Talking to Your Doctor
Perhaps the only thing more frustrating than RED-S is trying to describe your situation to a doctor (or anyone else for that matter). Even if you know something isn’t right, your regular practitioner probably doesn't have the time or resources to help you explore the subtle underlying reasons why. Despite the fact that this is a frighteningly common issue in sport, athletes still represent a small sub-set of society and many doctors won’t see athletes with RED-S very often.
For female athletes, one of the biggest red flags surrounds your menstrual health. If you’re on the Contraceptive Pill – this can be tricky to assess. Not only because the Pill works by suppressing your natural hormones, rendering it near impossible to know whether you would get them if you weren't on the Pill, but also because, for some desperately frustrating reason, doctors may well reassure you this is an acceptable substitute. Even if you’re not on the Contraceptive Pill and are experiencing menstrual abnormalities, you’re likely to be told this is normal for an ‘athlete like you’.
This is why we urge you to start becoming an active participant in understanding your own health picture and getting to grips with what to ask and how to explain your situation. Just knowing there is a high possibility your menstrual health wont be looked into should help you prepare for ensuring that it is. Here’s our advice on how.
1. Prepare for your appointment by pulling together a brief overview of your history, including training load, nutrition and any illnesses or injuries. It can be helpful to ask for input from your coach, physio or anyone else you might work with. Since your appointment is probably only 10 mins, try to keep this concise.
2. Take some information with you. We would strongly suggest taking a copy of the RED-S clinical assessment tool to your appointment. The chances of your doctor ever having heard of RED-S is slim, so the sooner you can present them with the details, the better. If they aren't willing to read it or learn more, you may want to consider seeking a second opinion from some who is.
3. Consider going privately. If you are at all able to afford a private practice, we would highly recommend seeking the medical support from one of the options found here. For reasons outlined above, this is likely to be your best bet in terms of getting support from experienced experts who have seen thousands of athlete's with RED-S before. Try to see it as an investment in your health.
4. Make the most of what you've got. If you aren't able to go privately and your doctor doesn't have the capacity to look into your problem further, ask to be referred to special sports medicine practices. A sports medicine doctor is far more likely to a) know what RED-S is and b) be delve into it further if they don't.
5. Bone health. If you’ve experienced any bone related injuries (e.g. stress fractures), ask for DEXA scan (measuring hip and spine density) to assess for signs of low bone density or osteopenia. This is a crucial indicator of RED-S and it is essential to treat it early. While your doctor might seem skeptical as to whether you need one, a scan should be available to anyone considered by their GP to be at risk of developing osteoporosis.
6. Remember you are not 'normal'. Be aware that certain athletes don't fit within 'normal' reference ranges for blood tests. For example, endurance athletes typically require more than double the iron levels of less active individuals. So, we suggest asking your medical practice for the actual test results and taking it to a specialist appointment. Also be aware that while your weight may sit within the 'normal' range, RED-S is not restricted to those with a low body weight and can occur in any athlete, of any size, at any time.
7. Be as honest as possible with yourself and your doctor about your relationship with food and training. If you are certain you don't display any disordered eating or exercise behaviours (like those described here) then be open to the possibility that you are unintentionally under-fueling. If you’re anxious about eating too much or gaining weight to the detriment of your sports performance, then mention it. If you’re not sure whether you eat enough to sustain your training load or hormone levels, then tell them. And, if you think you might have a full blown eating disorder or exercise addiction then be honest about it.
You should never ever feel ashamed or embarrassed while talking to your doctor. They'll have seen and heard far worse things than whatever you’ll come out with, so this is your opportunity to have a judgement-free conversation with someone who can help. Seize it.
8. Trust your instincts. Chances are, you’re an athlete who would be willing to push through most things if it meant continuing your training. If you’re willing to seek some help about your situation, then you need to be equipped with how best to gain the advice you need whilst avoiding further frustration. Arm yourself with as much understanding of your own health picture as possible and don’t give up if you don’t get everything you need from your first appointment.