In my clinic, I meet dancers who stopped having periods years ago. Most used to be told it was normal. In some peer circles they were even told it was a good sign – proof they were training hard enough. I cannot state this more clearly – it is not. More often, it is one of the clearest signs of RED-S in dancers, and it should never be waved away.
RED-S stands for Relative Energy Deficiency in Sport. In dance, specialists now use a dance-specific term, RED-D. Whatever the label, the problem is the same. The body is not getting enough fuel for the demands placed on it, so it starts shutting down the systems it treats as non-essential. The menstrual cycle is usually one of the first to go.
This matters because the warning signs are so often dismissed as simply part of dancing. They are not. They are physiology, and they are treatable – once someone asks the right questions.
What is RED-S, and where does RED-D fit in?
RED-S happens when energy intake does not meet the body’s needs. Those needs include training, performing and simply staying alive. When the gap grows wide enough, the body begins to ration. It cuts spending on reproduction, bone building and immunity.
Dance has its own version of this picture. Specialists now use the dance-specific term RED-D, relative energy deficiency in dance, to capture the particular demands dancers face. I am one of the specialists supporting Project RED-D, the UK charity leading this work.
The dance context is what makes the difference. Long rehearsal days, an aesthetic built around leanness, and a culture of pushing through all raise the risk. That combination makes RED-S in dancers both common and easy to miss.
Why dancers are especially vulnerable to RED-S
Three things stack up in dance. First, the energy cost is relentless, with class, rehearsal and performance filling a day and leaving little recovery. Second, the aesthetic places a premium on a lean, light physique. Third, the culture rewards those who push through discomfort quietly.
Age adds to the risk. Many dancers train seriously through puberty, exactly when the body needs energy to build bone and settle into a regular cycle. Under-fuelling during these years can carry consequences that last decades.
Awareness also remains strikingly low. In one study of dancers, fewer than a third had even heard of RED-S. It is hard to protect yourself from something nobody has named for you.
The warning signs of RED-S in dancers mistaken for “just part of dancing”
The most common sign I see is a change to the menstrual cycle. Periods turn irregular, grow lighter, or stop altogether. In dance this is so normalised that many assume it is simply expected. The research says otherwise. Studies of professional ballet have reported secondary amenorrhoea – periods stopping for months – in up to 69% of dancers. Among vocational ballet students, around 40% show menstrual dysfunction, and roughly two-thirds screen at risk of RED-S.
A missing period is not the only flag. Others include:
- Recurrent injuries, especially stress fractures
- Persistent fatigue that rest does not fix
- Frequent illness and slow recovery
- Performance that stalls despite harder training
- Low mood, poor concentration or disrupted sleep
Any one of these can have another cause. Together, in a dancer whose cycle has changed, they point strongly towards RED-S in dancers – and they deserve a proper assessment.
RED-S or an eating disorder? Why the difference matters
This is where real care is needed. RED-S and eating disorders can look alike from the outside, and they can occur together. But they are not the same thing, and treating one as if it were the other helps nobody.
An eating disorder is a mental health condition. RED-S is a physiological state driven by an energy gap. Sometimes that gap is deliberate. Very often it is not. A dancer can simply be eating too little for a workload that keeps climbing, with no disordered intent at all.
The distinction shapes the treatment. RED-S improves when the energy gap closes and, where needed, the workload adjusts. An eating disorder needs specialist psychological support. Many dancers need both. Naming the problem accurately is the first step towards the right help – never a judgement on the person.
Why getting this right matters long term
The risks of unaddressed RED-S are not small, and some are lasting. Bone that is not built during the teens and twenties may never be fully recovered. That raises the risk of stress fractures now and osteoporosis later. Fertility can be affected too, sometimes in ways that only surface years afterwards when a dancer wants to conceive.
There is also a common wrong turn worth naming. When periods are irregular, the default response is often the pill. For a dancer, that can mask the energy deficit rather than treat it. I have written before about how a PMOS label can hide RED-S, and the same caution applies here: could your symptoms actually be RED-S?
The principle is simple. The earlier RED-S is recognised, the more of this is preventable.
What to do if this sounds familiar
If you are a dancer whose periods have changed, or stopped, please do not file it under “just part of dancing”. It is information, and it deserves a proper look.
A thorough assessment weighs energy availability, training load, menstrual history, bone health and hormones together. It needs someone who understands both the dancing body and female hormonal health, rather than a standard panel that stops at a prescription.
I consult with dancers in London and Windsor, and virtually across the UK and internationally. If any of this resonates, you are welcome to book a consultation.
Dr Lamia Zafrani (MBChB, MRes, MRCOG) is a Consultant Gynaecologist and a leading clinical specialist in female athlete health. She consults privately in London and Windsor, treating elite and recreational athletes for conditions spanning RED-S, menstrual health, and postpartum return-to-sport. As the 2025 Perinatal Practitioner of the Year and a competitive powerlifter of over 15 years, she brings both top-tier medical credentials and lived athletic experience to her practice. Alongside her clinical work, Dr Zafrani is a commercial advisor to sports organisations and FemTech brands, advocating for evidence-led, performance-informed healthcare for women.