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Manchester City Women Participate In Pioneering Research Monitoring Effect Of Hormone Levels

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The English Institute of Sport (EIS) have teamed up with the Women's FA Cup holders, Manchester City, to monitor the hormone levels of their players in real time to accelerate the understanding of female athlete health in order to optimize training and performance support.

Developed by Mint Diagnostics, a cutting-edge system called Hormonix will enable women to measure their levels of oestrogen and progesterone from a saliva sample to connect the athlete's experience with biological data in a project which, it is hoped, could aid women in every walk of life around the world.

Through conversations with Dr James McCarron, head of Sports Science and Medicine for Manchester City Women's team, Dr Richard Burden, Co-Lead for Female Athlete Health at the EIS, established a partnership through which first-team players will be able to access rapid and accurate information on their hormone levels to create a better understanding of how the menstrual cycles influence their performance.

England and Manchester City captain Steph Houghton said, “I’m really happy to be able to take part in this study - menstruation has always been a taboo subject, but it shouldn’t be as it’s a key part of life for women, especially those who are professional athletes. Throughout my time in the game, there has been a real lack of information and research surrounding female athletes and the effect of hormone levels on performance, and it’s incredibly exciting that we’re able to now do some real work on it."

“Manchester City make sure that we have everything we need to reach our optimum, but the fact that they’re now going a step further into an area where the surface has barely been scratched is so important and speaks volumes about how highly the club values its women’s team. Hopefully, this collaboration can have a real impact on how we tailor our approach to the game around our own individual bodies to grow the levels of elite female sport even further.”

Established in 2002 and funded by UK Sport, a government agency responsible for investing in Olympic and Paralympic sport, the EIS already provide support to 40 high-performance sports across the United Kingdom and speaking to me about the collaboration, Burden found the Manchester City squad very receptive to the program. "They have a very engaged group of players and a very engaged group of staff from the top-down in trying to improve support of female athletes."

Burden explained to me why there are such misconceptions of how and why menstrual cycles effects women. "Historically, there's a lack of science and medical understanding about what underpins female health and performance. One of the reasons for that is our inability to understand how the menstrual cycle and the fluctuations in the hormones influence aspects of health and aspects of performance. This is due to the fact that you've needed to take blood samples. That's invasive, it's expensive, it takes times to get the results back and because it's invasive you can only really do it a few of time every cycle. That doesn't give you enough information."

"What we needed to be able to do was take samples every day, or every other day. In order to do that we needed to be able to measure it in a non-invasive way. The ultimate goal is for the technology to be in a little test-strip, a little bit like the at-home glucose measures. You can give it to athletes, you can give it to support staff and these hormones can be measured at any time, in any place."

The frequency of the data was necessary to compile a more accurate, tailored approach to women with very different requirements. "It is really, really individual" said Burden. "The symptoms that individuals experience in particular phases of their cycle will differ between people, but they will also differ within people. An athlete, for example, may experience food cravings at the end of one cycle towards menstruation, but in the next cycle they may not. Just because they experience at one point in one cycle doesn't mean they are going to experience the same in the next month or the month after that."

"Within a large squad you're going to get a number of them on some sort of hormonal contraception, within that group there will be different types of hormonal contraception as well. Then there will be some who are not on any hormonal contraception and will be experiencing symptoms. I think the more we talk about it and the more the players understand about how their cycles affect themselves, and the more the coaching staff also understand that, the better."

"Where we want to get to is a much more individualized and precise approach to athlete support. Right now, if you look at research papers, it's very broad-brushed generalized information. For elite athlete athletes, that just doesn't cut it any more. A lot of the time that will mean slightly different areas of support."

Nevertheless, Burden strongly believes that the collection of such data should never be used as a justification to prevent women from competing. "There has been a lot of noise in the last twelve to eighteen months about the ability to peroidize someone's training around the menstrual cycle. The fact is, because of the science and medicine not being there, there isn't any evidence for any of that."

"Now the capability is there with Hormonix, but it's still a long way off. I don't think it should ever get to that point. It's actually making sure that they are in the best possible shape and have the best possible support around them to be able to continue training and playing, regardless of what they are experiencing. That's what we're working towards."

United States defender Abby Dahlkemper, currently five months into a two and a half year contract at Manchester City, told me that she did not take part in the study but nonetheless recognizes its importance. "I think focusing on hormones and the way that the cycles work for females I think is important. Education comes from studying. I think it's amazing than Manchester City is pushing the barrier and looking into the health of women and looking at specifics in that way."

Eventually, the lessons learned from this pioneering research could benefit all women as Burden told me. "The outward experience of a healthy menstrual cycle doesn't necessarily mean that the hormones are fluctuating in the way they should be. For example, in General Practice you would assess the health of someone's menstrual cycle by saying, "do they have a period?" and "do they have an average 28-day cycle?" We've got athletes that tick both of those boxes, but actually by measuring the hormones it's showing that's actually not the case. That information is equally as relevant to the general population. There are both acute and long-term consequences of not having healthy menstrual cycles, it's really important to understand what's actually going on."

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