Exercise-induced amenorrhea is prevalent among female athletes. However, a large percentage of them do not seek help.
The lifestyle of an elite athlete puts a unique strain on the human body. Elite training burns significant calories and, as a result, athletes' bodies are often lean and muscular, containing very little body fat. If they don't eat enough to keep up with their calorie output, then issues with menstrual cycles, such as periods stopping for months, can occur.
Relative energy deficiency in sport (RED-S) was first recognised by the International Olympic Committee in 2014. The absence of menstruation is a key symptom of RED-S.
Female athletes face fertility challenges. Medical experts suggest that elite sports' potential effect on ovulation—including a potentially higher risk of miscarriage—seems to contribute to fertility problems. These are realities that require open, honest conversation.
For the female athlete, on the issue of pregnancy, what challenges will they have to overcome? Female athletes diagnosed with polycystic ovarian syndrome (PCOS), a hormonal disorder that occurs when the body produces too much androgen, often experience irregular periods, weight gain, fatigue, excess hair growth, acne, and infertility. PCOS is also relevant to anti-doping issues. PCOS not only negatively impacts performance but can have life-changing long-term consequences.
I read a recent report that said nearly two-thirds of female athletes experience interrupted periods, particularly in endurance sports. There are comparably high rates of periods disappearing. Absent periods can be a sign that ovulation (or egg release) isn't happening.
Among athletes, Heather et al. (2021) indicated that 36% (72/202) of athletes said their menstrual cycle had a frequent negative impact on performance. PCOS affects one in ten women (Williams et al., 2015) and is one of the most common menstrual disorders among elite female professional athletes (Eliakim et al., 2010; Hagmar et al., 2009; Lteif et al., 2015; Rickenlund et al., 2003).
The female athlete triad (cf. Stickler et al., 2015) also highlights the psychological impact of PCOS (Kelly & Hecht, 2022). Difficulty adhering to treatment plans, medication side effects, financial burdens of medical consultations, and potential stigmatisation are other impacts on the athlete due to PCOS (Chopra et al., 2021; Korsten-Reck, 2011; Weiss & Bulmer, 2011).
Elite female athletes have been diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), a condition that affects the autonomic nervous system, leading to symptoms such as dizziness, fatigue, and a rapid heart rate upon standing.
Given modern sports science research, we have a responsibility, duty, and obligation to address real issues impacting women and girls in sport.
I have heard sports leaders, coaches, officials, male and female, adopt an unsympathetic posture, saying "coldly" that a female athlete is only making excuses that she is "lazy and unmotivated." The stigma around periods is still cultural, taboo, strong, secret and shameful. Girls drop out of sports as menstruation is seen as an obstacle. Periods limit participation.
Admitting you are wrong takes more courage than pretending you are right. Systemic patriarchal attitudes and structures persist and marginalise transparent conversations about female health issues as embarrassing.
Safeguarding is a comfortable patriarchal language for assault and abuse. The danger is that the patriarchal systems doing the work of pretend safeguarding are the ultimate abusers.
Who benefits from a problem never being solved, and who is complicit in patriarchy?
Patriarchal instruments of control can be reinforced by people of any gender.
