"That's Normal for Athletes": Why I Didn't Accept It

I knew it wasn't normal

My daughters are athletes. Our days were filled with practices, lifting sessions, matches, tournaments, and travel across the country and around the world. Sports parents, I know you know how it can get.

Training got more intense, and we got busier. At some point, my daughters started skipping periods. And I never knew, because I never asked.

The expert in the room

Here's the embarrassing part. I'm a reproductive psychiatrist. I talk about periods and hormones with my patients all day, every day. And I still missed it in my own kids.

When I finally did ask, I took them to doctors. Several, actually. And more than once, I heard the same thing:

"That's normal for athletes."

That didn't sit right with me. How could skipping periods for months, even years, be normal?

What I found: REDs

So I went and learned everything I could. That's when I found REDs: Relative Energy Deficiency in Sport.

REDs happens when an athlete isn't taking in enough energy to cover both their training and everything else the body needs to function. Experts call this low energy availability. The body adapts by cutting back on systems it considers optional in the short term, and reproductive hormones are often among the first to go.

It's not just about periods. Low energy availability can affect:

• Bones: lower bone density and a higher risk of stress fractures
• Injury and recovery: more injuries and slower healing
• Mental health: mood, irritability, anxiety, and a strong two-way link between REDs and mental health
• Performance: reduced training response, strength, and endurance
• Many other systems, including metabolism, the heart, the immune system, and gut health

And it's not always about dieting or an eating disorder. Low energy availability can happen unintentionally, when a busy athlete simply doesn't eat enough to keep up with how much they're training. That's what a packed schedule of practices, lifts, and travel can quietly do.

REDs isn't only a female issue either. Male athletes can develop it too. In boys and men, there's no missed period to act as a warning sign, so it can be even harder to spot.

What the IOC says

The International Olympic Committee first described REDs in 2014. In 2023, it released a major updated consensus statement in the British Journal of Sports Medicine. The update was written by an international team of experts in sports medicine, nutrition, physiology, and psychology.

The 2023 statement draws on more than 170 new studies published since the previous update. It highlights:

• More evidence on the connection between REDs and mental health
• The growing role of low carbohydrate intake
• More data on how REDs affects male athletes
• A new clinical tool to help doctors detect and diagnose REDs and decide whether an athlete is safe to train and compete
• Prevention and treatment principles, with fueling at the center

In other words, the world's leading sports medicine experts treat this as a real and significant risk to athlete health and performance. It's not something to wave off.

What I want sports parents to know

Missing periods is not a normal side effect of training hard. It's a sign the body may not be getting enough fuel. It deserves a proper evaluation, not reassurance.

What to do:

1. Ask. If you have a daughter in sport, ask about her periods, even if it feels awkward. Don't wait for her to bring it up.
2. Take missed periods seriously. If periods stop, become irregular, or haven't started when expected, get it checked.
3. Find the right doctor. Look for a sports medicine physician or a clinician familiar with REDs. If you hear "that's normal for athletes," it's okay to get another opinion.
4. Look at fueling. Busy schedules make it easy to under-eat without meaning to. A sports dietitian can help match food to training load.
5. Watch the whole picture. Frequent injuries, stress fractures, fatigue, mood changes, or a performance plateau can all be signs too, in girls and boys.

I don't want you to miss it

I missed it at first, even as the expert in the room. I don't want you to.

This experience is what brought me to sports psychiatry. I wanted to understand what was happening to my own kids. And now I'm fascinated by athlete mental health and mental performance, and I'm sharing everything I've learned along the way.

References

This post is for educational purposes only and is not medical advice.

1. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–1097. doi:10.1136/bjsports-2023-106994
2. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491–497. doi:10.1136/bjsports-2014-093502