Female athlete health and RED-S
Specialist care for the medical and physiological aspects of training as a female athlete: the menstrual cycle and performance, low energy availability, RED-S, bone health, and considerations across pregnancy and the postpartum period.
Female athletes have been historically underrepresented in sports medicine research, which has produced gaps in routine care. The work has caught up substantially. Specialist sport and exercise medicine for female athletes covers the menstrual cycle, energy availability, RED-S, bone health, contraception choices that respect performance, and considerations across pregnancy and the postpartum.
Common areas we cover
Cycle and performance
How the menstrual cycle interacts with training, symptoms and performance.
Read more Under-fuellingRED-S and low energy availability
The health and performance effects of not fuelling enough for your load.
Read more Bone strengthBone health
Protecting bone density and reducing stress-injury risk in female athletes.
Read more Pregnancy and beyondPregnancy and postpartum
Staying active safely through pregnancy and returning to sport afterwards.
Read moreThe menstrual cycle and performance
For most female athletes, the menstrual cycle is a normal physiological background to training, not a barrier. Tracking the cycle can help identify symptom patterns (heavy bleeding, premenstrual mood changes, ovulation pain) that may be modifiable. Where periods are absent, irregular, or significantly disabling, that is a clinical signal worth investigating.
RED-S and low energy availability
Relative Energy Deficiency in Sport (RED-S) is a syndrome resulting from sustained low energy availability. It affects bone, immune, cardiovascular, gastrointestinal, endocrine, metabolic, haematological, and psychological function. Although most discussed in female athletes, it affects athletes of all sexes.
Common signs include disrupted or absent periods, recurrent stress fractures, frequent illness, persistent fatigue, declining performance despite increased training, and slow recovery from injury.
RED-S is treatable. The cornerstone of management is restoring energy availability, often with the support of an experienced sports dietitian, alongside attention to bone, cardiovascular, and mental health considerations. Early identification matters because the long-term consequences (particularly bone) can be substantial.
Bone health
Female athletes in low-impact and aesthetic sports, and those with a history of menstrual disruption or RED-S, are at higher risk of low bone density and bone stress injury. Specialist assessment includes evaluation of risk factors, appropriate investigations (DEXA, vitamin D, calcium intake), and a structured plan to support bone capacity. See bone health for the broader principles.
Contraception for athletes
Contraception choice is a personal decision with multiple sport-relevant considerations: bleeding patterns, mood, weight changes, bone effects, and the ability to schedule or skip periods around competition. The conversation belongs in primary care or with a women's health specialist, but the sports-specific context matters and can be discussed within the specialist consultation.
Pregnancy and postpartum
Most active women can continue training during pregnancy with sensible adaptations. The detail varies by trimester, by sport, and by the individual pregnancy. Postpartum return to running and high-impact sport benefits from a structured pelvic floor and core assessment, often led by a women's health physiotherapist, with specialist sport and exercise medicine input where return is complicated by injury or persistent symptoms.
Common questions
I have not had a period in months and I am training hard. Should I be worried?
It is worth a conversation. Functional hypothalamic amenorrhoea from low energy availability is a recognised pattern in athletes, and the longer it continues the more it matters for bone, cardiovascular, and broader health. Other causes also need to be considered.
I keep getting stress fractures. Why?
Recurrent stress fractures often signal a problem with energy availability, bone health, biomechanics, training load, or some combination. A structured workup identifies which.
Can I keep training while pregnant?
For most pregnancies, yes, with adaptations. The plan is built individually.
