Competitors’ fertility is at risk

One of Britain’s leading Olympic sports scientists has warned a “medals over menstrual cycles” approach in elite sport is damaging female athletes’ reproductive health.

Dr Emma Ross, who has spent more than a decade working in highperformance sport, believes sportswomen are not being educated about long-term implications of Relative Energy Deficiency in Sport (RED-S).

The syndrome occurs in athletes who under-fuel according to their training demands, leaving them with low energy availability.

In women, this can lead to menstrual dysfunction, such as missed periods, which can disrupt the production of oestrogen, which is essential for maintaining bone density.

Norway is the only country in the world which has set specific limits that prevent athletes with RED-S from competing. An athlete’s BMI, fat percentage and bone density is not allowed to fall below a certain level, while a woman must not miss her period for more than six months.

“RED-S is reversible if caught and treated, but we’re not sure how it impacts long-term fertility,” Dr Ross said. “There is some evidence that when a woman misses periods for a long time, there is some damage to her reproductive health.

“Even when their periods come back after months – sometimes years – because they’ve adjusted their training and nutrition, they might not be ovulating.”

Dr Ross said Britain’s Olympic and Paralympic system must be “really mindful” of having a duty of care towards female athletes experiencing RED-S in a similar way to rugby’s management of head injuries.

A UK Sport spokesperson said: “UK Sport, in partnership with the English Institute of Sport, is committed to ensuring that all funded athletes have access to the best sports science and medical support. Integrity, welfare and effective performance culture are at the heart of our high-performance community and how we win is more important than what we win.”