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Student-athletes in Alabama have to report information about their periods on physical evaluation forms in order to play a sport.

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

In the wake of the overturn of Roe v Wade, which made abortions illegal in Alabama and a felony punishable by 10 to 99 years in prison, concerns have grown about who has information about a woman’s gynecological health and how that data can be used. Some doctors say questions about a student’s menstrual cycle may not be necessary, or should now be asked differently.

“There are many reasons why a young woman might not be having a regular or recent menstrual cycle. Few of those reasons would have any bearing on whether she’s eligible to compete in athletics,” said Dr. Leslie Evans, an OBGYN with Fairhope Gynecology and Obstetrics.

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

Evans said she believes the question doesn’t need to be asked at all, and could be both invasive and discriminatory.

“I’d anticipate most gynecologists, pediatricians and [primary care physicians] that care for these young women to say it’s an unnecessary question for the form,” she said. “So at the least, unnecessary and invasive or embarrassing. But at the extreme, worry about discrimination based on the answers.”

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

In Florida, multiple school districts have asked the Florida High School Athletic Association to alter its physical evaluation form for student-athletes so it no longer includes optional questions about menstrual history.

The Alabama High School Athletic Association says the forms 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 secondary school age level when these problems are first identified,” said Ron Ingram, director of communications at AHSAA, in an email. “It has been recommended by all of the Primary Care specialties and Sports Medicine societies since 1990.”

No major organizations have recommended changes to this question on the evaluation form. The Florida High School Athletic Association is meeting this month to vote on removing the questions on its forms.

“Only school personnel authorized by the school’s administrators have access to the files once uploaded into the student’s account,” Ingram said. “Typically, this is the principal and athletic director or school nurse or athletic trainer. No one outside those designated school individuals can access the files-including staff of the AHSAA.”

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

DragonFly’s privacy policy stipulates that users must comply with state and federal laws, including the Health Insurance Portability and Accountability Act, which requires disclosures of personal health information to be authorized in writing by the patient, unless requested by law enforcement officials who have a court order, warrant, subpoena or administrative request.

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

If a period has stopped or becomes irregular, it can be a sign of inadequate nutrition called relative energy deficiency in sports, which manifests as poor health and declining athletic performance. It can also lead to an increased likelihood of stress fractures in athletes.

“Medically, a menstrual cycle is really important for us to know about in adolescent young ladies because it’s almost viewed as a vital sign,” said Savage.”Having a normal monthly cycle tells us whether their body is functioning appropriately.”

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

“You could technically just ask doctors if there is any concern for relative energy deficiency in sports or to note any menstrual disorder concerns or something like that where you don’t have to actually write down any dates or [period details],” Savage said.