I have been lifting weights for fifteen years. I trained through my own pregnancy. And I’m a Consultant Gynaecologist specialising in elite female athlete health. Those are not three separate facts about me. They are the same fact. The experience of being an active woman at different stages of life is not separate from the clinical work I do — it’s the foundation of it.
That convergence is also what led me to a position I hold firmly, and that shapes every consultation I have: treating the symptom in front of me is not enough. The Elite Rugby player who has PMOS whose elevated androgen levels are giving her a natural competitive advantage that she doesn’t want to diminish right now whilst mid competition season, but at a later stage will want to manage the side effects of this symptom.
The problem with fragmented care
Women do not experience their health as a series of isolated episodes. A menstrual problem in their twenties, a pregnancy question in their thirties, a postpartum complication, a perimenopause symptom a decade later — these are not separate stories. They are chapters in the same one.
The healthcare system, for the most part, treats them as entirely unrelated. A woman sees her GP for a missed period and gets a referral to one specialist. She sees a different specialist when she is pregnant. She sees someone else when she is trying to return to sport after having a baby. Each practitioner treats the presenting problem in front of them. Nobody holds the whole picture.
For active women — those who train throughout their lives, who have performance goals that don’t pause for biology, whose relationship with their bodies is close and demanding — this fragmentation causes real harm. Not because any individual clinician is failing them, but because the system is not designed to ask the right questions across time.
The four stages of the athletic life
In my practice, I think about female athlete health as a single continuous journey, moving through four interconnected phases.
- Preconception and fertility. Active women have specific questions about fertility that standard gynaecological care often doesn’t address — about the impact of training load on ovulation, about RED-S and its fertility implications, about how to optimise their health before a planned pregnancy without compromising performance unnecessarily.
- Pregnancy. The standard advice around exercise in pregnancy is still, too often, either overly cautious or naively permissive. Active women need nuanced, specific guidance — not “take it easy” and not “carry on as you were.” They need a clinician who understands what their training actually involves and can make an informed, personalised recommendation using the current evidence, science, and expert experience.
- Postpartum return to sport. This is the most underserved phase of all. Women are discharged after birth and largely left to figure out their return to training without clinical support. The consequences -pelvic floor dysfunction, injury, and burnout are well documented and almost entirely preventable with proper guidance.
- Perimenopause and beyond. More women than ever are competing and training seriously into their forties and fifties. The hormonal changes of perimenopause interact directly with training capacity, recovery, injury risk and wellbeing. This is not a phase to manage into retirement from sport – it is a phase to manage through it.
Why fragmentation fails athletes specifically
For a recreational exerciser, fragmented care is frustrating. For a serious athlete, it can be career-limiting or physically damaging.
A missed RED-S diagnosis in a young runner, not connected to her later fertility struggles. A pregnancy managed too conservatively by a clinician unfamiliar with her training background. A postpartum return to heavy lifting that goes unsupported and ends in injury. A perimenopause that derails a decade of performance gains because no one thought to ask about her hormones in the context of her sport.
These are not hypothetical scenarios. They are the patterns I see, repeatedly, when women come to me having navigated years of disconnected care.
What continuity looks like in practice
Treating the whole athlete life means holding the full picture — not just the immediate presenting problem, but where it sits in a woman’s broader health history and her future goals.
It means asking about training when a patient presents with a hormonal issue. It means thinking about sport when managing a pregnancy. It means considering the athletic timeline when advising on postpartum recovery. It means understanding that a woman who has been training seriously for twenty years is not the same as a woman who has just started, even if their presenting symptoms are identical.
It also means being willing to say things that are more complex and less reassuring than standard clinical guidelines allow for — because active women deserve honest, specific answers, not averaged-out advice designed for the population mean.
I always ask my women what their next competition or goal is and what their long term performance goals are? My approach then differs based on this answer.
Who this is for
This approach is not only for elite athletes. It is for any woman who trains — seriously, consistently, as part of how she lives (you are an athlete!) and who has ever felt that the healthcare system doesn’t quite understand what that means for her body.
If that is you, and you are looking for a clinician who will ask the right questions across time rather than treating each visit in isolation, I would be glad to hear from you.