Menstrual Dysfunction is Not a Medal –The Hidden Cost of Overtraining

For decades, women in sport have been told that if you work hard enough, something will have to give. That ‘something’ is the menstrual cycle. Missed periods are seen to be a side effect of hard work, discipline, and dedication as a trade-off for success. There is a misconception that losing your period to become an efficient, lean, elite machine, is worth it. Human physiology tells a very different story. Amenorrhea is not a marker of optimum performance and discipline. It is a clinical sign that the body is under physiological stress and conserving energy for essential survival processes. It is a clinical marker of energy deficiency, systemic stress, and hormonal dysregulation. Yet in the sporting world, a blind eye has been turned to this, and it has even been quietly rewarded. This article argues that menstrual dysfunction in athletes should not be normalized as a sign of dedication or elite performance, but recognized as a red flag requiring further education, open discussions without any taboo, medical monitoring, and a cultural change within sport. Although this article refers primarily to athletes assigned female at birth, menstrual dysfunction can also affect transgender men and non-binary athletes who menstruate. The physiological mechanisms discussed therefore apply to anyone who experiences menstrual cycles. The Female Athlete Triad is a spectrum of disorders including low energy availability (LEA), low bone mineral density, and menstrual disorders. Relative Energy Deficiency in Sport (REDs) can occur in both female and male athletes when energy intake is insufficient to meet the demands of exercise and basic physiological processes such as the menstrual cycle, resulting in low energy availability. REDs recognises that insufficient energy intake and increased energy output results in disruption in various physiological systems such as the menstrual cycle, basal metabolic rate, bone density, cardiovascular health, and the immune system.