RED-S: More than a third of female athletes ignoring warning signs of 'lifechanging' disease
Some 30% of female athletes have been told by a medical professional that period abnormalities - including missed periods - were "normal" given their activity level, despite their being a key symptom of Relative Energy Deficiency in Sport (RED-S), which can cause irreparable damage.
Wednesday 3 May 2023 19:56, UK
More than a third of female athletes have ignored missed periods, thinking it was either normal or beneficial to them, a new survey has found.
Some 30% have also been told by a medical professional that period abnormalities were "normal" given their activity level.
The Female Athlete Health Report from Project RED-S and Kyniska Advocacy looked at responses from 769 athletes in the UK assigned female at birth, asking them questions about their menstrual cycle and body image.
Their report found GPs and other healthcare professionals "were not sufficiently informed about the potentially serious health implications of irregular/missed periods".
Common reasons for missed periods include polycystic ovary syndrome, an overactive thyroid or heart disease.
The absence of menstruation is also a key symptom of Relative Energy Deficiency in Sport (RED-S). It is a condition which can affect elite and non-elite athletes and is characterised by low energy availability due to a calorie deficit.
The disease causing 'irreparable' damage to women
Pippa Woolven is a former track and field athlete and co-founder of Project RED-S, who helped to develop the Female Athlete Health Report.
She struggled with fatigue, injuries and low moods throughout her career but was repeatedly given the all clear by medics to continue competing. She was finally diagnosed with RED-S in 2017 and retired four years later.
RED-S can lead to irreparable damage, impairing almost every system in the body if left untreated. But the report also found less than half of those polled had heard of it before taking the survey.
One athlete who completed the survey said: "My GP told me it was normal to miss my period. I had every RED-S symptom, but because none of them were 'that bad', my doctors and coach just let me carry on. I thought it was just part of being an athlete."
Ms Woolven said: "RED-S carries widespread and often life-changing health and performance consequences to athletes of any age, gender, ability or activity. Historically, it has been misunderstood, undiagnosed and untreated. We're here to help push for change across all levels of sport."
How body image plays a part
The report also looked at athlete body image.
Some 74% of the survey group agreed that they had "felt as though they did not look like an athlete", while half said they had consciously restricted their food intake in order to improve their performance.
Just over half (52%) said they restricted food in order "to fit in or look the part in their sport".
The report found 91% had worried about how many calories they were eating, with 19% admitting these worries occurred "all the time".
More than half (53%) of athletes said they had received comments about their bodies, with athletes receiving those comments four times more likely to restrict their food intake.
One respondent said: "When I was deep in anorexia, someone actually said to me 'you're looking like a real runner these days'.
"I was so unwell and so underweight, yet someone felt the need to make that comment."
The report recommends mandatory, centralised and comprehensive coach education on female health to be embedded within all coaching qualifications at all levels.
It also called for the creation of an athlete-led female health, body image, eating disorder and RED-S support network, and widespread distribution of an online female sports health toolkit to athletes and parents, so it can be used from an athlete's first entry into sport.