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While AFLW matches were largely closed to fans this weekend as a result of the global COVID-19 pandemic, the Friday night game between Geelong and North Melbourne became an official fundraiser for endometriosis.
Officially, one in 10 women has endometriosis, which equates to about 176 million women worldwide. But it takes on average 7-10 years for them to be correctly diagnosed.
It's just one of the many barriers to adequate treatment for a disease that is so poorly funded and managed that in 2017 Health Minister Greg Hunt formally apologised on behalf of the Australian parliament and medical system for the "historic failures that sufferers of endometriosis endured".
The Cats, who during the week participated in an endometriosis education session with Katherine Stanley of Talking Endo, were so moved by the presentation they chose to wear yellow shoelaces for the game, the official worldwide colour for endometriosis.
The club also hosted an endometrium sculpture by artist Bec Van Dyk who, along with representatives of EndoHelp, was on hand to discuss endometriosis with passers-by on game night.
Stanley, an endometriosis sufferer, said raising awareness of the condition was critical to alerting more women to the symptoms of the disease.
"Women are often actually relieved when they come out of surgery to find out they have endometriosis, because they've usually endured years of [implications] that … maybe it's in their head, or their pain tolerance is really low," Stanley said.
"I think that says a lot that people can be relieved to [be diagnosed with] a disease with no cure that you have to spend the rest of your life managing."
Clubs educating players on pelvic health
Statistically, Stanley said, it was likely AFLW players had endometriosis — athletes were not immune to the disease.
North Melbourne AFLW physiotherapist Melissa Haberfield agreed, saying while none of her players had been diagnosed with the condition, they had reported troubling symptoms.
At Haberfield's initiative, the Kangaroos this season brought in Alison Harding, who is experienced in treating women's health problems, from Inner North Physiotherapy in Thornbury, to screen players' pelvic health.
"From that screening we reviewed five players out of 30 who warranted further attention," Harding said.
"That wasn't just to do with endometriosis, but we found pelvic health-related symptoms like pain with higher intensity activity, but also incontinence of the bladder and bowel."
Both Harding and Haberfield said players were reluctant to discuss pelvic health with club physios, despite battling disruptive symptoms.
"These are fairly debilitating symptoms, [but] it's quite a personal thing to talk about," Harding said.
"More often than not, people suffer in silence because it's a difficult thing to bring up in any context, but particularly in elite sport."
"It's also pretty normal for elite athletes not to talk.
"They generally don't like talking to the physios about their issues because they don't want to be taken away from the game. But we wanted to be proactive and create a safe space for our athletes."
Players have minimal understanding of menstrual cycles
Haberfield, who is also a research assistant at La Trobe University, works closely with Brooke Patterson, an ex-Melbourne player who is now doing a PhD on injury recovery and also works as a development coach for the Dees' AFLW team.
Patterson said education was key.
"There's a clear gap in knowledge for AFLW players, as well as a desire for more knowledge," she said.
She pointed to research by Griffith University's Associate Professor Clare Minahan and Dr Brianna Larsen, which showed female athletes generally had a low level of knowledge about menstrual cycles.
Preliminary analysis of a separate study by La Trobe University's Dr Anthea Clarke, meanwhile, showed about one third of AFLW players had an abnormal menstrual cycle, 50 per cent experienced changes in their cycle when their training load increased, one-third had had to adapt training due to their menstrual cycle and associated symptoms, and two-thirds felt they performed worse either during or just before their period.
More research needed on menstrual cycles, links to injuries dubious
But, while menstrual cycles were clearly an important part of the health and wellbeing of elite women athletes, both Patterson and Haberfield cautioned against media reports linking women's menstrual cycles to injury.
"What we do know is that there might be an increased laxity in the ligaments during particular points in women's cycles," Patterson said.
"But that does not necessarily mean they're more likely to do their ACLs because of that."
Haberfield agreed: "If we start saying to girls that they can't take to the field because they're at a particular point in their cycle, I think that would be very dangerous. We need to sort the hype out from the facts."
Kate O'Halloran is a sportswriter and former Victorian cricketer. She hosts AFLW radio show Kick Like a Girl 12-1pm Mondays on RRR and writes a Monday column on the AFLW for the ABC.
Topics: sport, australian-football-league, australia
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