Category: Active Women

A growing number of sports organisations now offer athletes egg freezing as a benefit, sometimes folded into healthcare cover, sometimes offered as a standalone perk. Most recently, the Spanish football federation are offering the treatment to elite female players. It’s increasingly becoming the norm. 

Nobody frames it as a message about when an athlete should or shouldn’t get pregnant. But that is, quietly, what it can become.

I think egg freezing is a genuinely valuable option for the right person, at the right time, for the right reasons. That is exactly why I think it matters how it’s being offered here, and why organisations doing the offering owe athletes more honesty about what it does and doesn’t promise.

What is corporate-sponsored egg freezing, and why is it appearing in sport?

The logic behind offering egg freezing as an athlete benefit is straightforward enough: a career in elite sport has a short, biologically inconvenient window, often overlapping exactly with the years many women would otherwise consider starting a family. Freezing eggs earlier, while ovarian reserve is at its best, is framed as giving athletes options later, without asking them to choose between a career and a family in real time.

On paper, that sounds like support. In practice, offering it as a benefit does something else too. It puts fertility preservation into the same category as any other performance or wellbeing perk, alongside physiotherapy access or nutrition support, as something an organisation provides so an athlete can keep training uninterrupted. That framing is where the ethical question starts.

What egg freezing does and doesn’t guarantee

Egg freezing preserves eggs at the quality they were at the point of freezing. It does not guarantee a future pregnancy, and it does not guarantee a live birth. Outcomes depend on age at freezing, the number of eggs retrieved, and what happens at thaw, fertilisation and implantation, none of which can be promised in advance. It is a chance at more options later, not an insurance policy with a fixed payout.

This matters enormously when the benefit is offered by an employer rather than sought out independently. An athlete considering egg freezing on her own initiative has, in my experience, usually done the research and understands it as one option among several. An athlete offered it as a contract perk may reasonably assume the organisation has done that thinking for her, and may not interrogate the limitations of what she’s being offered in the same way.

The message this benefit can unintentionally send

Here is the part I think goes unexamined. When an organisation offers egg freezing but has no clear, athlete-facing pathway for what happens if she gets pregnant during her contract, the underlying message is not neutral. It reads as: we’ve given you a way to delay this decision, so we’d rather you did.

That message doesn’t need to be spoken to land. It is implied by what sits alongside the benefit, or more often, by what doesn’t. Is there a clear return-to-sport pathway after pregnancy, with funding and support protected? Is there any policy on how pregnancy during a contract is handled, beyond the standard employment minimum? If the honest answer is that egg freezing is the only fertility-related support on offer, then it isn’t really offering athletes a genuine choice about family planning. It is offering them a technological workaround for an organisational gap.

What a genuinely supportive fertility policy looks like instead

A fertility benefit that actually supports athletes sits alongside real structural support, not in place of it. That means a properly resourced pregnancy and postpartum return-to-sport pathway, contractual clarity on what happens if an athlete becomes pregnant, and a culture where that conversation can happen without it being read as the end of a career. 

Egg freezing can be part of a good policy. It should never be the whole of one, and it should never be positioned as a reason not to build the rest.

If this resonates with you

If you’re an athlete considering egg freezing, whether it’s been offered to you or you’re looking into it yourself, it’s worth getting independent counsel on what it can and can’t offer you before you decide, separate from whoever is funding it.

If you’re a sports organisation reviewing your own policy in this area, I’d urge you to ask what sits alongside the benefit, not just whether it exists. I offer advisory work with sports organisations on exactly this, alongside consultations in London, Windsor, and nationally and internationally via virtual appointments. Get in touch. 

A fifteen-year-old athlete missing her period for three months is not a training milestone. It is a warning sign that a teenage athlete may have RED-S. 

I see the aftermath of this in my clinic regularly, but I don’t see it early enough. By the time a young athlete reaches me, RED-S (Relative Energy Deficiency in Sport) has often been present for months, sometimes years, quietly affecting bone density at exactly the stage of life when bone mass should be at its highest rate of accrual. Adolescence is not just another life stage RED-S can affect. It is the stage where the cost of missing it is highest and the hardest to reverse.

What is RED-S in teenage athletes, and why does the timing matter so much?

RED-S occurs when an athlete’s body is not receiving enough fuel to cover both the demands of training and the basic requirements of everyday physiological function, including growth. In adults, the body deprioritises the reproductive system when that energy gap opens. In adolescents, it deprioritises more than that.

Roughly ninety per cent of adult bone mass is built by the late teenage years. That window does not reopen. An adolescent athlete training in an energy deficit isn’t just at risk of a missed period or two – she is at risk of never laying down the bone density she needs for the rest of her life, with consequences for fracture risk that can follow her well into adulthood. Growth and pubertal development can also be affected, sometimes resulting in delayed puberty or primary amenorrhoea (a period that never properly starts in the first place), which is easy to miss if nobody is asking the right questions.

This is the piece of youth sport menstrual health that I think gets least understood: in adults, RED-S is a health problem that can usually be reversed. In adolescents, some of what it affects cannot be undone.

The warning signs coaches and parents are best placed to see

Athletes at this age rarely raise these issues themselves, whether from embarrassment, not knowing what’s normal, or not wanting to be pulled from training. That makes coaches and parents, not clinicians, usually the first people in a position to notice something is off. What I’d want them watching for:

1. A period that hasn’t started by fifteen, or one that starts and then stops for three months or more
2. Recurring stress fractures, or bone stress injuries that keep coming back in different sites
3. Growth or development that seems to be stalling compared to peers
4. Fatigue that doesn’t improve with rest, or a performance plateau despite training consistently
5. Getting ill more often than teammates on a similar programme
6. Mood changes, low mood or increasing anxiety around food or training load

Why “she’ll grow out of it” is the wrong response

Missed periods in a young athlete get normalised more often than they get investigated. Sometimes that’s because heavy training genuinely can shift a cycle slightly, and it’s assumed this is simply more of the same. Sometimes it’s because nobody wants to be the person telling a promising fifteen-year-old that her training load needs to change. Both are understandable. Neither is safe to act on without proper assessment.

An adolescent athlete who is not getting a period is not operating on a hormonal profile that will simply correct itself once she’s a bit older or training slightly less. Left unaddressed, RED-S at this age can affect fertility later in life in ways that don’t surface until she’s trying to conceive, sometimes over a decade later, when the original cause has long been forgotten. 

What I’d want every coach to do differently

If an athlete you coach hasn’t had a period by fifteen, or hers has stopped for three months or more, that’s worth a conversation and a referral, not a wait-and-see approach. The same goes for repeated stress fractures or a performance plateau that doesn’t respond to the usual adjustments. None of this requires you to diagnose anything. It requires you to notice, ask, and know that “it’s probably just training” is not a safe enough answer at this age.

If this resonates with you

If you coach or parent a young athlete and recognise any of this, it is worth seeking a proper assessment rather than waiting to see if things settle on their own. A thorough RED-S assessment looks at energy availability, training load, growth and pubertal development, and bone health together, not just whether a period eventually shows up.

I offer consultations in London, Windsor, and nationally and internationally via virtual appointments. You can book via this link HERE. 

Could your PMOS diagnosis actually be RED-S? Before we get to the pill, find out HERE.

There is a conversation I have in my clinic more often than I would like. A woman comes in – usually an athlete, usually someone who has been active for years – and she tells me she went to her GP with irregular or painful periods, was put on the pill, and has been on it ever since. Sometimes for five years. Sometimes for ten. Sometimes longer. 

When I ask what was identified as the underlying cause, the answer is almost always the same.

Nobody looked.

This is not a criticism of the clinicians involved. The prescription makes a certain kind of sense: hormonal contraception regulates cycles, reduces pain, lightens bleeds, and generally makes the problem less immediately visible. For many women, it is exactly the right choice. But for athletes presenting with period problems, reaching for contraception before establishing what is actually driving those symptoms is a significant clinical gap – and one that can have serious long-term consequences.

The short answer first

Hormonal contraception does not treat the cause of period problems. It manages their presentation- almost like a plaster. In athletes, where the most common driver of menstrual disruption is an energy deficit rather than a hormonal condition, this distinction matters enormously.

The default pathway and where it falls short

When a woman presents with heavy, painful or irregular periods, the standard clinical response is broadly consistent: a conversation about symptoms, sometimes blood tests, sometimes a scan, and frequently a prescription for hormonal contraception to regulate the cycle and manage the pain.

For a significant number of women and even athletes who want cycle control, this is appropriate and effective. But the pathway has a built-in problem: it treats the symptom and stops there. The question of what is causing the symptom – which is the only question that leads to actually resolving it – often goes unasked.

In athletes, that unasked question is particularly costly.

What might actually be driving the problem

Period problems in active women are rarely straightforward, and they are rarely caused by a single thing. The most common drivers I see in my clinic include:

• Relative Energy Deficiency in Sport (RED-S). When the body is not receiving enough fuel to support both training demands and basic physiological function, the reproductive system is one of the first things it deprioritises. Menstrual disruption (ranging from subtle cycle changes to periods stopping entirely) is usually the earliest and most visible sign. Hormonal contraception will regulate the bleed, but it will not close the energy gap. The underlying deficiency continues, silently, with its consequences accumulating. [Link to RED-S and PMOS blog]
• Endometriosis. One of the most common causes of painful and heavy periods, endometriosis affects an estimated one in ten women and is notoriously underdiagnosed. The pill can reduce pain and manage symptoms, but it does not treat the condition. Women who spend years on contraception without ever receiving an endometriosis diagnosis may eventually find that the disease has progressed in a way that affects their fertility and quality of life.
• Thyroid dysfunction. An under active or overactive thyroid can significantly disrupt menstrual function, and it is often missed when period problems are managed symptomatically rather than investigated. Thyroid function is a straightforward blood test, but it requires someone to ask the question.
• Other hormonal imbalances. The hormonal picture in active women is complex, and changes in training load, recovery, nutrition and stress can all influence cycle regularity in ways that deserve investigation rather than management.

The specific problem for athletes

For athletes in particular, the stakes of missing the underlying cause are higher than they might appear.

If a woman has RED-S and is put on the pill, her cycle will return – artificially. She will look, on the surface, as though the problem has been resolved. But the energy deficit driving her symptoms is still there. Her bone density is still declining. Her hormonal environment is still disrupted in ways the pill does not address. Her fertility may be affected in ways that won’t become apparent until she tries to conceive, potentially years later.

There is also the question of performance. Athletes making decisions about their contraception need accurate information about the potential effects on training adaptation, recovery and energy availability. The evidence on hormonal contraception and athletic performance is evolving, but it deserves to be part of the conversation – not ignored because the prescription was made on the basis of symptom management alone. Then there is the consideration of Anti-Doping regulations and how hormones fit into that (but that is an entire conversation in itself). 

What should happen instead

A proper assessment of period problems in an active woman should ask several questions before any prescription is written. How much is she training? What does her nutrition look like around exercise? Has her cycle changed in the context of increased load or reduced energy intake? Is there any family history of endometriosis or other gynaecological conditions? What does her thyroid function look like?

These are not complicated questions. They do not require specialist equipment or lengthy referrals. They require a clinician who understands that active women have a specific hormonal context and that the standard pathway does not always account for it.

A word on what this is not

This is not an argument against hormonal contraception. For many women (athletes included) it is an appropriate, well-tolerated and effective choice, whether for contraception, symptom management, or both.

The issue is not the pill. The issue is using the pill as a first response to period problems without first establishing what is causing those problems. Contraception can be part of the answer. It should not be the whole answer before the question has been properly asked.

If this resonates with you

If you are an athlete with period problems and you have been managing them with hormonal contraception for a significant period of time – particularly if something has never quite felt resolved – it is worth asking whether the underlying cause has actually been explored.

A proper assessment, with someone who understands both the gynaecological and the athletic picture, can tell you a great deal more than a prescription alone.

Book a consultation with me HERE. 

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.

Book a consultation

Women’s training advice online can sometimes make it sound as though every life stage requires an entirely new rulebook.

Hormones fluctuate, physiology shifts and different life stages bring new considerations. But according to clinicians working closely with female athletes, the core principles of good training remain remarkably consistent.

Strength training, cardiovascular activity, adequate recovery and proper nutrition form the foundation of long-term health and performance. These fundamentals—lifting regularly, fuelling well, prioritising sleep and reducing sedentary behaviour—continue to matter whether someone is in their twenties, postpartum or navigating perimenopause.

When Adjustments Matter

That doesn’t mean physiology is irrelevant. Certain life stages, particularly pregnancy and postpartum, require more individualised guidance and careful modifications.

For some women, tracking the menstrual cycle may also provide useful insight. Hormonal fluctuations can influence energy levels, recovery and potentially injury risk. Adjusting training intensity during symptomatic phases may help some individuals train more effectively.

However, not every woman experiences noticeable changes across the cycle. For many, rigid “cycle syncing” protocols promoted online may add unnecessary complexity rather than meaningful benefit.

The key principle remains simple: listen to your body first, and use technology or tracking tools as supportive information—not strict instructions.

Avoiding the Extremes

One of the biggest challenges in women’s training advice is the tendency toward extremes.

On one side are generic, one-size-fits-all programmes that ignore individual physiology. On the other are highly specialised protocols that portray women as fragile or dependent on complex supplements and highly specific routines.

In reality, the most effective approach sits between the two. General lifestyle and training principles form the base, while individual symptoms and life-stage considerations guide adjustments where needed.

Beyond Physiology: The Real Barriers

Improving women’s long-term health through exercise is not only a physiological challenge—it is also structural.

Dropout rates in physical activity often rise during key life transitions such as puberty, pregnancy, postpartum and menopause. Barriers range from lack of education about menstrual health to limited access to childcare, supportive facilities and knowledgeable coaching.

Addressing these gaps may be just as important as refining training protocols themselves.

This article summarises a recent newsletter exploring training across life stages, hormonal changes and the structural barriers that influence women’s long-term participation in physical activity.

Read the full newsletter here

Feb 2025

An interesting conversation I was having with an esteemed athlete last week brought to mind an important point

that is well meaning but used too often by clinicians and coaches to pregnant athletes.

‘Listen to your body’ as a means to guiding them intuitively through how to train for their sport in pregnancy.

Whilst well meaning, it’s not very helpful.

What are athletes meant to be listening out for?

The very voice (‘athlete brain’) that makes them great athletes and successful is probably not the one to listen to the most intently in this season of your life.

Training in pregnancy is about training Smart.

But is all pain a sign of injury and not to be pushed through?

What’s safe?

Can we have black and white guidelines for what you can/can’t do in pregnancy when it comes to training?

What are the variables and what are the confounding factors?

As an Obstetrician managing high risk pregnancies and specialising in athlete health there is very little black and white and a lot of grey.

(This is true of Obstetrics in general to some degree).

Each athlete will have specific risk factors in their pregnancy and each different sport