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Nobody but your doctor should know your menstrual history

The big problem with Florida asking for so much of its student-athletes’ health information.

Two stacks of cardboard boxes.
Miami-Dade County Public Schools forms and Florida High School Athletic Association records from students at Miami Senior High School are stored inside the office of the athletic trainer at the school on Friday, February 3, 2023, in Miami.
Matias J. Ocner/Miami Herald/Tribune News Service via Getty Images
Keren Landman, MD is a senior reporter covering public health, emerging infectious diseases, the health workforce, and health justice at Vox. Keren is trained as a physician, researcher, and epidemiologist and has served as a disease detective at the US Centers for Disease Control and Prevention.

Last August, two months after the Supreme Court overturned Roe v. Wade, parents in Florida’s Palm Beach County School District began raising questions about a rule requiring the state’s student-athletes to submit detailed medical history forms to their schools prior to sports participation.

For at least two decades, the forms have included a set of optional questions about students’ menstrual cycles. But now, with abortion criminalized in many states, there’s greater concern that menstrual data could be weaponized to identify or prosecute people who have terminated pregnancies. (In 2022, Florida passed a ban on abortions after 15 weeks, and its leadership has signaled interest in further restricting access to the procedure.)

And this school year, the Palm Beach County school district began offering students the option to submit the form via a third-party software product, leading to a particularly high level of alarm about data privacy.

Some district parents wanted the period questions gone. The episode also raised larger questions about whether any of the medical data collected by these forms should be held by a school or a district at all.

Over the course of several meetings, the Florida High School Athletic Association (FHSAA), which makes the rules governing student involvement in school sports statewide, leaned into a hardline position on both questions.

In January, the organization’s sports medicine committee recommended making the menstrual history questions mandatory and requiring students to turn their responses over to the school, according to the Palm Beach Post’s reporting.

Florida wasn’t the only state to ask student-athletes for their menstrual histories. In fact, a minority of states — only 10 — explicitly instruct student-athletes to keep menstrual information and other health data private.

Regardless, the proposal to require this information was extraordinarily hard to justify: It created privacy risks and defied the recommendations of national medical associations, and was at jarring odds with the state’s prevailing educational trends, which have prioritized parental rights over almost everything else.

In the end, the proposal failed after it attracted national scrutiny and prompted debates about what entities should have access to menstrual information. On February 9, the Florida High School Athletic Association voted to adopt a new medical evaluation form that does not include questions about menstrual history. Instead, students will submit an eligibility form that contains no medical details.

(Also on February 9, Florida Democratic Rep. Sheila Cherfilus-McCormick and two other representatives introduced federal legislation that would prohibit publicly funded schools from requiring students to report menstrual information.)

In a microcosm, the episode drives home a new reality of post-Roe America: Period data should only be shared between patients and their health care providers.

Periods are signifiers of health, and people should talk about them — with their clinicians

Menstrual cycles are such an important signifier of health that many health care providers call periods the “fifth vital sign.” In athletes in particular, period changes can signify a person isn’t getting enough calories to offset high levels of activity.

So yes, athletes with periods should watch and seek care for changes in their cycles, said Judy Simms-Cendan, a Miami-based pediatric and adolescent gynecologist and president-elect of the North American Society for Pediatric and Adolescent Gynecology.

“But the physician or clinician assessment of a menstrual history, and what it may or may not signify, is different than a school’s use of that information,” said Simms-Cendan. Coaches aren’t usually health care providers, so they’re not equipped to medically evaluate people based on menstrual symptoms. But also — and crucially — schools and sports programs are not required to keep health information private in accordance with federal HIPAA laws. (Schools are subject to other rules about sharing student data, but those rules permit access to data for a broader range of reasons than HIPAA does.)

The American Academy of Pediatrics (AAP) publishes separate forms for medical providers to complete when evaluating an athlete prior to their participation in a sport. One form is just for the health care provider’s eyes: a physical evaluation form that includes a warning that it’s not to be shared with schools or sports organizations. Then there’s a separate eligibility form for the physician to share with the school, with much less room for detail.

The AAP keeps unnecessary medical details off the eligibility form for a reason, said Simms-Cendan. “That’s nobody’s business. You shouldn’t have to disclose it, because it doesn’t have anything to do with your sports activity,” she said.

Good arguments against (and no arguments for) sharing period information outside a clinician’s office

Parents’ fears around sharing their kids’ health data with schools are rightly grounded. Without HIPAA protection, disclosing health information can threaten individuals’ right to privacy.

Less scrupulous period-tracking apps also pose risks, as do some apps aimed at treating addiction disorders, depression, and HIV. In 2019, the director of the Missouri health department was caught using a period-tracking spreadsheet to identify patients who may have had “failed” abortions; there’s good reason to fear that an activist state government seeking to criminalize abortion would attempt to use period information tracked online in service of that goal.

It was unclear why the FHSAA’s sports medicine committee was so eager to have Florida schools gather menstrual data from the state’s student-athletes, or how they could use that data to discriminate against students.

Florida Gov. Ron DeSantis reportedly favors a near-total ban on abortion, and in 2021, he signed a bill barring transgender girls from playing on girls’ teams in public schools. Could the questions have been intended to identify and punish students who don’t conform to the state’s gender politics?

The questions — which ask about the date of menstrual onset and the timing and frequency of periods — wouldn’t have yielded the kind of data that would help identify teens seeking abortion services, using contraception, or getting evaluated for sexually transmitted infections. They would have been poor screening questions to identify transgender students.

(The new medical eligibility form has been revised to include a non-optional question indicating the student’s sex assigned at birth. According to the Palm Beach Post’s reporting, FHSAA staff have indicated the new form aligns with the 2021 law restricting transgender girls’ sports participation.)

Insisting on the menstruation questions’ inclusion over the objection of parents was also weirdly out of sync with the state’s Florida’s Parental Rights in Education bill, often called the “Don’t Say Gay” bill, said Simms-Cendan. “Our governor is incredibly supportive of parental control over student education,” and parents should also have the right to control and protect their children’s health information, she said.

“I really don’t know what they’re trying to get at by asking this information,” she said in an interview prior to the FHSAA’s decision to change the form.

Overall, Simms-Cendan thinks it’s “really positive” that more people are talking openly about periods. But it’s one thing to educate students about menstrual health, and another thing entirely to assess and analyze someone’s personal menstrual history outside of a health care setting.

Young people need to be aware of the risks that can arise when they lose control over that information, she said. “We call our reproductive health system ‘our privates’ for a reason.”

Update, February 10, 5:30 pm ET: This story was originally published on February 7 and has been updated to reflect that the Florida High School Athletic Association is dropping the requirement for students to share their menstrual histories and has revised the new medical eligibility form to include sex assigned at birth. Also added was information about proposed federal legislation to prohibit similar requirements in other public schools.

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