Female Athlete Health & RED-s

Understanding Female Athlete Health

Active women face a unique set of health considerations that require specialist knowledge to assess and manage properly. Menstrual irregularities, recurrent stress fractures, persistent fatigue, and declining performance can all be signs of an underlying issue that standard investigations may miss.

As a Sport and Exercise Medicine Physician with experience across Olympic, Paralympic, and elite-level sport, I assess and manage these conditions in athletes and active people at every level.

Relative Energy Deficiency in Sport (RED-s)

RED-s occurs when energy intake is not sufficient to support the energy demands of both exercise and normal body function. The body responds by down-regulating systems it considers non-essential, which can affect hormonal function, bone health, immune function, cardiovascular health, and mental wellbeing.

RED-s is not limited to eating disorders. It can result from unintentional underfuelling, a sudden increase in training load, or a mismatch between nutrition and activity levels. It affects both women and men, though women are more commonly diagnosed.

Assessment includes a detailed history, blood work, bone density testing where indicated, and a structured approach to recovery that balances training with adequate energy availability.

Menstrual Health

Changes to menstrual function are one of the earliest indicators that something may be wrong. Irregular periods, absent periods (amenorrhoea), or changes in cycle length in active women should not be dismissed as a normal consequence of training. These changes often signal low energy availability and can have long-term consequences for bone health and fertility.

Assessment includes hormonal evaluation, investigation for other causes, and a management plan that addresses the underlying driver.

Bone Health

Low energy availability and hormonal disruption can significantly impact bone density, increasing the risk of stress fractures and long-term osteoporosis. Active women with recurrent stress fractures, menstrual irregularity, or a history of low energy availability should have their bone health assessed.

Investigation may include bone density scanning (DEXA), blood work for calcium, vitamin D, and hormonal markers, and a review of training load and nutrition.

Iron Deficiency & Fatigue

Iron deficiency is one of the most common medical issues in active women and a frequent cause of fatigue, reduced performance, and poor recovery. It can occur even without anaemia and is often missed on standard blood tests if ferritin levels are not checked.

I investigate and manage iron deficiency with targeted blood work and a treatment plan that may include dietary guidance, oral supplementation, or referral for intravenous iron infusion when indicated.

Overtraining Syndrome

Persistent fatigue, declining performance despite adequate rest, mood changes, sleep disturbance, and increased injury rates can all indicate overtraining syndrome. This requires a comprehensive assessment to exclude other medical causes and a structured approach to recovery, load management, and return to training.

Metabolic & Hormonal Health

Thyroid function, vitamin D status, and broader endocrine health all play a role in performance, recovery, and wellbeing. When symptoms suggest a hormonal or metabolic component, I arrange the appropriate investigations and coordinate care with endocrinology if needed.

When to Seek Assessment

        Consider a specialist assessment if you are experiencing:
        Irregular or absent periods
Bone stress fractures or bone injuries
Persistent fatigue not explained by training load
Declining performance despite consistent training
Difficulty maintaining weight despite adequate intake
Low mood, anxiety, or changes in mental wellbeing related to training
Frequent illness or slow recovery from training

    

Frequently Asked Questions

What is RED-s and how do I know if I have it?

Relative Energy Deficiency in Sport (RED-s) occurs when energy intake is insufficient relative to energy expenditure, causing the body to down-regulate normal physiological functions. Signs include irregular or absent periods, recurring stress fractures, persistent fatigue, declining performance despite training, mood changes, and frequent illness. It affects both women and men, though women are more commonly diagnosed. A specialist assessment can identify the condition and guide recovery.

Do I need a GP referral?

A GP referral is not required but is recommended. Dr Wells has access to top-tier Medicare rebate rates (MBS A4), so with a referral your rebate is maximised, with approximately $150 rebate back to you on an initial consultation. Without a referral, the full specialist fee applies with no Medicare rebate. See the FAQ page for more detail.

Is this only for elite athletes?

No. RED-s, menstrual health concerns, iron deficiency, and bone health issues affect active people at every level, from recreational exercisers to elite athletes. If you are physically active and experiencing any of these concerns, a specialist assessment is appropriate.

Does private health insurance cover the consultation?

Private health insurance does not cover specialist medical consultations. However, Dr Wells has access to top-tier Medicare rebate rates (MBS A4), so with a valid GP referral your rebate is maximised, with approximately $150 rebate back to you on an initial consultation. Dr Wells can also refer for Medicare-rebateable MRI scans. See the FAQ page for more detail.