Alabama student-athletes asked about last period: ‘Unnecessary and invasive,’ says doctor

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Student-athletes at Alabama must report information about their periods on physical evaluation forms in order to play sports.

The question is one of 17 on the standard Alabama High School Athletic Association form. It is not listed as optional. Other questions concern the student’s medical and surgical history.

Since the overturn of Roe v. Wade, which outlawed abortion in Alabama and made it a felony punishable by 10 to 99 years in prison, concerns have grown about who has access to a woman’s gynecological health information and how that information can be used. Some doctors say questions about a student’s menstrual cycle may be unnecessary or should be asked differently now.

“There are many reasons why a young woman may have an irregular or recent menstrual cycle. A few of these reasons could have affected her eligibility to participate in track and field,” said Dr. Leslie Evans, OB/GYN at Fairhope’s Department of Obstetrics and Gynecology.

The Alabama High School Association Physical Evaluation Form is required of all high school athletes whose schools are members of the association. Along with questions about medical conditions, the form includes questions about when the student had her first and last menstrual cycle and the longest time between periods.

Evans said she thinks the question shouldn’t be asked at all and could be invasive and discriminatory.

“I expect that most gynecologists, pediatricians and [primary care physicians] that care about these young women to say that this is an unnecessary question for the uniform,” she said. “So, at the very least, it’s unnecessary and invasive or embarrassing. But as a last resort, worry about discrimination based on answers.”

The AHSAA has not said it will make any changes to the health assessment form, which was last revised in 2018.

In Florida, several school districts have asked the Florida High School Athletic Association to change the physical fitness assessment form for female student-athletes to no longer include additional questions about menstrual history.

The Alabama High School Athletic Association says the uniforms are digitized, uploaded to their database and archived for up to seven years.

“Question #17 is asked to try to identify menstrual dysfunction. This is an extremely important question to ask at the high school level when these issues first emerge,” said Ron Ingram, director of communications for the AHSAA, in an email. “It has been recommended by all primary care and sports medicine societies since 1990.”

No major organization recommended changing this question in the assessment form. The Florida High School Athletic Association is meeting this month to vote to remove the questions from its forms.

“Only school personnel authorized by school administrators have access to files uploaded to a student’s account,” Ingram said. “Typically it’s the principal and the athletic director or the school nurse or the athletic trainer. No one outside of these designated school officials can access the files, including AHSAA staff.”

The AHSAA uses DragonFly, an electronic medical records platform used by several other state high school athletic associations and the Atlantic Coast Collegiate Conference.

DragonFly’s Privacy Policy requires users to comply with state and federal laws, including the Health Insurance Portability and Accountability Act, which requires a patient’s written consent to disclose personal health information, except when required by law enforcement officials who have court order, warrant, subpoena or administrative request.

According to Dr. Rebecca Savage, an adolescent medicine specialist at UAB and Children’s of Alabama, knowing about an athlete’s period helps ensure that hormonal health is normal.

If menstruation has stopped or become irregular, this can be a sign of insufficient nutrition, called relative energy deficiency in sports, which is manifested in the deterioration of health and reduced sports performance. It can also lead to an increased chance of stress fractures in athletes.

“Medically, it’s very important for us to know about the menstrual cycle in young girls because it’s almost considered a vital sign,” Savage said. “A normal monthly cycle shows us whether their body is functioning normally.”

Noting privacy concerns, Savage says the question could be rephrased so that doctors have the information they need without revealing the intimate details of a student’s period.

“Technically, you could just ask doctors if there are any concerns about relative energy deficits in sports, or mention any problems with menstrual irregularities or something like that, if you don’t have to write down dates or [period details]” Savage said.

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