While the physiological, psychosocial and obstetric health benefits of exercise are well established, there is less awareness of the health implications of long-term intense exercise. Relative Energy Deficiency in Sport (RED-S) represents a complex inter-relationship of health consequences that arise as a result of low energy availability. The common presentations of elite sportswomen to gynaecologists include menstrual abnormalities, delayed menarche, subfertility and urinary incontinence. Gynaecology input, including screening, recognition and management, can minimise the risk of consequences and optimise health, fertility and performance.
Learning objectivesTo understand the short-term and long-term impacts of elite sport on gynaecological health.To describe the gynaecologist's role in the screening, investigation and management of elite sportswomen.
Ethical issuesElite sportswomen should be fully informed about the potential health implications of long-term vigorous exercise to enable autonomous decision making. While it is the role of the coach to optimise performance, it is the physician's responsibility to prioritise the health of sportswomen, even if this is at the expense of performance level, ability to train or competition rules. To reach an elite level, training is often necessary from childhood; however, many girls will not have capacity, and the health consequences of RED-S can cause them irreversible problems.