Relative Energy Deficiency in Sport (RED-S) is a syndrome of impaired health and performance that occurs as a result of low energy availability (LEA). Whilst many health effects associated with RED-S have been widely studied from a physiological perspective, further research exploring the psychological antecedents and consequences of the syndrome is required. Therefore, the aim of this study was to qualitatively explore athlete experiences of RED-S. Twelve endurance athletes (female n= 10, male n= 2; M age = 28.33 years) reporting past or current experiences of RED-S, associated with periods of LEA, took part in semi-structured interviews designed to explore: contexts and mechanisms underpinning the onset of RED-S; the subjective experience of RED-S; and contexts and mechanisms influencing “recovery” from RED-S. Regardless of how RED-S was initiated, all athletes experienced a multitude of physiological impairments, accompanied by significant psychological distress. This paper contributes novel understanding of the complex interplay between physiological and psychological components of RED-S from the perspective of information-rich cases. The findings suggest that system-wide educational prevention and awareness interventions are vital for athletes and support personnel, such as coaches, parents, dieticians, psychologists, and sports medicine staff.

Certain nutritional practices may reduce menstrual-related symptoms, but there is no current consensus on what foods/supplements are sufficiently evidenced to warrant promotion to reduce menstrual symptoms of naturally menstruating individuals. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two online databases were searched for published experimental studies that investigated the effects of foods/supplements on menstrual-related symptoms in eumenorrhoeic women. Extracted data and study characteristics were tabulated and grouped on the basis of food/supplement intervention and dosage compared with UK dietary reference values (DRV) and safe upper limits. In total, twenty-eight studies and twenty-one different foods/supplement interventions were included in the review. None of the studies reported a negative effect on symptoms, twenty-three reported a positive effect and five had no effect. Eighteen different ways of measuring menstrual-related symptoms were described across the studies. The results indicate a lack of consistency in studies to confidently provide information to eumenorrheic, naturally menstruating women regarding the use of foods/supplements to reduce menstrual symptoms. Determination of menstrual-related symptoms varied along with dose and duration of food or supplements provided. These data provide some evidence for the use of vitamin D, calcium, zinc and curcumin to reduce menstrual-related symptoms of non-hormonal contraceptive users, on an individual basis; however, further investigation is required prior to implementation with a focus on robust protocols to determine and measure changes in menstrual symptoms, with interventions adhering to DRV and safe upper limits.

This research investigated the implications that the COVID-19 pandemic had on the menstrual cycle and any contributing factors to these changes. A questionnaire was completed by 559 eumenorrheic participants, capturing detail on menstrual cycle symptoms and characteristics prior to and during the COVID-19 pandemic lockdown period. Over half of all participants reported to have experienced lack of motivation (61.5%), focus (54.7%) and concentration (57.8%). 52.8% of participants reported an increase in cycle length. Specifically, there was an increase in the median cycle length reported of 5 days (minimum 2 days, maximum 32 days), with a median decrease of 3 days (minimum 2 days and maximum 17 days). A lack of focus was significantly associated with a change in menstrual cycle length (p = 0.038) reported to have increased by 61% of participants. Changes to eating patterns of white meat (increase p = 0.035, decrease p = 0.003) and processed meat (increase p = 0.002 and decrease p = 0.001) were significantly associated with a change in menstrual cycle length. It is important that females and practitioners become aware of implications of environmental stressors and the possible long-term effects on fertility. Future research should continue to investigate any long-lasting changes in symptoms, as well as providing education and support for females undergoing any life stressors that may implicate their menstrual cycle and/or symptoms.

The purpose of this study was to determine symptom severity and frequency in female exercisers and athletes from a diverse range of sports who have a menstrual cycle (MC) or use hormonal contraceptives (HCs). An additional aim was to explore the perceived impact of MC/HC use upon exercise and sport performance. In total, 604 self-identifying female athletes and exercisers (M = 29.4 years, SD = 9.0) from 85 sports/activities completed a survey which included: sport/exercise participation, bleeding characteristics, HC use, symptom severity/frequency, symptom management strategies, menstrual product use, and perceived impact of MC/HC use on exercise performance. The data were subject to mixed-methods analysis. Over one third (n = 225; 37.25%) of participants reported current HC use. Ninety-five percent (95.36%) of participants experienced symptoms related to MC or HC use. Physiological, psychological, and affective symptoms were all among the most prevalent. The most frequently noted severe and very severe symptoms for all participants, MC and HC users, were abdominal cramps (36.92%, 39.32%, and 32.89%, respectively), mood changes (26.16%, 25.07%, and 28.00%, respectively), and tiredness (25.33%, 25.59%, and 24.89%, respectively). Symptom impact was self-managed through medical and/or other (cognitive/behavioral) strategies. Qualitative content analysis of the data produced four overarching themes: (a) the impact of symptoms, (b) menstrual stigma and taboos, (c) protective factors, and (d) coping strategies. In conclusion, menstruation is a multifaceted, unique experience that impacts upon sport/exercise performance. Practitioners should consider athletes’ distinct needs, including the frequency of occurrence and severity of their symptomatic experiences, when facilitating menstruation-supportive training, avoiding a “one-size fits-all” approach.

To date, no research has explored the effects of low energy availability on cognitive performance using dietary and exercise regimens relevant to athletes. Twenty female participants (10 eumenorrheic, 10 oral contraceptive [OC] users) completed three 3-day conditions: 1) controlled-balanced energy availability without exercise (BAL; 45 kcal·kg lean body mass [LBM]⁻¹·day⁻¹); 2) diet-induced low energy availability without exercise (DIET; 15 kcal·kg LBM⁻¹·day⁻¹); and 3) exercise-induced low energy availability (EX; 15 kcal·kg LBM⁻¹·day⁻¹, including 30 kcal·kg LBM⁻¹·day⁻¹ treadmill running at 70% maximal oxygen uptake). A cognitive test battery was completed before and after each 3-day condition. Mental rotation test accuracy improved in the BAL condition, but there was a decline in accuracy in the EX condition (BAL, +2.5%; EX, −1.4%; P = 0.042, d = 0.85). DIET (+1.3%) was not different to BAL or EX (P > 0.05). All other measures of cognitive performance were not affected by condition (P > 0.05) and OC use did not affect cognitive responses (P > 0.05). Accuracy in the mental rotation test was impaired when low energy availability was induced through increased exercise energy expenditure. All other aspects of cognition were unaffected by 3 days of low energy availability through diet or exercise. OC use did not mediate the effect of low energy availability on cognition. Novelty: Cognitive function was not affected by 3 days of diet-induced low energy availability. Only spatial awareness was impaired during 3 days of exercise-induced low energy availability. Reproductive hormones affected spatial awareness independent of energy availability.