It is encouraging to see more athletes becoming aware of RED-S.
That awareness is vital, because no — it is not normal to lose your period just because you are training hard.
Like many things in women’s health, we have learned to accept what is common.
But common does not mean normal, and it certainly does not mean healthy.
RED-S, or Relative Energy Deficiency in Sport, is now gaining attention.
But as gynaecologists, we have recognised its effects for years.
It was previously categorised under terms like “secondary amenorrhoea” or the “female athlete triad.”
Often, menstrual dysfunction is only considered in the context of PCOS.
But functional hypothalamic amenorrhoea — the result of under-fuelling and overtraining — is a serious indicator that the brain’s hormonal signalling is disrupted.
The truth is simple.
If you are not menstruating, it is a sign that your body does not have the energy it needs.
And this goes far beyond fertility.
It affects bone health, mental health, immune function, mood, recovery, and overall performance capacity.
Yes, RED-S can affect ovulation and make it harder to conceive.
But there are other, less talked-about consequences too:
- Irregular or inconsistent cycles
- Shortened luteal phase, which can increase the risk of miscarriage or failed implantation
- Lower bone density
- Hormonal imbalances that influence recovery, mood, and training outcomes
When the body does not have enough energy, it goes into survival mode.
Reproductive health becomes a lower priority — and that has lasting effects.
In my practice, here is how I approach RED-S:
- Taking a thorough history that goes beyond menstrual symptoms
- Conducting a comprehensive review of training load and nutritional intake
- Running detailed hormone profiles that look for optimal, not just average, levels
While hormonal contraception is sometimes offered to address symptoms, I advocate for a more holistic, athlete-focused plan.
This might include education, nutritional support, medical monitoring, and targeted strategy.
If hormones are needed, hormone replacement therapy (HRT) is often a more suitable option.
We cannot afford to wait until fertility is at risk to address RED-S.
If you are concerned that RED-S could be affecting you or one of your athletes, reach out.
I can help you navigate the gynaecological and performance implications — so health and longevity are prioritised alongside sporting goals.