Aspire guide
Female Athletes
Female Athletes manual
RED-S Warning Signs & Prevention
Recognize Relative Energy Deficiency in Sport before it causes lasting damage.
Why this matters
Recognize Relative Energy Deficiency in Sport before it causes lasting damage.
Read time
4 min
Audience
Athlete + Coach + Parent
Use it for
Female Athletes
Start here
RED-S is not a phase to outwork.
Coach prompt
I care more about your health than the next workout.
Print & share
Printable handout preview
One-page sheet
RED-S Warning Signs & Prevention
Read time
4 min
Audience
Athlete + Coach + Parent
Start with the printable
RED-S is not a phase to outwork.
Quick reference map
Use the guide like a structured handout
Protocol
Start here
Jump to this section and use it like a coaching quick reference.
Callout
What to watch before it becomes a crisis
Jump to this section and use it like a coaching quick reference.
Overview
Performance and training
Jump to this section and use it like a coaching quick reference.
Timeline
Food and behavior
Jump to this section and use it like a coaching quick reference.
In the library
Format
Read the full ebook here, then jump to the one-page handout when you need the shareable version.
Best use
Open the sections you need, print the handout, then send both to coaches, parents, or athletes.
Quick start
Start here
Recognize Relative Energy Deficiency in Sport before it causes lasting damage.
Start here
RED-S begins when fuel does not cover training plus normal body function
- The body pays for underfueling by scaling back hormone function, bone building, recovery, and immunity.
- This is not just about food choices. It is about total energy availability across the week.
Coach red flags
Look for clusters, not isolated bad days
- Constant exhaustion, stalled progress, repeat illnesses, or slower recovery between sessions are common first signals.
- Recurring bone stress injuries or pain in low-risk areas should raise the urgency immediately.
Vital sign
Menstrual function is one of the clearest windows into adequate fueling
- A regular cycle is not a performance inconvenience. It is a health signal.
- Missing three or more cycles, cycles longer than 35 days, or no cycle by age 15 deserve referral. Use the referral chain inside a school for who to tell, and in what order.
Watch for
What to watch before it becomes a crisis
Performance drop-offs, stress injuries, menstrual disruption, and persistent fatigue rarely show up as isolated issues.
- Under-fueling is often quieter than coaches expect.
- The best first move is usually a food-plus-screening conversation, not a supplement guess.
- Parents and coaches should hear the same short message.
Performance and training
- Workouts feel harder than they should
- Recovery between sessions gets worse, not better
- Pace or power declines even while training load stays high
Food and behavior
One bad week does not equal RED-S.
Skipping meals or cutting carbs while training hard
Fear around "bad" foods
Fixation on body composition
Guilt after eating or anxiety about fueling
Refer now if any of these are true
RED-S is usually best handled with a team: sports medicine, sports dietitian, and mental-health support when needed.
Missing 3 or more cycles after previously regular periods
A stress fracture or repeat bone-stress history
Rapid weight loss, food restriction, purging, or extreme food fear
Performance decline plus fatigue that does not improve with rest
Mood changes or anxiety that are clearly affecting eating and training
Quick checklist for the next conversation
If two or more of those are off, the next move is referral, not more motivation.
Is the athlete eating before practice?
Is there a real lunch and an afternoon snack on school days?
Has training gone up without intake going up with it?
Have periods changed?
Has there been a recent stress reaction, stress fracture, or persistent shin pain?
Go deeper next
- When recovery starts sliding, look at total intake: Adolescent Runner Nutrition
- If iron and fatigue are part of the picture: Iron Questions: A Food-First, Clinician-Routed Guide
- If you need help deciding when to escalate: When to Seek Professional Help
Quick reference
Key targets to keep in view
Use these as planning anchors when you turn the manual into weekly actions.
Well-fueled
enough energy for training and health
Treat this as a decision anchor, not a trivia stat.
Risk zone
under-fueling the training load
Treat this as a decision anchor, not a trivia stat.
Immediate referral
2+ major red flags
Treat this as a decision anchor, not a trivia stat.
Coach takeaways
Coach reminder
These are the cues worth repeating before the week gets busy.
What to ask
Has your period changed, have you had stress injuries, and do you feel like recovery is getting worse?
Are you skipping meals, restricting carbs, or feeling anxious around food?
What to stop
Stop body comments, public weigh-ins, and praise for visible restriction.
Do not tell an exhausted athlete to train through obvious RED-S signs.
Who belongs on the team
Sports medicine physician, sports dietitian, parent or guardian, and mental health support when needed.
Early referral protects both performance and long-term bone health.
What to do next
Use it this week
I care more about your health than the next workout.
Source topics
Mountjoy M, Ackerman KE, Bailey DM, et al. IOC consensus statement on Relative Energy Deficiency in Sport (REDs): 2023 update. Br J Sports Med. 2023;57(17):1073-1097. • Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J Acad Nutr Diet. 2016;116(3):501-528. • Clénin GE, Cordes M, Huber A, et al. Iron deficiency in sports: definition, influence on performance and therapy. Swiss Med Wkly. 2015;145:w14196.