RED-S & The Female Athlete

RED-S symptoms were prevalent in up to 80% of a female athlete cohort studied in Australia.

The 2014 IOC Consensus Statement redefined the female athlete triad as ‘relative energy deficiency in sport’ (RED-S).  RED-S is a syndrome that results in impaired physiological function of the reproductive, gastrointestinal, cardiovascular, endocrine, metabolic, psychological, skeletal, haematological, and immunological systems.  Low energy availability in athletes may be driven by intentional or inadvertent restriction of dietary energy (e.g. misguided approaches to body composition, inadequate energy intake for training or competition etc).  Subsequent consequences of RED-S may have a negative impact on training, performance and health in female athletes.

In response to the IOC’s call for further research on RED-S, the Australian Institute of Sport (AIS) Female Performance & Health Initiative recently investigated the prevalence of RED-S in female athletes. The study, which was published in the British Journal of Sports Medicine, included 112 elite and pre-elite female athletes across multiple sports (Athletics, Boxing, Rowing, Triathlon etc).  The female athletes were assessed for symptoms and prevalence of RED-S through a variety of clinical methods such as biochemical markers, psychiatric interviews, DXA and resting metabolic rate assessments. 

The AIS study found that RED-S symptoms were prevalent in up to 80% of the female athlete cohort.  Specifically, Rogers et al (2020) highlighted that there was a high prevalence of impaired function of physiological systems (immunological, gastrointestinal & haematological) even though all the female athletes were undertaking training and competition at the time of the study.  Therefore, as female athletes can train (and compete) with impaired physiological function in one or more systems, the researchers advised for clinical attention of RED-S in female athletic populations. 


Dr Kris Beattie is a Lecturer in Exercise Physiology in the Department of Sport and Health Sciences in AIT.  Kris’s research interests include the physiology of strength, speed and endurance training and athlete assessment.



Rogers, M.A., Appaneal, R.N., Hughes, D., et al (2021).  Prevalence of impaired physiological function consistent with Relative Energy Deficiency in Sport (RED-S): an Australian elite and pre-elite cohort.  British Journal of Sports Medicine; 55: 38-45.