look at the words. But I found these short, poetic chapters were really engaging, and I could pick up and remember the last one and jump to the next one. And you're right, it was going backwards and forwards. So and I think you opened it up so beautifully with visualizing the game, and then you closed it so beautifully because you're visualizing it from the stands versus from the individual.
And while I did not play soccer as a sport, it really made me relate to other kind of challenges in my life. So I think it's a very relatable book. You spent more time talking about off the soccer field than on the soccer field. And when I first picked up the book, I didn't know how that was going to be approached.
And so it was really nice to be able to relate it to other areas, even other careers. Right? I mean, I'm a physician and a women's health physician, and the commitment that you had to do is similar to the to, you know, the pathway, a lot of women's careers end up taking the commitment they have and the struggles that you went through, whether it was physical pain or emotional pain, being away from your partner and being in other countries, those were sacrifices you made at such a young age.
And in some parallel, we as women physicians, having to go through four years of undergrad, four years of medical school, some of us throwing masters or PhDs with that, and then four years or three to six years or even eight years of residency and then fellowship training. So we all make sacrifices.
And so I thought that that was what was so eloquent also is that while it was a book about sports, about your experience in the soccer leagues, it was very engaging and relevant to a lot of women that were reading it.
And then leading into that. I'm a women's health physician, so what I do is and we have a women's health center here at Mayo Clinic, actually, we have them in all clinics, Mayo Clinic, Arizona, Florida, as well as Rochester. And I am specifically trained in vascular medicine because I look at the intersection between hormones and the heart. And that doesn't just happen to have impact women at the time of menopause, which we know the average age is 52, when that women lose their estrogen naturally and normal.
And that's a normal stage of a woman's life. And half of an adult woman's life, by the way, is spent in that stage menopause. But I also study the impact of estrogen across a woman's lifespan, and that can be anything from when a woman starts her period and how that impacts future heart risk to functional hypothalamic amenorrhea, which is what you talked about in the book and its impacts athletes. It's estimated that it impacts almost 30% of athletes. So it's important to look at how that impacts, and for me it's vascular health of the heart.
Dr. Denise Millstine
I'm just going to re-emphasize 30% of women athletes have navigated this and probably many of our listeners will not have even heard of it or spent time considering it. So we're going to dive deeper into that.
And actually, Chrisandra, one thing that this just made me think of when you were speaking is that Georgia's experience with soccer, particularly when you were coming into it, Georgia. There was not a lot of ability for a woman to be a professional soccer player. There just weren't a lot of opportunities or teams or even the leagues that exists today were either just starting or hadn't started yet.
And Chrisandra, you have been a pioneer in establishing the field of women's health itself. As you and I were coming up through training, there wasn't this idea of, oh, you could go and be a women's health physician who's focused on this topic. So there are a lot of parallels in navigating these fields that are important and necessary. But there is a time where they didn't necessarily exist kind of so smoothly. And of course, women's health is now burgeoning and blossoming, but we need way more of it in the country.
Georgia Cloepfil
Yeah, it's so cool that you say that my mind is really firing. I feel very honored to be connected to this conversation because, yeah, you guys are such experts, and I think the two things sort of blossoming at once really shows, because how I write about women's health in my book is sort of like thing no one really knew much.
We sort of like hush, hush, just get rid of it and like, power through. And things hadn't been so studied like ACL injuries and hormones and how these things impact the female athlete. And now already so much more of the science is being integrated into the training and of people across all sports. And it's so important for the success of female athletes to have an understanding of the way the cycle impacts performance and recovery and all of this. And it was just absolutely not talked about even like five, ten years ago. So very cool and makes a lot of sense that the two things are sort of marching forward in tandem.
It's also funny because just this weekend, someone was talking to me --- in the ways you say it's relatable to people who don't play sports at all, the book and someone was talking to me and said, you know, I was reading it and I really thought it connected so much to the menopausal woman's body. Like the idea of like sort of ending one phase of life through like this sort of, you know, in soccer, it's like injury or time or, you know, your age down at like 30. But in a different way you're moving into a different phase physically. And I love that connection. It was the first time I've heard of that parallel. So cool. That's coming up too.
Dr. Denise Millstine
Yeah, that's really interesting. Well, let's jump in to our main focus then. So Georgia, you're playing soccer overseas and you suddenly stopped getting your period. And actually you write that you felt to some degree thankful because you knew that athletes who are having their period were more prone to injury, more likely to develop anemia if they have a heavy period and that could lead to affecting energy levels. So you were relieved. And I just wonder if you'll talk to listeners about what that experience was like, at the time anyway.
Georgia Cloepfil
I sort of my period was always very light, came and went and then went for a period when I was first started playing professionally. And I think I talk about a friend that I made in Korea who hadn't had her period in many, many years. And it was a thing sort of the associated with like strength because it was associated with masculinity, really, which is associated with athleticism. You know, all of this sort of like baked in sexism into sports, I think comes with that idea of like that period being an obstacle to avoid if possible.
I write about the first time I got my period was in the football locker room, where I was by myself and my boys, male teammates. They're very young, but were in a different room. And I just had this feeling or I definitely, in retrospect, think of that moment as like, here's where our bodies diverge and I become disadvantaged, you know and the period is associated with that. So, so problematic, all of those ways of thinking and like the ways that we sort of we could go on and on about like endurance and pain tolerance and what people say about women's bodies and like ultra endurance sports and stuff. But I'd be so curious to hear Chrisandra talk about more of what's actually going on.
Dr. Chrisandra Shufelt
So this condition functional hypothalamic amenorrhea. I'll just define it, Denise. So it's a condition where young women stop their menstrual cycles for at least three months in a row. It's usually not one or two months. It has in order to really kind of be diagnosed, it’s three months of consecutive menstrual periods, often due to a combination of factors.
So it's usually due to extreme psychosocial stress over exercise or excessive exercise or restrictive eating habit. And its usually a combination. It just doesn't have to be one solely. And then we've also in athletes because it is common I mentioned. we call it female athletic triad. But that is just a subset of functional hypothalamic amenorrhea.
And then what happens, this condition disrupts the part of the brain that regulates our estrogen our reproductive organs. So what it does is it leads to low estrogen levels in young women. However, unlike menopause, which is as I mentioned earlier, this condition also changes many other hormones. And this is where I say women are at an advantage because we have the menstrual cycle, because that's actually the clinical sign, or this is a way that we can start to think about, maybe this is what's happening, but the same condition happens in men. They just don't have a clinical signal. They don't have a menstrual cycle.
I say this is where the menstrual cycle, as we call it, is a vital sign you should be having a monthly menstrual cycle. And if you're not or if it's irregular or if you're skipping it, then it's important to know why. Because it's a sign that something might be disrupted in the body. It might not be this condition. There's many reasons.
But actually functional hypothalamic amenorrhea and I call it functional because that's its full name, because it is reversible. So it's not that you're doing damage to your ovary or you can't, you know, women go on and have successful pregnancies after this, but we need to study that. But the other thing is, while women don't have their menstrual cycle, they can't have a child. This is a form of infertility during that period, and it can last from months to years. And we are still trying to understand how women can regain their menstrual cycles back.
And when I mentioned it can lead to other hormone changes, it lowers estrogen. It upticks So this is where it goes up. This is different. the stress hormones. So our stress hormone most commonly is cortisol. So that's where we see an increase in cortisol. And cortisol in small doses is good, right. When you're sick your body releases cortisol. It's a fight or flight kind of you know, you're trying to fight an infection. When we admit patients to our ICU, their high cortisol levels are protecting.
But in long exposure to cortisol, we know that there's it's a bad effect. So we see that having high cortisol in this setting is problematic. And we also see thyroid dysfunction, an early form of thyroid dysfunction. We said some of the hormones in the gut start changing. And now we're learning a lot more about things like leptin and other hormones that regulate our sense of needing food.
But there's a lot more that goes into this than just the estrogen. But to date, really what's only been studied is the impact of low estrogen really on the bones, because we know that women with this condition can lead to significant bone loss from the lack of estrogen. And it's estimated that even after six months of missing your period, that's almost comparable to losing estrogen in your 50s.
So the average age of this condition is 26 years old. That's the average. And imagine that your bones are aging so fast, almost two decades. So bones can be impacted by low estrogen. But what our research has expanded well beyond that in terms of overall health. But I'll stop there because I really would like your thoughts on that in terms of what I explained.
And then you mentioned something so eloquent, which is I didn't you know, women don't kind of want to get their periods because they think they're going to get injured more. They think during your menstrual cycle is when your estrogen is at its lowest and then you start to raise your estrogen mid-cycle, then it goes back down. It's interesting because this condition, functional hypothalamic amenorrhea, drops your estrogen to even lower than what it is during your menstrual cycle. So there's this misconception that not having my period is a good thing, when in fact it's not a good thing because you're actually lowering your estrogen overall, probably more prone to injury if you want to talk about that.
Dr. Denise Millstine
So I want Georgia to comment on that. For our listeners, I just want to breakdown and highlight a couple of things that you just said. So you said functional hypothalamic amenorrhea. So breaking that down, functional means there's something situational going on. There's not a problem with the gland, it's how the gland is behaving and you clarified that that means it's reversible. The hypothalamus is a gland in the brain that is driving much of the endocrine system to increase, decrease hormone levels from other organs and glands, making the hormones.
And then amenorrhea is the term for not having periods. And you said that in order to have this, you will have missed your period a minimum of three cycles. So if you miss one cycle, it's not necessarily what we're talking about. It's this stringing together of multiple cycles where the period doesn't appear. And that is in the setting of nothing else in the system. So if this is in the setting, for example, of being on a hormone therapy like a birth control pill, that is a very different setting. And we'll comment on that in a moment. But Georgia, can you go ahead and respond to Chrisandra?
Georgia Cloepfil
Yeah. So cool to hear like what's actually happening. Like I said, I've just experienced it head down and in like hushed manner sort of during that time of my life and I think absolutely like not a good thing, not something to encourage or celebrate.
I list all these bad side effects, too, that you were listing Chrisandra in the book. You know, but it's that problem where you have athletes if they don't have this knowledge, which is so helpful to say, like you're actually you're not even helping yourself in the short term, because I think so much of my career was spent ignoring injury, like in the long term.
You know, I'm getting these injections, I don't care, I just want to play tomorrow. I don't really care about my bones when I'm older, you know? But actually your performance and your health in the moment is also being hurt.
And it's like athletes only listen to their coaches and their trainers and their doctors sometime. You know, if they're very sternly communicating what is happening to their body. Otherwise, it's just like, how can I play the next day, you know? And and how can that be more convenient for me, whether that means being like, pain free or not, having to wear a tampon during a game, you know, whatever that looks like. So yeah, it's so important that athletes understand that science.
And like you said, I'm so curious if there were ever research about, especially ACL injuries, is what's talked about a ton with women's soccer players specifically during this phase of not having period. I'm not going to try and pronounce it because I'm gonna humiliate myself.
Georgia Cloepfil
If the likelihood was just as great, if you're saying the hormones are doing a similar thing, I would guess it would probably be so. That's pretty remarkable.
Dr. Chrisandra Shufelt
This is where we are not study good enough. We're not studying it enough. And athletes, we're not studying it enough around the world. Even if you think about, you know, you mentioned earlier, you know, we don't really talk about the menstrual cycle or you didn't talk about the menstrual cycle and think about the we don't really know even what the global prevalence of this condition is, in part probably due to cultural taboo surrounding menstruation that really limits are open discussion about it. And then that will limit diagnoses.
And we need to explain this, but from a global perspective as well, because there's women around the world, we make up 52% of this population globally, and there's athletes around the world. So if we're not even talking about it in athletes, imagine we're not talking about it in certain cultures or countries. And, you know, stress is a big part of this.
And while the focus of your book is also about the endurance of soccer, there's so much stress that went around that you endured from living in six countries, you know, talking about having a working wage. But then there were some countries that you were making $30 a week. The stress that goes along with that, as well as the nutrition, having that diet.But you're spending more of your calories and you're probably taking it.
So I do think that there's a lot to answer, and I think it would be a really interesting study to see about women with functional hypothalamic amenorrhea that our athletes and find out if they're more prone for injury, because I would imagine they likely are. But we're not even asking about menstrual cycles in physical exams much.
When women are asked about their menstrual cycles is because they're going into their gynecologist office. They ask when your last menstrual cycle was. Well, the reason they ask that is usually by, you know, the medical assistant as well. The reason they ask that is to confirm you're not pregnant.
The bigger question should be, are your menstrual cycles happening every month and are they irregular? And you know, this is an important thing and I don't want to make this a that is about professional women or professional soccer because it is expanding into the global issue, because women's health is a global issue. But I will sit around with a group of colleagues and talk about this openly, and you'll start to see hands raised. Oh yeah, this happened to me. Oh yeah, I was in college. This happened to me or yeah, my first job. This happened to me because I was so stressed out. I was away from home.
It does happen and it's common, but we're not documenting it. We're not asking about it. And the Endocrine Society came out with guidelines, position statement in 2017 about this condition. And even then, what the recommendation to treat it was cognitive behavioral therapy. There's really no other treatments right now. We have to reverse the underlying cause. But then how do you tell a professional athlete to stop exercising so much? How do you tell a young woman who's in a war-torn country to stop stressing so much because she's displaced from her family?
There's a lot that goes into this condition that I do think it is a condition where your body's saying, okay, you're not healthy enough to carry a child. Therefore, we're going to shut off this ability to have a child. You're not going to be able to ovulate or release an egg every month. But then the reciprocal is true. Your uptick in your stress cycles and everything that goes into that.
I mean, talking about the tip of the iceberg for this area of women's health, we have not begun to even understand how this can impact the brain, how this can impact the gut, how this can impact future pregnancies.
Because what we're seeing in our research at Mayo Clinic, in some women, not all. And I don't want to generalize this to every woman that stops their period due to this condition, but it's about one in every three. We're seeing an impact where the blood vessel function is not acting normal. And so what I mean by that is that your blood vessel has an inner lining, and that's called the endothelium. It's about one cell layer thick. It controls the ability of your blood vessels to open and close when you need to exercise, when you need more blood flow to the organ.
I liken it to like, get those really nice rubber bands sometimes in the mail, like your mailman or mail woman will bundle your mail up in this beautiful rubber band. That's nice and stretchy. It's thick. It's that's how the vascular health should work your blood vessel when it needs to open up. It's that beautiful bouncy rubber band that opens up and lets you stretch. What we're finding in this. We know that estrogen plays an important role in allowing that rubber band to open because it promotes nitric oxide, it promotes all these chemicals to cause dilation.
But in this condition, with FHA, we know women are walking around at 26, looking very healthy physically on the outside. But what we're finding on the inside is that's about one in every three that rubber band. It's not the rubber band that you're excited to stretch out. It's like the rubber band that you just found in the back of the drawer. It's been in there for a while. It may be a little chalky. It's not opening up as it should. It's not heart problems. It's not heart disease. And what we are hopeful is it's reversible. But we are finding that in this condition, it's about one in every three women are getting endothelial dysfunction, so that endothelium that lining is acting dysfunctional.
Dr. Denise Millstine
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Dr. Denise Millstine
Will you comment on Georgia writes about one of her teammates who arrives for a team and is provided with birth control pills, enough to last her for the entire year. Will you just comment about the role for hormone treatments in the setting of FHA?
Dr. Chrisandra Shufelt
Well, the purpose of a birth control pill is to also give a high enough dose of estrogen that it tells the brain. It almost tricks the brain into thinking it's pregnant, so it shuts off the signals to the ovary. The challenge with having a birth control in this situation, or if a woman has FHA and has stopped having their period. Handing her birth control pill, which is three weeks of hormones and usually four to five days of a placebo pill, which causes you to have a period, it causes you to have a withdrawal bleed. It's not a real period, it's a withdrawal bleed.
It gives a false sense of security that she's regained her menstrual cycle. It doesn't reverse the underlying cause. I can't say we know this for sure because it's the research is still being done. It's not reversing the underlying high cortisol levels, thyroid dysfunction. It's not reversing all of those because they're all precipitated by the underlying cause. So to me, a birth control pill is a Band-Aid for this condition and it's a false sense of security.
Now, birth control pills are great because they prevent pregnancy and are important. And by the way, 80% of women in our country have taken a birth control pill at some point in their life. So that doesn't mean that they're bad. But in this situation, we don't want to falsely create a period so that the woman doesn’t, She thinks she's back to protecting her bones and her brain and her heart and all these things.
Because what we've found is that while it can help with bone health, we know that birth control pills are not designed to treat bone loss. But we have seen small studies, but we don't see that signal for the heart. We've studied at giving back estrogen to women with this condition, with the vascular dysfunction, and it doesn't reverse that. So I think there's a bigger picture here in terms of all of the hormones that are disrupted, not just estrogen.
Dr. Denise Millstine
It's so complicated because you would think, well, I have a pill that can make me then have my period problem solved. But it's a really obviously not as straightforward as that.
There's a lot of physiology and being an elite athlete. Georgia, you write in the book not just about your periods. It's only really referred to in two of the essays, but also about a lot of the other data that you follow as you're playing, things like your heart rate and your percentage of body fat. Can you talk to listeners about what it's like to be constantly mindful of those physiologic parameters in that data?
Georgia Cloepfil
Athletes are such a group of like such competitive people that I feel like when you present them with numbers, they're going to just want to do something to the very most extreme. Whereas really like all of this data, I mean, I hear you talking about, I'm thinking about the hand out of the birth control to this whole national team, you know, and again, this is ten, 15 years ago. So things have changed immensely in that time. But it's like one solution for everybody, which is crazy in all of these instances when it comes to like diet and nutrition and menstrual cycle and recovery and everyone's bodies are so different.
While data is really interesting, it also sort of like flattens things, especially when there isn't like also an influx of like care and research and like attentiveness in the medical sphere. But I mean, soccer is a sport where data is only very not that relevant or helpful because it's such an organic sport where, you know, I'd be curious to talk to like a runner or a cyclist who has those numbers are exactly what their performance is. You know, there aren't so many organic elements can probably make you crazy.
Dr. Denise Millstine
For sure. And Chrisandra, there is a period where Georgia gets this elevation in her heart rate, not just when she's exercising, which would be physiologically appropriate. She starts to run, her heart rate should go up, but she starts to have this, what we call tachycardia or fast rhythm, unprovoked. It just happens at moments. Can you talk about that and also why she teaches herself a strategy to hum or cough when she notices that it's happening.
Dr. Chrisandra Shufelt
Yeah, so coughing can break the rapid heart rate in some if it's just an onset that happens really quickly or even what we call a vagal maneuver, which is you kind of bear down and that's used not just for rapid, normal heart rates, but we can do that in some other irregular heart rates. It's a condition that we've been trained to do, only do it in front of a doctor.
But at the same time, there's a lot of hormone changes that can affect heart rate. We know anxiety can affect heart rate. Thyroid dysfunction can affect and impacts heart rate as well. But traditionally, you know, athletes heart rates and and also women with functional hypothalamic amenorrhea are hovering in the 40s and 50s, very, very low. So to go from a 40 and 50 to 120, that's going to seem a lot different than someone who sits in the 70s and 80s and then goes to 120. So she's also physically fit. And you know, when you have that chest cavity that your heart sitting right there, you can feel it more palpable.
Dr. Denise Millstine
So another hormonal component of being an elite athlete and being a young woman as pregnancy is Georgia. You write about one of your teammates who becomes pregnant. Can you talk a bit about that at this stage of life and facing that as potentially a career ending event?
Georgia Cloepfil
I was in Korea and again, there's such a like quietness in all of these contexts around these things happening because it is like so disruptive. You know, if a period's disruptive, a pregnancy is 100 times as disruptive. Sort of thought of like an injury in some ways, especially if it's sort of unplanned, which it was for this particular athlete.
And again, that's something I'm thinking now, I only know in women's soccer.
But, you know, across the board, actually Nike finally having a maternity leave for their track athletes. Women getting, you know, insurance that covers cryopreservation of their eggs on soccer teams. You know, the Portland Thorns did that. I think some other teams. So thinking of it's unfortunate that your prime window for competition is also your prime time to get pregnant and have a baby if you wanted to, when you can play through age 36, 38, you know you're pushing the edges there.
And so it's funny because right now there's three very young, super famous soccer players in the United States who got pregnant in their, you know, they're in their mid 20s or something on the national team. And it's so cool because it seems like, you know, if they wanted to be pregnant, what great timing. And they have so much more support now. And they can come back and play. And it can be now sort of like a, a regular part. That's not just a sort of like, oh, hush, hush and like go hide away and have your baby. Like, we live in the 1800s. Now, there can be a lot of support.
But I mean, you also hear mothers come back to really high competition like that and say their body is never the same. I mean, I had a baby two years ago. I would say that's true. And I'm not competing at the highest level anymore. So it's really hard, even if you do have the support, to sort of facilitate that and then come back to it again. It's like a 100% level of operation of your body is needed to compete. If we're talking about national teams and, and things like that. So yeah, it's a challenging subject.
Dr. Denise Millstine
It really feels like a cruel trick that in this years of your best performance there also your years of your highest potential and ability to become pregnant, if that's something that you desire.
Dr. Chrisandra Shufelt
I was going to comment that, you know, this is where the parallel came back to medicine for me, because we delay our fertility as female physicians and our training, and even how that one surgeon, the females, or if she's a female vascular surgeon, she's standing around a table, one of the only female vascular surgeons at our hospital, and she can't think about having a child. And that's when she said, I stopped having my period due to stress. I felt like I was becoming more masculinized because I was around men all the time.
So we do sacrifice, I think from a professional standpoint, no matter what profession you end up being in. Thankfully there are options for women. Lifespan versus health span. As health span is getting longer for women and so having a child in your 30s, late 30s, early 40s now is challenging, but it can happen. Right. And it's I think it's more becoming more of a cultural acceptance as opposed to, oh, you're advanced maternal age, meaning you're over the age of 35. And I've always hated that term because both of my children were born over the age of 35. But with that comes complications.
And you said, Georgia, your your training was different after you had your child. And I will say you'll never sleep again the same after you have a child. So that probably impacts a lot of training as well. But our bodies do change significantly after childbirth as also with the chronological aging. Right? There's also something called ovarian aging, right?
There's some women that go into menopause earlier under the age of 45 or even under 40. Those women are physiologically different as well. So it is an interesting approach, but I will say that most women now are having children in their mid 30s. And but it's refreshing to hear that they're also these teams are offering cryopreservation and fertility offerings and maternity leave.
Georgia Cloepfil
Right. Yeah. I think this year was the first year that the like global governing body adopted like a recommendation for pregnant players on the team for like how the team should manage that in terms of employment, which is crazy to me. But you know, women's sports is pretty young. Same with like women being able to be doctors. It's like sort of a new thing, women in the workforce. It's sort of a new thing to the point where we don't even have, you know, maternity leave or parental leave at all in many of our states, so very behind. And those things will help a lot.
Dr. Denise Millstine
And hopefully books like yours and conversations like this will help people to stop and think about it a little bit. So clearly more research is needed on this topic. Chrisandra, will you talk to us about some of the projects that you have going on now?
Dr. Chrisandra Shufelt
Absolutely and this is the time where we need to get the word out about research, because it's so underreported and understudied, and we need to know more information. Whether you're an athlete or whether you're living in a country that is in turmoil.
We have two studies right now, and I will share with you the link. If you know of anybody that might have this condition, they can just reach out to us. The first one is actually using tracker like Fitbit. We're actually looking at exercise patterns in these women and looking at their blood vessel that rubber bands stretchy blood vessel health. It's called noperiod.info/arch A R C H. And that stands for amenorrhea related cardiovascular health. So that's where we get arch from. And I liken it to saying we're arching over between periods and cardiovascular health. That study is funded by the NIH. So this is where our tax dollars are putting money towards studying this condition.
And to get more funding, especially right now, we need to prove that we can recruit more women with this condition and study it. And so that's what's the exciting time about. That study would involve a visit to our campus in Florida and we have a travel stipend for that. But there's plenty more information where you reach that URL.
The next one is a registry. This is what's really exciting. We've opened an international registry called Reveal. We are revealing that this is a problem. It's the registry of very early estrogen loss and anovulation. So no, not releasing an egg. So that's where we get reveal from. And it's noperiod.info/reveal
So both of those will take you to a landing page that you can fill out information. We will contact you if you're interested and we will tell you about the studies in great detail. But, I really think avenues like this, it's going to get the information out. It's books like this that are going to get the information out to women that they are not alone, and they can talk about their menstrual cycle.
Dr. Denise Millstine
Before we wrap up, I do want to make sure that we have set the right tone for intense activities, and particularly being an elite athlete for a young woman, because while there are many physiologic impacts to that intensity, there are also many gifts to being able to participate in sport for many years. And I wonder if both of you would comment on some of the best aspects of being a participant in an intense sport, or an intense training for young females.
Dr. Chrisandra Shufelt
Well, I think one of them most joy I get out of being a female physician is being a mentor and being a role model. And, you know, all the sacrifice that you put in, all the years that you train and read and study and you're in the basement of the library and your friends are out doing other things, while you're sitting there studying, or you're having to take an eight hour exam all day because you're getting certified, your board certification.
But the sacrifices that you do make it ends up becoming well worth it because of that role model that you get to be, not just for your the people that you work with, but even for your children. So that's how I see it being so rewarding.
Georgia Cloepfil
I mean, this is so funny because I feel like in the book, I was very conscious of trying to balance the elements of joy with all the elements of like, struggle and pain, because the only reason I continued to play soccer was because I loved it. And because it offered me these moments of ecstatic joy, which proved very challenging to write about very much, because they're sort of like wordless moments. I'm sure we've all experienced the joy that sort of made us like, forget everything. And for me, being in my body in the ways that it's like feeling it's strongest and healthiest and most effective, enabled me to get to moments of like, unthinking joy, which is still why I still play. And I think it's so important to have something like that that lets you sort of tap into a really, like, sort of childish play.
Dr. Denise Millstine
Well, thank you both for talking about these important topics with me. And listeners should go out and read “The Striker and the Clock: On Being in the Game” by Georgia Cloepfil. It was a great conversation, thank you.
Georgia Cloepfil
Thank you.
Dr. Chrisandra Shufelt
Thank you.
Dr. Denise Millstine
Thank you for doing this important work. Clearly we have so much more to learn and we will put both of those links in the show notes for listeners.
Listeners interested in this topic can explore stress further with the book “Burnout: The Secret to Unlocking the Stress Cycle” in Episode 23, and also intensity of medical training with the book, “I Can't Save You” by Dr. Anthony Chin-Quee in Episode 19.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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