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Pippa's Story

I’ve been a runner for as long as I remember. With three older siblings and parents all international athletes in various sports, it's fair to say I came from a strong athletic gene pool. We were that family who dominated the school sports day, exercised a survival-of-the-fittest approach to meal times and did whatever it took to secure the front car seat. Thanks to my awesome sporting set-up, it didn’t take long for me to earn my place on the family podium, winning my first National Schools track race at 16 and representing Great Britain at the World Junior Championships soon after.

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After starting University life in Birmingham (UK), I was offered a chance to chase my athletics dreams across the pond to one of the best NCAA Division I Universities in America - an opportunity I seized with both hands. One the outside, I appeared to have it all: the scholarship, the sponsorships, the chance to do what I loved every single day. On the inside, 4000 miles away from my home and support system, I was fighting a losing battle with a problem I didn't even know existed.

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It had made no sense to me at the time. I’d been following my American University athletics scholarship programme for 18 months; training in exactly the same way as my teammates, eating healthier than ever in order to maintain my new ‘elite’ physique, and resting as much as my sport and studies allowed. From a simple training and conditioning perspective, nothing in my set-up had changed. Yet, over the recent months, a mysterious health condition characterised by a set of seemingly unconnected symptoms had started seeping into every aspect of my life.

It had started subtly with the odd cold that took too long to shift; unusually low moods muddled in with homesickness; a growing preoccupation with food, disguised as dedication to my sport; plummeting Ferritin (iron) scores that seemed to come from nowhere; and an inconsistent and unfamiliar form of fatigue. On some days I could get by just fine, keeping up on group runs and convincing myself that the problem in my head. On others, it was as though I was fighting against a brick wall—an out-of-body experience that no amount of determination could push past.

When I tried to describe my problem to a doctor, even I could admit I sounded insane. I’d spent the best part of a year visiting healthcare professional after healthcare professional, chasing around answers and achieving nothing other than galloping neurosis. I was willing to work with anyone and do anything it took to fix my problem, but no one could even offer a diagnosis, let alone advise on how to help.

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In the absence of any other abnormal test results, anemia seemed enough to justify the fatigue, but its inconsistency remained puzzling. And, after intravenously increasing my iron levels the exhaustion only intensified. On days where I was too tired to train I grew disproportionately anxious about eating for fear of gaining weight and losing the body composition I’d worked so hard to achieve. When I could run, I felt so weak that I’d push harder—fueled by a mounting pressure to perform and the absurd notion that this could all be driven by a lack of fitness.

With every set of ‘normal’ blood test results came increased confusion and with every visit to the doctor, a mounting sense of frustration. Since I was on the Contraceptive Pill, didn’t appear visibly skeletal, and my bone density scan results were acceptable, the Female Athlete Triad was never mentioned. And, since I wasn’t ready to admit to my escalating eating disorder (to myself, let alone another soul), no one probed further into my relationship with training and nutrition. So, despite knowing full well that something just wasn’t right and that this ‘something’ could be serious, I pushed on—continuing to sail miserably under the RED-S radar for a few frustrating years to follow.

Fast forward...

Fast forward a few years and I was finally starting to make sense of my experience. For years, I’d been a living, breathing, just-about-running example of RED-S, yet I, nor anyone else I'd ever worked with, had ever even heard of it. Despite the fact RED-S was a relatively new term (only introduced by the International Olympic Committee in 2014), it appeared the problem was one of indeterminate magnitude within the sports community. As I trawled through page after page of other athletes describing MY condition in words that could’ve easily been my own, it started to hit me that I wasn’t going insane or facing some sort of rare medical phenomenon after all, but a relatively straightforward one shared by countless others all over the world.

In the end, all it had taken was hearing others describing the shattering - yet subtle - symptoms I was facing in order to line up the pieces of my own RED-S puzzle. I'd spent years dismissing many of them in ignorance or denial, unable to believe that a competitive athlete like me could really be suffering from an energy-related issue; that someone who still ate three meals a day could be experiencing an eating disorder; that my 'fatigue' wasn't just a lack of fitness; that the Pill wasn't a suitable replacement for a period; or that my missing natural period was a critical indicator of my condition.

Once armed with the information I had needed about my problem, it was time to learn how to fix it. Falling into the hands of a wonderful psychotherapist helped me unravel years worth of disordered eating behaviours and my beyond-supportive boyfriend (now adored husband) helped me handle time away from my sport. Yet finding a doctor who would take my periods (or lack thereof) seriously was another matter. Since my blood tests, BMI and athletic appearance deemed me to be a typical healthy runner, I was repeatedly reassured that it was normal for ‘someone like me’ not to have periods. Worse still, I was encouraged to go back on the Pill and, with no remaining symptoms I could define, given the all-clear to get back into training.

If at that point, I’d had access to a RED-S specialist or sports doctor, returning to running would have been a far smoother and successful process. Instead, taking on this challenge alone sparked new frustrations and uncertainty. This experience was a journey (and still is), and one that I’m incredibly lucky to say resulted in a restored natural menstrual cycle, a repaired relationship with food, and an approach to exercise that is now more precious than any medal, race win or PB.

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Sadly, I am all too aware of how many others are now, where I was five years ago. I’ve come to realise how easily this can occur in anyone, at any time. I have seen what happens when it’s overlooked and how dangerous it is to dismiss the importance of periods or not too look beyond the surface level of ‘health’. I also understand how tricky it can be to talk about this issue. At the time, I felt so isolated by my experiences that I didn’t know where to begin describing it to others. Once I had finally begun made sense of it, I wasn’t sure I wanted to relive the awful experience, or that what I had to say about my own journey was important enough to share. As someone who has always been open to sharing personal information with others, talking about this felt tricky in a way I was unfamiliar with. I couldn't imagine anyone could understand what I had gone through emotionally, or how I could begin to justify experiencing this much personal trauma over something so trivial as sport.

Eventually, I came to realise that problems like RED-S thrive on isolation and the longer we keep quiet about them, the longer these issues fly under the radar. Thankfully, awareness is slowly building, with high profile athletes all over the world sharing their own experiences and growing research of this condition among both male and female athletes. While this short summary of my own story may sound all-too familiar to those already aware they have RED-S, I've shared it in even more detail here, in the hopes that it may help others reach out for the support they need.