Diagnosing RED-S

by Dr Nicky Keay

Blood Tests

There is not one, definitive “test” to confirm if someone has, or is at risk of developing, RED-S. This is because low energy availability can impact many systems in the body. So, the best way to find out is to “ask” your body. This means doing a blood test to look at a range of aspects of your internal health. A blood test is the “gold standard” for measuring these internal health markers, like hormones. However, hormones themselves are complex, so it is often necessary to check an interrelated “family” of hormones.

Fortunately, a RED-S screening blood test has recently been developed by medical experts which includes all the essential markers to assess the likelihood of low energy availability. You can access them here - the Male RED-S Profile and Female RED-S Profile should cover all the essential bases. Then, you can take your results along to your first appointment with a RED-S specialist, saving you time and money when it comes to getting the answers you need.

Female Athletes

Since female hormones vary over the menstrual cycle with personal timing, the situation can be a little more complex. For female athletes who are having natural periods, artificial intelligence can be used to assess personal hormone fluctuations using MyFORM™. This can detect early warning signs of low energy availability on female hormones and be used as a monitoring tool to prevent periods stopping. Mapping female hormones is also useful for athletes recovering from RED-S to assess return of female hormone function. For older masters athletes, this clinical tool can also help distinguish perimenopause from low energy availability. An article in the British Journal of Sports Medicine, “Hormone Intelligence for female athletes, dancers and exercisers”, explains this in more detail here.

For female athletes not having periods (amenorrhoea) it is essential to establish why. Regardless of how much exercise you perform, periods are a crucial natural indicator of health. Some athletes are incorrectly and unhelpfully told that it is “normal not to have periods”, or that their blood test results are “normal”. However, it is never normal not to have periods unless you are a child, pregnant or menopausal, which is why carrying out the right tests and having them assessed by a doctor with expertise in RED-S is so essential.

You can read an article in the British Journal of Sports Medicine explaining, “What’s so good about menstrual cycles?” here.