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Restoring Menstrual Health and RED-S

Some physically active individuals may be at risk for Relative Energy Deficiency in Sport, also known as RED-S. Both male and female endurance runners, gymnasts, cheerleaders, bodybuilders, and even recreational athletes are among the few who are the most likely to develop RED-S. RED-S consists of intentional or unintentional underfueling, amenorrhea or the lack of a menstrual period, and low bone mineral density. (1) To these athletes, losing their menstrual cycle may not seem like a big deal. In fact, many may view it as a convenience, for they no longer have to deal with the symptoms of PMS let alone worry about the preparation that is involved during the week of a menstrual period. As nice as this may sound, absence of a menstrual period is a sign of a deeper issue within the body, and it is crucial that each athlete is performing optimally inside and out. 


Amenorrhea is the absence of a missed menstruation after a normal menstrual cycle. It can be caused by a number of factors including excessive exercise, mental stress, low body weight, or underfueling. (2) Though studies have not confirmed long term effects in men and women, RED-S is thought to result in reproductive problems, osteoporosis, muscle wasting and disrupted hormone functioning. Fortunately amenorrhea and RED-S can be reversed and menstrual health can be restored. 


Consume Adequate Calories, Vitamins, and Minerals

It is crucial to ensure calorie needs are being met to support training, bone health, and prevent any nutrient deficiencies. One of the first steps to recovery involves increasing caloric consumption and in some cases gaining a healthy amount of weight.  Support your bone health by consuming sources of vitamin D and calcium. These foods include milk, cheese, Greek yogurt, sardines, salmon, and fortified juices. (3) Lactose free plant sources include leafy greens, vegetables, tofu, almonds, and beans. 


Reduce Stress

Assess the level of physical and mental stress in your life and cut back where needed. It may be necessary to reduce duration and frequency of training to allow the body to rest, recovery, and remain in a caloric surplus. 


Cultivate Positive Body Image

Although RED-S and amenorrhea may not always stem from disordered eating behaviors, it is important to note the impact of body image perception. Realize that the thinnest athletes are not always the fastest and strongest. Thank your body for what it can do on and off the field, including maintaining a predictable menstrual cycle. 


Treating RED-S and amenorrhea multidisciplinary, and may require help from a physician, dietitian, physical therapist or licensed therapist. (4) If you or a friend struggles with disordered eating patterns, excessive exercise, or display symptoms of RED-S you may want to seek professional help as soon as possible. If you are unsure of your energy needs, consult a registered dietitian. 



  1.  https://pubmed.ncbi.nlm.nih.gov/24620037/ 
  2. https://bjsm.bmj.com/content/48/7/491 
  3. https://nutritiondata.self.com/facts/finfish-and-shellfish-products/4114/2 
  4.  https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/treatments 

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