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Signs & Symptoms

Whilst every case of RED-S is complex and unique, most athletes experience some combination of the symptoms below. The RED-S CAT™ Clinical Assessment Tool (CAT) can be a useful resource for exploring these further.

Physical signs

  • Unexplained fatigue/lacking energy
  • Recurrent or persistent injuries (including bone and soft tissue injuries)
  • Recurrent or persistent illness
  • Difficulty adapting to training
  • Performance stagnation or deterioration

How to spot / monitor them

  • Note down anything you’ve been experiencing: illnesses, injuries, niggles, inconsistencies in training, fatigue, changes in mood, difficulty adapting to training or generally poor performances
  • Consider keeping a training diary to keep track of your daily exercise activity and make a note of how you're feeling day-to-day
  • Consider logging your food and exercise for a few weeks or months to help assess your energy intake and expenditure, but please see 'challenges to be aware of' below before deciding whether this is a good idea for you
  • If you've experienced a bone-related injury (or multiple) and haven’t already had a DEXA scan, try to do so via your GP or sports doctor (head here and here for guidance)

Physical signs

  • Secondary amenorrhea (missing or irregular periods having previously had a menstrual cycle)

How to spot / monitor them

  • Consider whether you’ve experienced any menstrual disturbance or missing periods over the past few months - please note, a withdrawal bleed from an Oral Contraceptive Pill is NOT a period. I know it may look and feel similar, but it is entirely different and if you’re a female experiencing other signs of RED-S, it’s more than possible your natural period would be missing. If you are showing subtle signs of menstrual disturbance e.g. a longer length of time between periods, then tracking your symptoms via a mobile app like FitrWoman can be really helpful.

Physical signs

  • Primary amenorrhea in females (not starting their period by the age of 15)

How to spot / monitor them

  • If you're over 15 years old and haven't had your first period, you must see a doctor to investigate possible reasons for this before looking into RED-S further

Physical signs

  • Low libido (in males and females)

How to spot / monitor them

  • Keep tabs on your sex drive (if you're of the age to have one) to check for signs of hormonal disruption. Make a note on whether it’s been lower than usual or absent completely. This is a sign your endocrine system is lacking in fuel to direct towards 'non-essential' functions

Physical signs

  • Iron deficiency

How to spot / monitor them

  • Ask your GP to check your ferritin levels and make sure when you ring up for the results, you are given the actual number rather than be told you’re in the ‘normal range’ – since this differs for athletes (more advice on this here)

Physical signs

  • Scoring low on an energy availability scale

How to spot / monitor them

  • Head here for more details

Psychological signs

  • Increased irritability/poor concentration/depression
  • Unwillingness to take rest days (including continuing to train when in pain or unusually fatigued)
  • Anxiety around meal times or avoidance of eating certain food groups e.g. carbs/fats
  • An irrational fear of weight gain
  • Feeling the need to ‘earn your food’
  • Body dissatisfaction: untrue belief that changing body size/shape will result in being better or happier

Try to answer these questions as accurately and honestly as possible

  • How do you feel about your weight?
  • Are you trying to lose or gain weight?
  • Do you think that losing weight could improve your performance?
  • Are there certain foods you try to avoid or eliminate from your diet?
  • Do you feel a need to exercise to ‘earn’ your food, eating less on rest days than you would on training days?
  • Do you try to avoid rest days from training or feel an urge to make them ‘active’ rest days?
  • Do you think about food a large percentage of the time?
  • Do you find it hard to sit down and truly rest?
  • Do you find yourself sticking rigidly to exercise plans – even if it means ignoring your bodies signals e.g. when you’re tired or in pain?
  • Do you think you might have an eating disorder?
  • Do you think you display some disordered eating behaviours?