A delicate balance: raising hormonal health awareness among females in the Ballet Community

Current research on the infradian rhythm of the female hormonal cycle is severely lacking, especially as it applies to those involved in athletic pursuits. This lack of knowledge is even more apparent in the ballet community, where hormone-influencing conditions such as RED-S (Relative Energy Deficiency in Sport) are pervasive. Current evidence reveals that hormonal irregularities can have long-lasting mental and physical effects that can ultimately impair athletic performance, yet both anecdote and science illustrate that the current approaches being used to address them are fraught with misunderstanding and an overall lack of awareness. This project includes a research review to propose a demonstrated need for a shift in ballet culture and education that allows for female dancers to better understand how to attend to the unique function of their bodies on an individual basis while training in a pre-professional environment. It also details my personal efforts to create a RED-S and hormonal wellness awareness initiative within the School of Dance at the University of Utah to help improve the health of my own community. The initiative includes presentation of creative work exploring some themes from my research, as well as collaboration with the school's dancer support team on spreading helpful information. It is my hope that this process can be emulated and expanded in other dance settings in order to fuel further discussion on the issue.

A DELICATE BALANCE: RAISING HORMONAL HEALTH AWARENESS AMONG FEMALES IN THE BALLET COMMUNITY by Olivia Huseonica A Senior Honors Thesis Submitted to the Faculty of The University of Utah In Partial Fulfillment of the Requirements for the Honors Degree in Bachelor of Fine Arts In Ballet Approved: ______________________________ Christine McMillan Thesis Faculty Supervisor _____________________________ Melonie Murray Chair, Department of Dance _______________________________ Christopher Alloways-Ramsey Honors Faculty Advisor _____________________________ Sylvia D. Torti, PhD Dean, Honors College May 2023 Copyright © 2023 All Rights Reserved ABSTRACT Current research on the infradian rhythm of the female hormonal cycle is severely lacking, especially as it applies to those involved in athletic pursuits. This lack of knowledge is even more apparent in the ballet community, where hormone-influencing conditions such as RED-S (Relative Energy Deficiency in Sport) are pervasive. Current evidence reveals that hormonal irregularities can have long-lasting mental and physical effects that can ultimately impair athletic performance, yet both anecdote and science illustrate that the current approaches being used to address them are fraught with misunderstanding and an overall lack of awareness. This project includes a research review to propose a demonstrated need for a shift in ballet culture and education that allows for female dancers to better understand how to attend to the unique function of their bodies on an individual basis while training in a pre-professional environment. It also details my personal efforts to create a RED-S and hormonal wellness awareness initiative within the School of Dance at the University of Utah to help improve the health of my own community. The initiative includes presentation of creative work exploring some themes from my research, as well as collaboration with the school’s dancer support team on spreading helpful information. It is my hope that this process can be emulated and expanded in other dance settings in order to fuel further discussion on the issue. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 BALLET CULTURE AND HORMONAL HEALTH 4 AWARENESS INITIATIVE PART ONE: “INFRADIA” 14 AWARENESS INITIATIVE PART TWO: POSTER 20 AWARENESS INITIATIVE PART THREE: PANEL DISCUSSION 25 IMPACT AND CONCLUSION 29 SUPPLEMENTARY PHOTOS 31 BIBLIOGRAPHY 32 iii 1 INTRODUCTION LANGUAGE ACKNOWLEDGEMENT: Throughout this essay I use the word “female” to refer to female-identifying individuals who naturally experience their hormonal cycles in the way that I describe. Those who do not identify as female but have similar biochemistry may benefit in their own way from this discussion. Those who identify as female but do not experience a hormonal cycle in this way may also use thoughts from this discussion to better understand and tune in to their feminine energy. However, this content is not specifically tailored to these populations. When it comes down to statistics, ballet is a woman-dominated profession. In 2021, 73.4% of professionally practicing dance artists in the United States identified as female. 1 This percentage has the potential to be larger when it comes down to the gender ratios of local studios and dance schools. The physically demanding practice of ballet attracts and propels high-performing female athletes to the spotlight. Dance is not the only athletic discipline where this is the case. In several other sports, the participation, support, and visibility of female competitors is on the rise, and has been for some time. 2 Data has shown that the popularity of women’s sports has increased the last 50 years and continues to expand. 3 We are beyond proving that we are strong, resilient, physical, and capable of incredible athletic feats. “Ballet Dancer Statistics By Gender,” Zippia, Accessed April 7 2023, https://www.zippia.com/balletdancer-jobs/demographics/. 2 Lindsey Douglas, “The Rise of Women’s Sports: Identifying and Maximizing the Opportunity,” The Nielsen Company, (2018): 4. 3 Douglas, “The Rise of Women’s Sports,” 4. 1 2 That being said, it is only recently that studies, theories, and ideas about women’s health, particularly in regards to their hormonal balance as athletes, have begun to surface. 4 Despite the plethora of research that has been done on the athletic performance of men, these new ideas are still considered cutting-edge. It is clear that a divide remains, an echo of a social and cultural problem with a deeply rooted patriarchal history that is extensive and complex. There is something specifically to be said about the way that this patriarchal history of health science manifests for females in the dance community. This new research has demonstrated again and again that athletes with female biochemistry have specific and unique needs when it comes to navigating hormonal wellness. However, as will be thoroughly demonstrated through statistics and anecdote, there is great possibility for growth and expansion on this topic when it comes to application and awareness. Specifically in ballet training, which tends to lag behind the realm of sports science in terms of implementing new information and ideas, there is a lot to be desired when it comes to taking hormonal health into account within the dance studios. In one project, I cannot tackle the gender inequality of the world, or even the world of sports science. However, I can identify specific problems within my own community, and take steps towards solving them. Upon researching the health challenges facing women in today’s ballet world and observing the patterns of my own environment, I have identified a few specific areas of traditional ballet culture that provide a barrier to the full exploration of the new scientific information that is coming to light. Establishing an environment where hormonal ebbs and flows are more accounted for and accepted, G Bruinvels et al., “Sport, exercise and the menstrual cycle: where is the research?” British Journal of Sports Medicine, 51 (2017): 487. 4 3 body ideals are more realistic, and important topics are more openly discussed would aid the dance world in not only supporting female health, but maximizing female performance. Part one of this thesis project is devoted to analyzing some of the evidence that supports this view. Because there is no doubt that supporting women’s health would be a mutually beneficial goal, helpful for both dancers and arts leaders alike, the second half of my research endeavor involves exposing the students and staff of the University of Utah School of Dance community to information about hormonal health. I designed an awareness campaign in order to convey the ideas that I had learned through my research and my own personal health journey to my peers in the dance program. Part one of the awareness initiative was an artistic work that was presented in the ballet program’s student choreography showcase in the fall of 2022. Part two was an informational poster that I designed, printed, and hung in various locations around the School of Dance. Part three was a panel discussion that I organized with experts in this newly emerging field. Just as dance requires precision and stability, achieving hormonal health, especially as a female athlete, is a delicate balance. However, just as in ballet, the process can be fascinating, empowering, and incredibly rewarding. Based on the enthusiastic feedback that I received from my work, this kind of message is something that dancers are extremely interested and invested in. I hope that these efforts and ideas can be replicated and expanded upon in the future in order to change ballet culture for the better and build more momentum for the amazing, much-needed research that is being done on women’s health. 4 BALLET CULTURE AND HORMONAL HEALTH As mentioned previously, I have identified three major ways that the dance world can progress in terms of being better attuned to hormonal health, backed up with research and observations from my own experiences in this industry. The first is to establish a culture that acknowledges varied chronobiological patterns. Chronobiology is a field that seeks to understand and interpret cyclical phenomena and physiological rhythms in organisms. 5 In our society, we are very aware of how chronobiology applies to us when it comes to the circadian rhythms that govern this rise and fall of the sun and the 24-hour cycle of work days. 6 However, although the male hormonal cycle follows this circadian clock, the female hormonal system is programmed to a completely different timeline - the 28-day infradian rhythm. 7 In her book, In The Flo, author Alisa Vitti calls for a societal change that allows those with female biochemistry to become more aligned with their inner selves. Over the course of the work, she outlines different stages of productivity, self-care, and play that follow the phases of the menstrual cycle. Particularly interesting is her chapter on exercise. According to Vitti, most major athletic regimens subscribe to a very patriarchal outlook. 8 These regimens, which promote a “go hard or go home” mindset and involve doing a similar routine day in and day out, operate more in-tune to a circadian cycle. 9 This method is used by many preprofessional ballet training programs, where dancers take class almost every day and a Alisa Vitti, In The Flo (New York, United States: HarperOne, 2020), 40. Vitti, In The Flo, 40. 7 Vitti, 41. 8 Vitti, 133. 9 Vitti, 133. 5 6 5 standard of consistency and excellence is expected of their work on a regular basis. For example, at the Vaganova Ballet Academy, one of the most highly regarded dance schools in the world, the students practice for every day of the week except for Sunday, doing a very similar set of exercises, and linear growth and development is expected to be displayed in their yearly exams. 10 A 2022 article in the Journal of Dance Medicine and Science remarked upon how dance training is often not periodized throughout the year (as most other sports are) and is instead ongoing from performance to performance, creating a unique risk factor for symptoms of burnout (one of which is menstrual dysfunction). 11 There is no doubt that these training programs produce beautiful dancers. However, training at a high intensity consistently is not necessarily the most productive route for athletic growth and overall health, especially for those with a menstrual cycle. In her book, Vitti imagines a reality where training is more attuned to chronobiological theory. It has been shown that the late luteal phase of the hormonal cycle is a time when the body tires quicker and is more prone to injury, so she suggests slowing down the pace of exercise and allowing rest for the body. 12 Conversely, it has been shown that the first half of the menstrual cycle is an ideal time for strength training and increasing cardio capacity, so she suggests increasing exercise intensity in the follicular and ovulatory phases. 13 This is consistent with research and anecdotal evidence that demonstrates that workouts are less draining, more productive, less painful and less hazardous when taking this infradian rhythm into account. For example, members of the gold medal-winning US Jaden Grimm, “A Day in My Life at the Vagonova Ballet Academy” Jaden Grimm (blog), December 27, 2019, https://www.jadengrimm.com/post/a-day-in-the-life-vaganova-ballet-academy. 11 Jana S. Dewet, Africa Eileen, and Venter Ranel, “Recovery-Stress States of Professional Ballet Dancers During Different Phases of a Ballet Season,” Journal of Dance Medicine & Science, 26, no.1 (February 2022): 9. 12 Vitti, In The Flo, 140. 13 Vitti, 140. 10 6 women’s soccer team have been tracking their periods and integrating this advice into their practice routine, based on research that suggests that athletic performance in their sport may worsen during the menstrual phase. 14 They report that it has both reduced PMS symptoms and given their training an edge. 15 Sabine Krautgasser-Tolman, a sports dietician at the University of Utah, divides the phases up differently for her athletes, thinking of the luteal phase and the follicular phase as the two major components of the cycle, with menstruation as part of the follicular phase and ovulation as a singular point of time (it should be noted that there is no one correct way to go about splitting up a phenomenon, which is in truth just flowing and repeating without regard to our tendency to label and categorize it). 16 However, she shares with Vitti the idea that the environment within the body is in a constant state of change, and that respect and attention must be devoted to this fact when taking things like food and exercise into account. In her presentation that she regularly gives to her female athletes, she mentions how hormone levels vary throughout the different phases of the cycle, affecting everything from performance to metabolic demands to nutrition needs to substrate utilization.17 She discusses how hormone ratios can increase resilience to strength training during menstruation, and how things like even the fluctuation of body temperature during the luteal phase can change time to exhaustion during exercise. 18 As a Gabby Landsverk, “The World Cup-Winning US Women’s Soccer Team Tracked Their Periods for Peak Performance, and Evidence Shows Everyday Athletes Can Benefit from Doing the Same,” Insider, July 25, 2019, https://www.insider.com/world-cup-winning-uswnt-period-tracking-how-to-improve-performance20197#:~:text=After%20the%20U.S.%20Women's%20National,can%20help%20or%20hinder%20workout s. 15 Landsverk, “World Cup Winning Women’s Soccer Team.” 16 Sabine Krautgasser-Tolman, email message to author, March 24, 2023. 17 Sabine Krautgasser-Tolman and Madeleine Hutchison, “Nutrition Through Your Menstrual Cycle,” March 31, 2023, Marriott Center for Dance at the University of Utah, Salt Lake City, Utah, 39:45, https://youtu.be/MwJss0nJIm8. 18 Krautgasser-Tolman and Hutchison, “Nutrition Through Your Menstrual Cycle.” 14 7 dietician, she even has different suggestions for macronutrients to emphasize during different parts of the menstrual cycle in order to stimulate ideal performance. For instance, she recommends a higher intake of fats and proteins during the luteal phase when the fat-bearing estrogen is low and catabolic progesterone peaks, and an increased carbohydrate consumption during the follicular phase when the body is not as efficient at accessing glycogen stores. 19 Of course, this is all very new science, and studies are still coming to some conflicting conclusions about these things depending on what is being measured and how to go about properly measuring them. However, there still exists a plethora of evidence that suggests that chronobiology is more than relevant to female athletes, who would greatly benefit from understanding the changes that their bodies are going through on a month-to-month basis. Of course, nobody is asking ballet schools and companies to track the periods of all their female dancers and arrange their classes and shows accordingly. Even Vitti concedes that this is often not possible, acknowledging that professional athletes may not be able to reschedule their tournaments and training. 20 However, there are things that can be changed in the environment of dance studios to allow students to pay attention to their bodies and the infradian rhythms in their lives with more ease. For one, dancers can be encouraged to abide by a more sustainable cross-training regimen that supports whatever phase of the cycle that they are in. They should be told to include all macronutrients in their diet and be informed on how and when to consume these nutrients to reach optimal performance. Days off to rest, as well as training days that require the modification of athletic effort, should be better understood by those in charge, so dancers do not have 19 20 Krautgasser-Tolman and Hutchison, “Nutrition Through Your Menstrual Cycle.” Vitti, In The Flo, 146. 8 anxiety or fear over losing status or position in their organization if they think coming to work or school would do them more harm than good. As Vitti states at the end of her chapter, syncing life to your cycle is not meant to prevent women from doing what they love, but rather to maximize their experiences to make going after their dreams as easeful and pain-free as possible. 21 These suggestions could not only increase the hormonal health of the performers in question, but allow for a more functional, empowered population, ready to utilize their studio time to their full advantage and minimize their chances of injury, unpleasant PMS symptoms, and burnout. But what if a dancer’s menstrual cycle is absent altogether? I struggled with this very thing as a young dancer. At age nineteen, I had to contend with the fact that I had not yet had my menarche (or first period), which is an extremely large indicator of female health. It was a long and difficult journey to get to where I am today in terms of hormonal function. Unfortunately, there are many young artists out there who have similar issues, and it is a problem that can be linked back to ballet culture and standards in many cases. There are several reasons why someone can have a menstrual cycle that is absent or missing, such as pregnancy, ovarian failure, or thyroid dysfunction. 22 Anyone who is experiencing this problem should be tested for all of them. However, a common cause of this issue (called amenorrhea) in dancers is a condition named Relative Energy Deficiency in Sport (or RED-S). In 2018, a consensus statement on the topic by the American Olympics defined RED-S as “impaired physiological functioning caused by relative energy deficiency, and Vitti, In the Flo, 146. Karolina Łagowska, Karina Kapczuk, and Jan Jeszka, “Nine–month Nutritional Intervention Improves Restoration of Menses in Young Female Athletes and Ballet Dancers,” Journal of the International Society of Sports Nutrition 11, no. 1 (December 2014): 2. 21 22 9 includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.” 23 Before it was called RED-S, it was described as the “Female Athlete Triad.” 24 The “triad” of ailments in question are three common signs of RED-S in those with a menstrual cycle - loss of the menses, disordered eating, and decreased bone density. 25 The name has since been modified to RED-S to include all genders and to make the symptoms and causes of the condition more clear, among other reasons. 26 However, the terms are often used interchangeably in the field of sports medicine. Since I have chosen to focus on female athletes in particular, both titles will be utilized in this discussion. Here is where ballet culture and ideals come into play in propagating this issue. RED-S is a particularly large problem in sports where a lean physique and low body weight is emphasized. 27 This is because one of the main and most worrying symptoms of RED-S- the loss of menstrual function - has been directly linked to low BMI, as well as a large deficit in caloric intake versus energy expenditure. 28 According to a 2014 study published by the International Society of Sports Nutrition, a large percentage of menstrual disturbances in young female dancers and athletes could be remedied through a personalized nutritional intervention, which often included an increase in caloric intake and a bit of weight gain. 29 However, researchers Margo Mountjoy et al.,"International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (red-s): 2018 Update," International Journal of Sport Nutrition & Exercise Metabolism 28, no. 4 (2018): 317. 24 Kimberly K Yeager et al., "The Female Athlete Triad: Disordered Eating, Amenorrhea, Osteoporosis," Medicine and Science in Sports and Exercise 25, no. 7 (1993): 775. 25 Yeager et al., "The Female Athlete Triad,” 775. 26 Margo Mountjoy et al.,"International Olympic Committee (IOC) Consensus Statement,” 317. 27 Andrea Stracciolini et al., "Body Mass Index and Menstrual Patterns in Dancers," Clinical Pediatrics, 56, no. 1 (2017): 51. 28 Stracciolini et al., "Body Mass Index,” 51. 29 Łagowska et al., “Nutritional Intervention Improves Restoration of Menses,” 1. 23 10 found a lot of resistance to their intervention in athletes who practiced sports in which “silhouette was of vital importance.” 30 They mentioned the dancers in particular as being problematic participants, as they feared that their status in their training program would be at risk if there happened to be an increase in their weight. 31 This finding points to a significant concern in ballet, one that anyone familiar with the art form knows well. As evidenced by the dancers referenced in this study, there still exists a permeating expectation of a certain “ballet physique” that aspiring artists feel pressured to maintain. Many dancers feel that, in order to be successful, they must be lean, and resist the suggestion of weight gain. I would say that this sentiment was very true and relatable to me in my struggle with amenorrhea. I wanted to be healthy and to get better, but this desire was hampered by the fear that peers, mentors, and future employers would see me differently if my appearance started to change. I had a lot of restrictive eating practices at that time that were holding me back from recovery, and I had a lot of fear attached to letting them go. Of course, ballet is an aesthetic art form, and requires a certain look and level of skill onstage. However, no aesthetic should come at the expense of an artist’s health. As stated in its definition, Relative Energy Deficiency in Sport comes with all sorts of ramifications, some of which have been linked to a loss of menses in a cause-and-effect relationship (such as infertility and osteoporosis). 32 What if, instead of body shape, more leaders in the dance community emphasized athletic ability, performance quality, and health? What if the dancers that we saw on main stages represented many examples of Łagowska et al., “Nutritional Intervention Improves Restoration of Menses,” 8. Łagowska et al., 8. 32 Stacciolini et al., “BMI and Menstrual Patterns in Dancers,” 50. 30 31 11 what a healthy woman could look like, not just one? Then, maybe, dancers who do have issues with maintaining a menstrual cycle and balancing their energy expenditure would be more willing to make beneficial lifestyle adjustments, and there would be a shift towards better hormonal health in the community overall. That being said, even if body and training standards were relaxed in the ballet community, there is one more missing piece to the puzzle to encouraging a more hormonally balanced population. Ultimately, in my own journey towards menstrual health, I was able to gain my menarche through a combination of my own research endeavors and a global pandemic that gave me the time and space to rest, refuel, and heal. That being said, there was nobody within my dance community that found it important to provide me with any of the crucial information about exercise, caloric intake, and hormonal balance that I was able to seek out on my own. This, it seems, is the crux of the issue. Dancers, dance educators, and even health support teams that operate within the ballet community demonstrate a marked lack of understanding and awareness when it comes to hormonal issues. For example, a 2019 survey study conducted by the Journal of Pediatric and Adolescent Gynecology demonstrated that dancers tend to be particularly oblivious about the condition of RED-S as compared to other lightweight athletes. It was discovered that “a higher proportion of runners than figure skaters and dancers had high knowledge of the triad (16% vs 6% vs 5%, P <.01).” 33 It was also found that “dancers vs figure skaters and runners had nearly twice the odds of triad Marina Tosi et al., "The Female Athlete Triad: A Comparison of Knowledge and Risk in Adolescent and Young Adult Figure Skaters, Dancers, and Runners," Journal of Pediatric & Adolescent Gynecology, 32, no. 2 (2019): 165. 33 12 risk.” 34 These statistics quantify the ways in which health education in dance is lacking, and suggest a correlation between knowledge and incidence of the ailment. Knowledge of menstruation-related conditions in health professionals has also been shown to be strangely absent. A 2015 survey of multispecialty physicians at three separate institutions found that approximately one third of the physicians had heard of the Female Athlete Triad, while approximately one half of them were comfortable treating or referring a patient with symptoms. 35 A key point of the ensuing discussion is that “it is likely that many females are not diagnosed and subsequently treated for the Triad given the high number of physician responders who were unable to properly identify the Triad in a clinical setting.” 36 If the healthcare professionals that dancers might be going to for help are not aware and comfortable treating a major hormonal issue, that in and of itself is a significant knowledge gap that should not be overlooked. The solution to this problem is clear - dancers, teachers, and health professionals alike need to be educated better. We need to bring awareness into medical residencies and dance teacher trainings, have discussions with dance students that are open, honest, and sincere, and create safe spaces in our communities that allow this to be a topic that is interesting and important, rather than uncomfortable and taboo. This is easier said than done, certainly, but there have been efforts made out there. For example, Allison DeBona, principal of the Ballet West Park City Campus, has recently integrated “Wellness Wednesdays” into the training of her dancers (“Dancing Through the Tosi et al., "The Female Athlete Triad: A Comparison of Knowledge,” 165. Emily J Curry et al., "Female Athlete Triad Awareness Among Multispecialty Physicians," Sports Medicine - Open 1, no. 1 (2015): 1. 36 Curry et al., "Female Athlete Triad Awareness Among Multispecialty Physicians," 4. 34 35 13 Menstrual Cycle” was the subject of one of the installments). 37 I believe that this is an admirable endeavor, and would love to see it integrated more into ballet schools across the country and the world. Education is the first step towards opening the door to the changes that need to be made, and creating space for dialogue is vital to this process. It is true that, in our patriarchal world, the topic of hormonal health according to female biochemistry is still rarely breached. It is also true that in places where this knowledge is most relevant and useful - such as in a traditional ballet training environment - a permeating culture, fraught with outdated expectations, often stands in the way to unlocking the true potential of this information. Relaxing stringent, linear training expectations, doing away with unhealthy body ideals, and allowing for more open, honest educational opportunities for aspiring artists, could go a long way in making hormonal health more of a priority in our community. I truly believe that everyone in this field - regardless of gender or status - could grow stronger together if we gave more attention to these issues and devoted more time and energy towards finding our personal balance and “flow”. Allison DeBona (@allidebona), “Tonight we launch WELLNESS WEDNESDAYS at the @bw_academy Park City campus…” Instagram, September 14, 2022, https://www.instagram.com/p/CifS3O1L5Kl/?hl=en. 37 14 AWARENESS INITIATIVE PART ONE: “INFRADIA” Due to the lack of awareness and appreciation for hormonal health displayed in my research and witnessed around me in the ballet world, I decided to take some action within my own School of Dance community to make a change. Therefore, the second half of this project details a multi-component awareness initiative that I piloted at the University of Utah in order to spread my message. In this initiative, I used several modes of communication in order to educate and inspire as many dancers as possible. The first method I used was the creation, rehearsal and presentation of a choreography piece in our annual fall Ballet Student Showcase. After all, what better mode of communication and visual and kinesthetic learning for dancers, than dance? From my research, especially my dive into Alisa Vitti’s work, I became extremely inspired by the cyclical ebb and flow of the infradian hormonal rhythm. It has a beauty that I feel is so underappreciated and undervalued by our society. Therefore, I created a piece on nine dancers called “Infradia” to physically embody this amazing chronobiological phenomenon. From the nine dancers, I chose four soloists, one to portray each phase of the menstrual cycle. The rest of the dancers acted as the “corps de ballet,” dancing as a group and defining space as they made patterns around the soloists. I love how, in In The Flo, Vitti portrays a very distinct characterization for each phase of the cycle in different ways. One of these ways is an acronym, each phase represented in the word POWR. 38 It stands for Prepare (follicular phase), Open Up 38 Vitti, In the Flo, 66. 15 (ovulatory phase), Work (luteal phase), and Rest (menstrual phase). 39 However, since I wanted my piece to have some build to the end, I changed the order of the cycle a little bit to something more like “WRPO.” The work was constructed with intentional choices in everything from the movement quality of the dancers, the music, the costumes, and the lighting, in order to portray the distinct qualities of each of these phases. I opened the piece in a tableau, with down pools on the four main soloists. The music I chose for the first section, “The Path of Light” by Ethereal Isolation, began with some long, drawn-out tones. The soloists were introduced and illuminated one at a time as they slowly moved through a few main motifs that characterized their phase. Then, the lights came up on the corps, and all of the soloists except for the luteal phase (“Work”) dancer exited. The speed of this section was moderately slow and methodical, as this is the phase of putting your head down, tying up loose ends, and turning your attention inwards to focus on the task at hand. 40 The movement was drawn out contemporary ballet en pointe that involved an internal body focus and a lot of articulation through the feet, arms and shoulders. The piece section ended with the dancers exiting and leaving behind a soloist in socks, who entered abruptly and put a stop to the constant action. The soloist in question represented the menstrual (“Rest”) phase. I chose to put her in socks because, to me, pointe shoes don’t seem conducive to the concept of “rest” or the nature of the floor work I had in mind for this section. The music I chose for this portion was an instrumental song put out by the band The 1975 called “Please Be Naked.” It is slow and contemplative, yet also conveys notes of beauty and wonder that I really enjoy. For the first half of the song, the soloist danced alone. Her movement was 39 Vitti, In the Flo, 66. 40 Vitti, 68. 16 very floor-bound, a reflection on the fact that this is often a phase that contains lower levels of energy and less verticality in motion and in mood. In the beginning of her solo I had her go through little bursts of movement, followed by little collapses, meant to symbolize that something inherent is bogging her down. Eventually, I wanted it to seem as if she had grown used to her state of being by embracing her floorwork at a faster pace. Then, when the tempo of the music began to increase, I had another dancer enter and join her in a duet. This dancer represented the follicular (“Prepare”) phase. This phase is a time for beginning, for a fresh start, for clearing out the old and making way for the new, and for turning the attention back outwards. 41 In the duet, the dancer helped the menstrual phase soloist up off the floor, and they shared a special moment together. The corps slowly came back onstage, mimicking some of their partnering movement, and the two dancers interweaved through them, the follicular soloist literally “clearing the way” for her counterpart. When the menstrual soloist finally exited, the follicular soloist’s last act before following her was to prepare a spot on stage for the final dancer to start her section. The ovulatory (“Open Up”) portion was fast, showy, dramatic, and fun, with lots of charisma and flair. The music I chose was an electronic dance track by the DJ Matroda titled “La Pasion.” It started in silhouette, with the soloist’s back to the audience as she performed her signature motifs, before the music picked up and she began a very intricate and technical solo in her pointe shoes, with the corps entering intermittently to join in the dance. I was inspired for this section by the work of William Forsythe in his ballet 41 Vitti, In the Flo, 67. 17 “Playlist,” where dancers execute ballet steps with a lot of energy and precision to a similar genre of music. 42 43 At the very end of this section, I brought each of the former soloists on to do a faster, more dynamic version of their previous movement, as if to convey that each phase has its own special place and positive energy to bring to the table. Then, after a large unison section that aligned with an exciting beat drop, I choreographed movement to bring all the dancers back to the pose that they opened the piece with, to reinforce the notion that they were portraying a cyclical pattern that was destined to begin again. For a while, I debated whether or not clothing the dancers in red would be a fitting choice or simply an obvious one, given the subject matter. In the end, I thought the piece gave off very “red” energy, and fully embraced the color in everything from the costumes to the lighting. I was confident doing this because I felt that the movement portrayed my themes in a subtle way that did not render the red too over-the-top. My goal was not for the audience to watch the piece and fully understand which phase was which person and exactly what everything meant. Rather, I wanted them to see the nature of the cycle, the way it ebbs and flows, even if they were not sure what exactly it was meant to represent. I wanted them to appreciate the way that each soloist was different, but beautiful in her own way. I wanted them to enjoy watching the amazing women that I chose to put onstage, and the dynamic range in each one of them. We have the capability to be strong and spontaneous, yet also nurturing, creative, playful, and emotionally attuned, and all of those parts make us who we are. My goal was to somehow portray William Forsythe, “Playlist (EP): Track 2 (Extract) by William Forsythe: English National Ballet,” YouTube, English National Ballet, April 7, 2022, 1:37, https://youtu.be/WG0_Kh8hzlA. 43 William Forsythe, “Playlist (Track 2) by William Forsythe (Extract): English National Ballet,” YouTube, English National Ballet, March 27, 2020, 3:00, https://youtu.be/hLBpVsBpah0. 42 18 that. Given the audience reaction, I believe that I was successful in this endeavor. Several people expressed feeling an underlying sense of feminine power and confidence, and several more showed curiosity about the way that the piece transitioned from one mood to another. I hope that this led to more research and reflection on their part about what it really means to navigate society through this lens. The rehearsal process for this work was extremely rewarding. It was amazing to see my dancers investigate, grow, and learn through the creation of the piece. Although I started with a little material for each solo already, I really sculpted the work to each individual voice and their presence in the room. They, too, adapted their embodiment of the movement to what they learned from me along the way. It was wonderful to watch. It should also be noted that, throughout this process, I strived to be an example of some of the culture shifts that I mentioned wanting to see in the ballet world. To the best of my ability within the parameters of the choreography class and the audition process involved, I strived to cast dancers with diverse bodies and backgrounds in my work. The representation that many of us in the ballet community want starts with the next generation of choreographers, who are selecting the dancers that we see onstage. I think that I did a pretty good job of including a relatively wide range of body types and builds within my corps and my soloists. I also tried to be respectful of the dancers’ time and energy when it came to scheduling rehearsals, so as not to adhere to the standard cycle of stringent expectations and overwork. I tried to make sure that rehearsals that fell on show weekends were either cancelled, shorter, or more relaxed so as to not exhaust the artists. This became harder as we grew nearer to the performance and I started to get crunched for time to finish the piece, but I thought that overall I did a pretty good job of making 19 this happen. I also tried to make clear that if a dancer was not feeling at 100% capacity for any reason, she was encouraged to take her pointe shoes off and do whatever she needed to do to rehearse in the most easeful way, even if it meant sitting and observing. As we know, our bodies go through phases, and I didn’t want to increase any risk of injury or burnout in my rehearsals. There was also an effort made to keep my dancers fueled – I brought them breakfast and snacks on multiple occasions, which boosted both team health and team morale. One of the best days in rehearsal came towards the end, when I gave the dancers an educational PowerPoint about the topic of my piece. I feel like we had such a heartfelt and open conversation about what women face in our society today, and we entered show week feeling closer and more empowered. Their energy and enthusiasm made everything come together in the best way possible, and it felt like a mutually beneficial experience for everyone involved. We were all able to learn something, and cement that knowledge into our bodies and brains through the physical and emotional process of making art. Link to watch "Infradia" 20 AWARNESS INITIATIVE PART TWO: POSTER Another aspect of my awareness initiative was creating a poster to be displayed around the school. This idea came from noticing that the wellness clinic, the room out of which the School of Dance’s physical therapist and athletic trainer operate, had many interesting posters on its walls. When I visited, I would often read about things such as cross training, injuries, and anatomy. However, it did not have any information on my topic up for display. When I discussed this with resident AT Chris Michaels, he was extremely excited and open to sharing any materials that I created. Deciding what was most relevant to put on the poster was difficult. As evidenced by my detailed discussion on the topic of women’s health, there is a lot of interesting information out there that I wanted to share. However, in order to make the poster concise and readable, I needed to narrow down what I wished to convey. I decided that the most relevant information to be put on display in a physical therapy room would be the information about hormonal conditions that could affect bone health and chance of injury, so that is ultimately what I decided to make the most prominent aspect of the poster. For inspiration, I looked at a few reputable Instagram accounts that spread health information in easily readable and digestible posts. One of my favorites is AusDancersOverseas, run by an ex-dancer who is now a doctor and sports nutritionist who has conducted studies on this topic. 44 The way that she is able to spread important facts through her platform effectively is admirable, and I desired to emulate this in the layout of the poster. 44 “Home,” AusDancersOverseas, Accessed April 12, 2023, https://ausdancersoverseas.com/home/. 21 The title of the poster was “Your Menstrual Cycle, Your Dancing, and You.” I put it in a large, bold, attention-capturing font at the top of the page. I decorated the border with relevant and fun clip art from the online application Canva and used a pink and red color theme to draw the eye to the words. The first section provided a brief overview of the menstrual cycle phases as outlined in Alisa Vitti’s “In The Flo.” I wanted to put a visual reminder of the cyclical nature of the process on the sign, so I used a circle chart that denoted the length of time taken by each phase. Next to the chart, I used arrows and keywords associated with each phase. For the follicular phase, I used the words “creativity, planning, preparing.” For the ovulatory phase, I used the words “opening up, connecting, doing.” For the luteal phase, I used the words “working, focusing, finishing.” For the menstrual phase, I used the words “resting, reflecting, regrouping.” This was not meant to be an extensive overview of these ideas, since I had explored them more fully in my choreography piece. Rather, it was meant to be a fun reminder that put the information in a different format. I presented more scientific health information in the second segment. This section talked about the negative health ramifications of having a missing period, and how it is not meant to be a normal occurrence, even for physically active individuals. Since the poster was going up in the PT room, I thought that listing some of these effects in a bullet-point format would be an easily accessible and attention-grabbing way to draw the reader to the information and increase its personal importance. For the third section, I defined some important terms that can be used to describe the phenomenon of having an irregular cycle. I talked about the term “RED-S”, as well as the different types of amenorrhea. I thought that it would be helpful for those reading the 22 poster to know that there is a name for the things that they may be struggling with, and how to better express themselves when asking for help. The fourth section of the poster outlines a course of action for those suffering from amenorrhea. Amenorrhea can come from many causes, not just RED-S, and I wanted to make sure that this was clear and that I was refraining from diagnosing every individual who read and identified with the sign. I talked about the things that dancers with this issue should be medically evaluated for, again listing them with bullet points to make the information easily accessible. I finished the poster by writing a note in the lower right corner that anyone who thinks they might have an issue should seek help from a licensed professional. In addition to putting a larger version of the poster in the Wellness Clinic, my mentor, Christine McMillan, offered me permission to hang a smaller version of the sign on bulletin boards all around the Marriott Center for Dance building. In total there are six copies of the poster in different locations around the School of Dance. The posters have gotten a very positive reception from those that have noticed them. Both Chris Michaels and Trina Bellendir (PT) were very excited when I revealed it to the wellness clinic. Several other student and faculty members have commented on the execution, visual appeal, and information presented on the flier, and I have noticed dancers start to use and remember some of the terminology defined on the sign. I hope that the posters can stay up for some time to come, so that they get a greater chance to be noticed and referenced. 23 24 AWARENESS INITIATIVE PART THREE: PANEL DISCUSSION The final part of my awareness initiative was organizing a panel discussion around menstrual health for School of Dance students to attend. I thought that it would be extremely informative and beneficial for students to hear about the topic from experts in the field, who are actively doing research in this emerging area of science. Christine McMillan, who currently serves as the head of the ballet program, was very helpful in this endeavor. She cleared a date with the dance department that was during our regular pointe class hours, and required her own class to come to the discussion. She also checked with all the other dance professors who were teaching classes at that time, and many of them gave their own students permission to attend. On my end, I wrote the announcement promoting the discussion and handled everything with the guest speakers. Through the process of doing research interviews for this project, I was extremely lucky to find two experts who were willing to donate their time to this cause. The first guest speaker was Sabine Krautgasser-Tolman (MS, RD, RYT), who was referenced earlier in the research section of this paper. Sabine is in her first season as a sports dietitian with the University of Utah, working primarily with women’s basketball, soccer, softball, swim & dive, and men’s tennis. She is also currently serving as an associate professor at the University of Utah Nutrition and Integrative Physiology department. Before starting her career as a sport dietitian, Krautgasser was a student athlete at the University of Utah, competing for the Utah Ski Team from 2017-2020. She received her master’s degree in nutrition and integrative physiology at the University of Utah in 2022, and her undergraduate degree in kinesiology from the University of Utah in 2020. 25 Sabine was amazing, and so happy to share her knowledge. She already had a PowerPoint presentation prepared, because she often talks to her own female athletes about menstrual health and fueling through the menstrual cycle. This topic is her area of research and her passion. Therefore, this panel discussion was the perfect opportunity to relay her findings to the School of Dance. In her portion of the panel discussion, I asked her to talk a little more about the scientific aspects of the menstrual cycle phases, as well as ways to adjust nutrition in order to better support the ebbs and flows of hormones. Even though I had research experience in the subject, I still learned a lot by listening to her! The second guest speaker was a second-year graduate student in the University of Utah’s coordinated master’s program in nutrition and dietetics, Maddy Hutchison. Maddy also works as a nutrition specialist for PEAK, a health and wellness program on campus that has a partnership with the School of Dance. She completed her B.S. in Kinesiology at Western Washington University while competing in collegiate cross country. As a nutrition professional with a background in exercise science, she is aware of the importance of fueling your body for performance and longevity in sport, and working with athletic populations is one of her goals as a future dietitian. Since Maddy is a great resource that is easily accessible for School of Dance students, I thought that she would be a wonderful choice to provide a follow-up conversation that contained applicable and actionable information. While Sabine addressed some specific scientific material, Maddy talked about the “how” of using this knowledge in everyday life. She talked about creating well-rounded meals, the importance of caloric intake for athletic health, and finding the “fun” in food. She also 26 informed the students on how to connect to the free health resources that are provided through PEAK, which include nutrition consultations that are free of charge. I asked the guest speakers to leave at least ten minutes at the end of the presentation for questions, because I find open and honest conversation about this topic extremely important and necessary for changing a culture where these discussions are often taboo. Although the dancers seemed hesitant to talk at first, by the end the inquiries were flowing quite freely. We went eight minutes over our time limit, and we could have easily gone on longer were it allowed. For the sake of the privacy of the students, and for creating a safe space in the room as the panel was happening, I did not film the Q&A portion. I also will not go into full detail of it here. However, topics addressed included birth control, amenorrhea, diets and diet culture, and body image throughout the phases of the menstrual cycle. It was a very productive discussion. At the end of the panel, PEAK was generous enough to provide snacks for students to grab on their way out the door. The trail mix and oranges that Maddy brought were a hit, as well as a major draw to the discussion in the first place. Overall, the presentation was highly successful. Everyone seemed extremely invested in the topic and excited by the information that was being given to them. There were many head nods, exclamations of agreement, laughs in response to jokes, and enthusiastic answers to questions that were posed. I had several people come up to me afterwards and tell me how much they liked the talk and how happy they were that I organized it. Many told me how they wanted to learn more, and Chris Michaels, who was in attendance, brought up the idea of making it a more regular occurrence in the School 27 of Dance. I find all these reactions to be quite promising for the future of bringing these topics to the forefront of dance education at the U. Link to Panel Discussion 28 IMPACT AND CONCLUSION Oftentimes, cultural issues and gaps in the collective knowledge can remain unidentified and unchecked, unless someone tries to fix and fill them. This project, from its deep dive into ballet culture as it relates to hormonal health, to its efforts to convey this information to vulnerable populations within the School of Dance, was an attempt to bring one of these knowledge gaps to light and plant the seeds of change for a better future. With these goals in mind, I can say that the endeavor was extremely successful. There were many dancers changed by the wisdom they gained through my efforts. The artists in “Infradia” were fulfilled, inspired, and empowered through portraying their stories onstage. The audience was excited and entertained. Even if not all of them knew exactly what the work was about, the reception was enthusiastic. My posters remain on the School of Dance bulletin boards for all to see. I have watched them catch the eye of many who wander down the halls. Even if the dancers do not act on the information right away, at least they might remember what they read, and refer back to some of the concepts in future situations. The panel presentation was eye-opening and much-needed for many. I sensed a bit of shock from some of the dancers that this topic was being discussed in a context beyond the dressing room doors, but they soon eased into the talk with unbridled interest. Our guest speakers were amicable, warm, and entertaining, and once they got the conversation going, it was difficult to bring it to a close. I believe this bodes well for the possibility of continuing with these types of interventions in the future. In addition to these indicators of success, I have had several dancers come to me throughout this process with personal stories that my work brought out in them, and gave 29 them the courage to share. Although they will remain in confidentiality here, these conversations gave me hope that this project had an impact far beyond what can be observed and measured. Of course, there still exists a lack of knowledge on women’s health that is frustrating and obvious. Of course, many ballet environments still have stringent and unproductive daily expectations, unrealistic body ideals and practices of under- or miseducation that need to be dismantled. Of course, all of these things are not going to change in one year, even in a relatively receptive community such as the University of Utah. However, this work was a great first step, one that I hope can be repeated and emulated in more dance spaces. Understanding hormonal health can be difficult, especially for the female athlete. Stabilizing and maintaining a healthy menstrual cycle and hormonal levels can be even harder. However, armed with the information and environment they require to thrive, I think that dancers are ready for the challenge. After all, who are we but masters of balance? 30 SUPPLEMENTARY PHOTOS Presenting my notes to the cast of “Infradia” “Infradia” Performance Stills (Picture Credit: Todd Collins) 31 BIBLIOGRAPHY “Ballet Dancer Statistics By Gender.” Zippia. Accessed April 7, 2023. https://www.zippia.com/ballet-dancer-jobs/demographics/. 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Medicine and Science in Sports and Exercise 25, no. 7 (1993): 775-77. Name of Candidate: Olivia Huseonica Date of Submission: May 6, 2023