Run Well

by Juliet McGrattan

  Hormonal contraception can help to control HMB, but not every woman wants to or can use it. If you’re concerned about leaking blood, then have a look at some of the ‘period underwear’ available. These are knickers with the ability to absorb and retain blood. For lighter flows they can be used alone, but with heavy bleeding they can just give you some emergency absorption and therefore reassurance. Running skorts, skirts and dresses can hide bulky sanitary pads if that is a concern. Have a look at menstrual cups. As well as being environmentally friendly, these cups, which fit snuggly into the vagina, can hold up to two or three times as much blood as a tampon. They can be emptied and re-fitted while you’re on the go, although you will need to find a loo.

  If you think you may be anaemic or heavy bleeding is affecting your daily life and hobbies, then do see your GP. You may need a blood test and potential treatment for anaemia, but options such as using anti-inflammatories or a medication called tranexamic acid to reduce blood flow can be discussed.

  Real-life runners

  Heavy periods left me exhausted and defeated, both physically and emotionally, and resulted in anaemia. But once my bleeding was resolved, my energy returned and I found the joy in running once again!

  Deborah Halliday Mills, writer, runner and mum of boys

  Q Can running make my periods stop?

  A Sometimes running can lead to amenorrhoea, which is the medical term for absent menstrual periods. Amenorrhoea can be primary (periods never began) or secondary (periods started and then stopped). The definition can vary, but if you have missed periods for between three and six months and you had previously had regular periods, then you would be considered to have secondary amenorrhoea.

  There are many causes of secondary amenorrhoea, including pregnancy, menopause, polycystic ovary syndrome, hypothyroidism (underactive thyroid) and stress. It can also be caused by excessive weight loss and excessive exercise, and this is where running may be relevant. If your weight is stable and you are consuming adequate calories to fuel your exercise, then your periods should not be affected, but reduce your calorie intake or increase your activity (or both at once) and you may push the body into a negative energy balance and lose your period. It can be a difficult balance to strike. Without adequate energy the body shuts down some important functions. Menstruation can be one of these. The effects can be widespread in the body and include losing bone strength and being at risk of osteoporosis (see here). The point at which this happens is different for every woman. A regular menstrual cycle should be considered as a sign of good health.

  If you have amenorrhoea or your periods have become very infrequent (oligomenorrhoea), then although that may feel like a bonus for a runner – no one wants the inconvenience of bleeding – it is important that the cause is addressed, so please see your doctor to discuss it.

  Did you know?

  A survey published in the British Medical Journal in 2001 found that British girls today start their periods (menarche) at an average age of around 13. It’s widely believed that the age of menarche has fallen significantly over the years, but this study concluded that compared to girls 20 to 30 years ago, it has only fallen slightly and almost certainly by less than six months.

  Q Running gives me spotting. Is this normal?

  A Vaginal bleeding between periods is called intermenstrual bleeding (IMB). If the bleeding is just a few drops of blood then it’s called spotting. Strenuous exercise can occasionally trigger it. It’s unclear exactly why it happens but may be due to fluctuating hormone levels from the exertion. However, it’s really important that you don’t assume that this is the cause. There are lots of reasons, some of which may be serious, why spotting can happen. IMB can be due to hormonal contraceptives (particularly methods using progesterone), certain medications, pregnancy and infection. Cervical ectropion (delicate areas of cervical tissue), polyps, fibroids and, more rarely, cancer can cause it too. If you have recurrent bleeding between periods then you should make an appointment with your nurse or GP for an assessment. The nurse or doctor will examine your vagina and cervix with a speculum to work out where the bleeding is coming from. They may take some swabs to rule out infection and take a cervical smear test (if it’s due). If they have any concerns about the appearance of your cervix or are unsure about the cause of bleeding, then they will refer you to a gynaecologist. Once you have been given the all clear then you can return to running knowing that the bleeding is nothing to worry about.

  Q Can I run straight after a cervical smear test?

  A There’s no reason why you can’t go to your cervical screening in your running kit and run straight home afterwards. Sometimes having a smear can make you bleed a little, but this is usually only some light spotting that a panty liner can cope with, so pop one into your knickers before you leave home. Some women have a very sensitive cervix and find smear tests uncomfortable. Any discomfort is, however, usually very short-lived. If you do have any period-type aches afterwards it shouldn’t be severe enough to stop you running. The only other thing to bear in mind is that very occasionally having a smear test can make you feel light-headed and dizzy. The cervix can sometimes be very sensitive to contact from the speculum or the swab used to take the sample of cells. This sensitivity can trigger a drop in blood pressure. Again, this is usually short-lived, but you may need a little time to lie or sit and recover slowly. If this happens, particularly if you faint, then you would be better to postpone the run until later in the day when you’ve had something to eat and drink and are back to your normal self.

  Q Should I stop running while I try to get pregnant?

  A No. This is a perfect time for you to optimise your health. Regular exercise is a vital component of a healthy lifestyle. It will help you to maintain your weight and we know that many of the risks of pregnancy, such as gestational diabetes (diabetes of pregnancy) and pre-eclampsia (potentially dangerous high blood pressure in pregnancy), are related to being overweight or obese. Being obese can make it harder to get pregnant too. There’s no evidence that the high impact nature of running will reduce your risk of conceiving or increase your risk of miscarriage. You need to be having regular periods to conceive and sometimes women who are over-training and/or under-fuelling may have amenorrhoea (an absence of periods). You should be assessed by a specialist if this is the case for you. You will probably be advised to stop or reduce your running for your periods to return.

  Getting pregnant can take time, especially as you get older – 18 per cent of couples age 35 to 39 having regular sex haven’t conceived after a year of trying. This can be upsetting and the stress-relieving benefits of running can be very useful. Don’t forget to maximise your nutrition and take a daily supplement of folic acid while you are trying to get pregnant and until you are 12 weeks pregnant. This will help the early development of your baby’s spinal cord and nervous system.

  Did you know?

  Approximately one in eight pregnancies will end in miscarriage. This figure only includes women who knew they were pregnant. Many miscarriages happen without women knowing they were pregnant, so the number is almost certainly higher. The cause is not usually identified.

  Q How soon can I run after a miscarriage?

  A A miscarriage can be an emotional experience and spending time running, solo or with friends, can be very helpful as a coping mechanism. You can generally go for a run as soon as you feel able to, but there are a few things to bear in mind. It’s normal to bleed after a miscarriage and this can continue for up to three to four weeks. Blood loss should gradually get lighter over this time, but sometimes running can make it a little heavier or seem to make it restart when it had previously stopped. Take things slowly and see how you feel. If your bleeding has been heavy or prolonged, then there is a risk that you may be anaemic. This means you have low levels of red blood cells (see here) and as well as feeling very tired you may feel weak, dizzy and breathless on exertion. In this situation it’s definitely best to take a few weeks to recover and then re
start running very gradually. Very occasionally you can develop an infection after a miscarriage. If you notice your blood loss or discharge is smelly or discoloured, you have increasing abdominal pain or tenderness, or feel sick or shivery, then you may have an infection. Running is not a good idea if you have any of these symptoms and it’s important to see your doctor.

  Real-life runners

  Running after a miscarriage taught me to love my body again and feel proud of what it could achieve at a time when I felt that it had let me down so completely. With each mile I grew stronger, both physically and emotionally.

  Nat Scroggie, runner and vet

  Q Is running in pregnancy safe? I don’t want to stop.

  A If you have an uncomplicated pregnancy, then there is no need for you to stop running unless you want to. There are a few situations where running is dangerous, such as placenta praevia (where the placenta sits right over the cervical opening), early rupture of membranes and recurrent bleeding in the second or third trimester. In these and other complicated pregnancies, and if you have any doubts or concerns about the safety of running for you, then specialist advice is needed. Thankfully, for the majority of women running is safe and beneficial to both mother and baby. Regular exercise – and that includes running – can help to improve and maintain your physical fitness, which is important for labour. It can also help to reduce the risk of pre-eclampsia, lower the risk of gestational diabetes, and help you to feel mentally and physically well during your pregnancy.

  Breasts grow and can become tender, so you will probably need a new sports bra at least once during your pregnancy. You might find your feet grow too! It’s important to keep well hydrated, adequately fuelled and to listen to your body. If you keep your exercise to a moderate intensity, where you can talk while you’re running, and to sessions of up to 45 minutes, then you don’t need to worry about over-exerting yourself. Warm up well, take breaks and stop when you need to. Stop running and get advice from your midwife or doctor if you experience any of the following symptoms:

  • Abdominal pain.

  • Vaginal bleeding.

  • Fluid leaking from your vagina.

  • Painful, regular contractions

  • Chest pain.

  • Dizziness.

  • Headache.

  • Calf pain or swelling.

  A few women run right up to their delivery date, but others find that running becomes difficult and prefer other lower-impact activities such as swimming in the later months. You might find that your growing bump becomes uncomfortable, that running makes indigestion worse or that you lose your sense of balance. Whatever your reason to stop running (and it can be frustrating if you are keen to carry on), you should know that any exercise you do is beneficial and running will always be there when you are ready to try again.

  Did you know?

  The Chief Medical Officers’ Guidelines 2019 for physical activity during pregnancy are basically the same as those for non-pregnant women. They still recommend 150 minutes of moderate intensity activity every week and muscle-strengthening activities twice per week. They advise that if you’re already active you can keep going and if you’re inactive then you should start gradually. Listening to your body, adapting your exercise and taking care not to bump your bump are the other key pieces of advice.

  Q How soon after giving birth can I run?

  A The traditional answer to this is after your six-week check with your GP. In reality, this is very unhelpful. It is much more complicated than this and for the majority of women this is far too soon. The desire to be back out running can be intense, but equally it can be the last thing on your mind. Every woman is different and no one should feel under any pressure to get back to running until they want to.

  Returning to running too soon or too rapidly can cause future problems of incontinence and pelvic organ prolapse. This is true for both vaginal and Caesarean section deliveries. Even if you don’t feel you have any pelvic floor weakness (see here), you will benefit from returning to exercise in the correct way.

  The Returning to Running Postnatal Guidelines, written by three physiotherapists with huge experience and knowledge in this field, were published in March 2019. Their expert opinion is that it’s not advisable to run before 12 weeks postnatal or beyond this if there are symptoms or signs of pelvic floor dysfunction. They recommend allowing your body the time it needs to heal, and following a low-impact exercise programme to restore your pelvic floor and abdominal muscles to full strength before beginning high-impact exercise. Ideally this would be a guided, personalised plan supervised by a women’s health physiotherapist. Exercises can begin immediately after your baby has been born, with gentle walking, core and pelvic floor muscle work. They suggest building up to power walking, resistance work and some weights work at six to eight weeks, and further progression to swimming and spinning from weeks eight to 12. Assuming both core and pelvic floor muscle strength have been adequately restored, running can commence gradually, from 12 weeks. A Couch to 5k programme is an ideal way to do this, because it combines short periods of running with walking. Any woman who experiences urinary or faecal incontinence, a heaviness or pressure in the pelvic area or a bulging of their abdomen, suggesting that the abdominal muscles are separated, should seek a referral to a women’s health physiotherapist for assessment and rehabilitation.

  Patience is key. Running is an ideal way to guard against and treat postnatal depression, and will help you to regain your fitness and sense of self when the demands a baby places on you are intense. However, a planned and gradual return to running is the best way to ensure your body will be fit and able to run problem-free for years to come.

  Q I’m ready to get back to running, but I’m still breastfeeding my baby. Is this OK?

  A A study back in 1991 showed a significantly increased amount of lactic acid in breast milk ten minutes after maximal intensity exercise, but, by 30 minutes, the levels were almost the same as those pre-exercise. Most women will not be exercising at their maximum capacity and other studies have shown no increase in lactic acid in breast milk after moderate intensity exercise. There is no evidence to suggest that lactic acid in breast milk is harmful to babies anyway and maternal exercise hasn’t been shown to have any negative effect on the growth of breast-fed babies. A study looking at whether babies refuse breast milk due to potentially altered taste from lactic acid did not show any difference in the baby’s acceptance of the milk one hour after moderate or high intensity exercise. To date, the evidence is reassuring that running and breast feeding are entirely compatible. The benefits of a happy, exercising mother mustn’t be underestimated. Here are my top tips for running and breast feeding:

  1 Feed your baby or express some milk before you run. Your breasts will be lighter. You can then relax knowing your baby has just eaten and you might even have time for a shower when you get back before the next feed!

  2 Wear your most supportive sports bra with breast pads if you’re prone to leaking. If your nipples are sore, then protect them with some lanolin or petroleum jelly.

  3 Drink plenty of fluid before and after your run. Running is thirsty work and so is breast feeding.

  4 Make sure your diet is top notch with lots of fresh and iron-rich foods, and take 10 micrograms of vitamin D daily.

  5 Be aware that some of the hormones still circulating in your bloodstream post-partum may relax your joints and ligaments, and potentially put you at increased risk of injury.

  6 If you use sports supplements to fuel longer runs, then watch out for those containing large amounts of caffeine in case they affect your baby’s sleep. Up to 200 milligrams of caffeine daily is the recommended amount while breastfeeding, which is equivalent to two cups of instant coffee or one cup of Americano.

  Did you know?

  The average age of the menopause in the UK is 51 but the symptoms of the peri-menopause, which is the time leading up to the menopause, usually start when a woman is in her 40s.

 
; Q Will running help me with my peri-menopausal symptoms?

  A You reach the menopause when your periods have stopped for 12 months. The time leading up to this is called the perimenopause. The heavy or irregular bleeding coupled with tender breasts and fatigue often experienced by women during this time, which lasts for an average of four years, don’t exactly inspire you to put on your trainers, but it’s definitely worth it if you can. Running during the perimenopause can help to counteract some of the many symptoms you might experience. For example, bloating, headaches and joint pain can all be reduced by exercise and, although you might think running would make you more tired, it can actually give you an energy boost.

  A Cochrane review (a systematic review of primary health research) in 2014 found insufficient evidence to show whether exercise would help with hot flushes and night sweats. A small study in 2016 found that women who trained to increase their fitness experienced fewer sweats and flushes, but more research needs to be done to confirm exactly what type and how much exercise is needed for this purpose.

  Running will help to maintain and build bone and muscle mass, both of which decline rapidly from this point on. Strong bones and muscles will improve your future health and increasing your muscle mass will help to counteract the natural weight gain that can happen around the menopause too, so it’s a good idea to add in some work with weights alongside your running.