Why are Utah athletes being asked to provide menstrual histories in order to participate?

The practice is commonplace around the country, but has come under fire since the reversal of Roe v. Wade.

(Francisco Kjolseth | The Salt Lake Tribune) Athletes take the court at a Utah high school girls' basketball practice in 2021. The Utah High School Activities Association is one of many organizations around the country that ask girls to provide information about their menstrual cycles before participating in sports — a practice that has come under fire since the reversal of Roe v. Wade.

Sam Gordon answered the questions as anyone would when sitting in front of their doctor. Ever had trouble breathing after exercise? Ever had a concussion? Ever had an injury that required imaging or a cast?

Gordon answered these questions before every girls’ soccer season while she attended high schools in Utah. They showed up on a form that the Utah High Schools Activities Association requires all athletes complete in order to play sports.

But at the very end of that form, there is a set of questions marked “females only”.

“I remember that was always the section that I did feel sort of uncomfortable with,” Gordon said.

For years, female athletes in Utah high schools and some universities have answered questions about their menstrual cycles in order to participate in athletics — a practice that happens in almost every state in the country and has recently drawn heavy criticism in Florida.

This practice has come under fire due to privacy concerns for girls who are now living in a world where Roe v. Wade is no longer the law of the land. Critics of the landmark law’s reversal by the Supreme Court in June worry someone’s menstrual history could fall into the hands of lawmakers in states that ban or severely limit abortion.

The Utah High School Activities association, as well as high schools all over the Beehive State, store these forms electronically and have access to the information provided in them.

“There’s a good chance that ... if you’re checking [a] female athlete’s menstrual cycle, you would see irregularities that could be flagged as potential evidence that they have had an abortion, depending on just how rigorous someone wants to be about how they use that data,” said Nicole Bedera, a sociologist who studies gender equality.

Why are athletes asked about periods?

Dr. Rebecca Carl, associate professor at the Northwestern Feinberg School of Medicine and member of the American Academy of Pediatrics Council on Sports Medicine and Fitness, said physicians ask athletes about their menstrual cycles because irregularities could indicate poor bone health. For athletes who run a lot (i.e. soccer players, cross country runners), that could point to an increased risk of stress fractures.

Carl also said it’s common for athletes who menstruate and play sports that encourage a lean physique to have irregular or even nonexistent periods, and that can happen to multiple members of the same team. The commonality of that, however, is not necessarily considered healthy.

“The athletes may think that that’s normal, but that is an alarming sign of increased risk for stress fracture,” Carl said. “So sports medicine physicians and pediatricians, we do not consider that to be normal, even though it’s common. That’s concerning, and that’s why we ask about frequency of menstrual periods.”

The UHSAA, University of Utah, Weber State and Utah State all have forms that ask questions about an athlete’s menstrual cycle in a “females only” section. The USHAA’s form specifically asks:

• When was your first menstrual period (age when started)?

• When was your most recent menstrual period?

• How much time do you usually have from the start of one period to the start of another?

• How many periods have you had in the last year?

• What was the longest time between periods in the last year?

But those Utah institutions are not alone in this practice.

In fact, high school activities associations in nearly every state use preparticipation forms that ask for menstruation information, according to a review by The Salt Lake Tribune. Many of the forms were created by the AAP.

Oklahoma’s form does not ask about menstruation. Vermont does not have statewide mandates to use the forms but indicated individual schools can — and many do. New Hampshire’s association does not collect the forms, but schools there use them for the athletes’ physicals.

Three states — Louisiana, Mississippi and West Virginia — only ask about menstrual irregularities or problems.

The forms of only two states — Florida and Michigan — specifically state the questions about menstruation are optional.

The National Federation of State High School Associations links to one form used in many states. The UHSAA, Utah, USU and Weber State, however, all use different forms. But they still ask questions about menstruation.

Mark Van Wagoner, the UHSAA’s lawyer, said “[a]ny student could decline to answer the questions about menstruation.” But several former Utah high school athletes said that was not made clear to them when completing the sports physical.

Where is this information stored, and who has access?

High school athletes in Utah use the website Register My Athlete to complete a multistep process so they can participate in their chosen sport. An informational document on the UHSAA’s website says the association requires athletes to complete physical exams every year, and the forms associated with them are to be “filled out by a physician and then either uploaded or turned in to the school’s athletic administration in person.”

The latter part of that sentence is where a potential problem exists. Van Wagoner said that the documents are safe, saying they are “safeguarded by passwords and other industry-grade web security tools” and “only the school and UHSAA staff have access to this information.” But the practice of potentially sensitive medical information finding its way into the hands of school administrators and high school associations is not one condoned by the AAP.

“There was never any intention that the information on the history form was to be shared with the school,” Carl said. “This is really part of the medical record, and it’s designed to document the interaction between a physician and a student-athlete.”

Florida’s practice came under fire because the state’s high school association moved storage of participation documents to an online platform in August, raising general privacy concerns. Two months later, an even larger conversation was raised regarding the privacy surrounding reproductive health in a post-Roe world.

Dani Gibson, a former golfer at Alta High School who spoke at a walkout in protest of Roe’s reversal, said she remembers a push for people to delete apps that tracked periods because that data could potentially be shared without authorization. She views the questions about an athlete’s menstrual cycle in a similar light.

“It is potentially dangerous to have information like that in today’s world,” Gibson said.

Hope Feliciano, a swim coach at Rowland Hall High School and a former swimmer at Juan Diego High, said that, even as a school administrator, she does not feel she should know if any of her athletes are menstruating. She added that schools should only be aware of an athlete having a specific medical condition that could be considered uncommon.

“I think it’s good for them to know if you have asthma, some sort of heart condition, any sort of actual medical condition — I think that’s very important for the school to be aware of,” Feliciano said. “But something as common as a menstrual cycle is not something that needs to be shared with school administration, college or high school or whatever level.”

Medical and educational records are protected by the Health Insurance Portability and Accountability Act and Family Educational Rights and Privacy Act, respectively. But those don’t protect records if they are subpoenaed in a court of law.

“Just because something is technically a confidential record doesn’t mean it will always stay that way,” Bedera said. “The criminal justice system is one of the big exceptions to a lot of types of confidentiality.”

What is the solution?

Athletes who played girls’ sports in Utah say there should be more clarity in the section that asks about menstrual cycles.

“I think if it is optional, the girls need to know that it’s optional,” Gordon said.

The Palm Beach County School Board in Florida plans to petition the state to remove the questions from the form entirely. Carl said potentially removing the questions is “concerning,” but added that submitting “sensitive” and “protected” medical information should not be a requirement to play sports.

“I don’t think the idea here is to take out questions that have sensitive information,” Carl said. “I think we should be more focused on [ensuring] that information is part of the medical record and is between the health care provider and the athlete. We’d like to see schools change the requirement not by eliminating the questions, but by not requiring that the history questionnaires be turned into the school.”

The University of Utah Health and Utah Athletics said in a joint statement to The Tribune that they are looking into the practice of asking about athletes’ menstrual cycles.

“High school and college athletic programs across the country have historically included questions about menstrual health in student medical evaluation forms as a way to screen for eating disorders and bone health,” the two organizations said.

“At the University of Utah, this information has always been treated as a private medical record accessible only by a student’s health care team. In consultation with our Pac-12 colleagues, we are in the process of evaluating this practice to determine the necessity for this information and a way forward that prioritizes both the safety and privacy of our student-athletes.”

For Bedera, it’s all about educating the athletes so they can make a more informed decision about the information they’re providing.

“I think a better solution would be if there are medical concerns that female athletes need to be aware of, then we should educate them about those issues so that not only will they have that information whenever they might need it, but they can protect their confidentiality and it’s not even a question,” Bedera said.