When Dame Laura Kenny spoke last year about the number of sportswomen she knew who had struggled to get pregnant, it was one of the more sobering interviews Britain’s golden girl of cycling would give before calling time on her glittering career.
“We’ve all heard of Red-S – females losing their periods. You’re not going to be able to fall pregnant if you haven’t got a period,” Kenny, Britain’s most decorated female Olympian, said.
“It’s a really unhealthy lifestyle that these females can’t have kids, and it’s actually really sad.”
As she cradled her second son, Monty, Kenny went on to reference Red-S three times, describing it as “really dangerous” because of how it could severely impact a woman’s fertility. Kenny might have been well versed in the condition over the course of her athletic life, but knowledge of it across the sporting landscape remains worryingly scarce.
It stands for Relative Energy Deficiency in Sport and is a syndrome that has derailed – and continues to do so – the dreams of many sportswomen. Men can also experience the condition, which an athlete develops when they overtrain and under-fuel for a prolonged period.
Sometimes it can be unintentional – athletes simply do not realise they are eating insufficiently for the amount of energy being burnt. Other times, it can be exacerbated by “sports culture” and the perceived short-term performance gains of limiting calorie intake.
As well as affecting sports performance, the complex condition can impact a range of bodily systems, from reproductive health, cognitive function to impaired immunity. In women, one of the warning signs is the absence of periods, meaning the body has chronically low levels of oestrogen, the female sex hormone which is also crucial for bone density. Men can experience low testosterone and low libido.
‘We don’t think you should be doing sport’
Three years ago, Telegraph Sport interviewed two promising British athletes whose lives were unexpectedly turned upside down after they were diagnosed with Red-S. Bobby Clay and Issy Morris, a middle-distance runner and triathlete respectively, were national age-grade athletes with their best years ahead of them before discovering they had the condition.
Clay, a former European junior champion middle-distance runner, was a precocious talent who made Great Britain’s under-20 team when she was just 15. But three years later, her career came to an abrupt halt after she fractured her foot while kicking off the side of a swimming pool doing a tumble-turn. She was diagnosed with osteoporosis and put on hormone replacement therapy – usually used by older women to relieve the symptoms of the menopause – for more than a year to artificially induce periods.
Clay’s reproductive health has since improved. For the past two years, she has been having natural periods on a regular basis, but the invisible battle scars of Red-S are still there. “Bone-health-wise, I don’t think there’s been any improvement, but I’m in blissful ignorance now,” Clay says.
“I was working so hard with my rehab, everything in my body was telling me I was doing the right thing but I’d have a scan and a medical professional would say to me, ‘We don’t think you should be doing sport.’ The scores were never getting better, and I thought, ‘Do I really need this information?’”
Although she is still susceptible to stress fractures, Clay has her own holistic markers of success. Last summer, she completed an ultra-marathon, which provided the closure she craved seven years after her weakened bones gave up on her. “I never got to say goodbye to athletics,” she says. “One minute I was racing and on top of the world, and the next everything was gone. When I was training for the ultra, for the first time in my life running was a release and not a pressure. I was proud of just getting to the start line. Fuelling on my long runs became so normal. Food became a joy.”
Clay no longer wears a watch when she runs. Pace and other metrics have paled into insignificance. A near-fatal incident last October – when she was hit by a car while out on a run – also confirmed the 27-year-old’s body was more robust than scans might give her credit for. “Thank God my body withstood that,” reflects Clay, who fractured her lumbar spine in the accident. “The only reason it did, I’ve been told, was because I’ve spent so much time rehabbing and I’ve done the work in the gym. My musculoskeletal structure kept me together.”
