Women's Football Hub

Edited by Carolyn Kent Women’s Football Hub

Hypothalamic Amenorrhea (HA) is one of the most significant yet under-discussed health issues affecting female athletes today. Despite its prevalence, athletes, coaches, and clinicians often miss the early signs, leaving many young women at risk of long-term health consequences that extend far beyond the pitch. In a recent episode of the Women’s Football Hub podcast, Carolyn Kent spoke with Greta Jarvis, founder of the Center for Active Women, to bring clarity, nuance, and urgency to this conversation.

What is Hypothalamic Amenorrhea?

At its core, HA is the absence of a menstrual cycle. There are two types:

• Primary HA, where menstruation hasn’t started by age 15
• Secondary HA, where periods stop for at least 90 days in someone who previously had regular cycles

HA isn’t a disease in itself, it’s a message. The hypothalamus, a hormonal control centre in the brain, reduces reproductive hormones when it senses the body is under stress. That stress may come from under-fuelling, psychological pressure, or excessive exercise. The body shuts down functions that aren’t essential for survival. Reproduction, energy-demanding and long-term in nature, is one of the first to be paused.

This shutdown is not a sign of strength or athletic commitment, though many athletes have been told otherwise. It’s an alarm bell.

Why Female Footballers Are Particularly at Risk

Historically, sports like running, gymnastics, and dance were assumed to carry the highest risk of menstrual disturbance. But data is now showing that team sports including football carry significant risks. Football demands high volumes of running, strength, repeat sprinting, tactical thinking, and endurance. That workload requires substantial fuelling, yet many players aren’t eating enough to match the demands placed on them.

The schedule for many young athletes makes this even harder. School, training, matches, and part-time work can leave little room for regular meals. Add to that cultural pressure around appearance, social media ideals, and sometimes inconsistent nutritional support, and the risk of low energy availability becomes much greater.

The Hidden Danger: Bone Health and Performance Decline

Greta highlighted one of the most serious consequences of HA: its impact on bone density. During the teenage years and early twenties, athletes build the majority of their lifelong bone strength. When menstruation stops, oestrogen levels drop, and bones weaken silently. There are no immediate symptoms no pain, no warning.

The first sign is often a stress fracture.

For many players, this becomes the moment they finally seek help. By then, bone loss may already be significant.

Beyond bone health, low energy availability affects:

• Injury risk
• Illness frequency
• Cognitive function
• Concentration and decision-making
• Mood, anxiety, and motivation
• Recovery and adaptation to training

In a sport where tactical awareness, fast decision-making, and resilience are essential, HA can compromise performance long before an injury occurs.

Why Athletes Rarely Speak Up

The culture of silence around menstrual health remains a major barrier. Many athletes still feel embarrassed to raise the issue. Others think missing periods is normal for athletes, or even a sign that they’re training hard. Some are simply unaware anything is wrong.

Even when players do recognise an issue, they may not know who to tell. Coaches often feel unequipped to handle the conversation. Physiotherapists may hear information secondhand. Medical teams may not have specialist training in HA or RED-S.

This is where team culture becomes crucial. Open conversation, clear expectations, and a non-judgmental environment empower athletes to seek help early.

Recognising Low Energy Availability

Coaches and practitioners won’t always know when an athlete is missing their period, it’s invisible. But there are other signs to look out for, including:

• Fatigue that seems disproportionate
• Mood changes
• Increased hunger or avoiding eating around teammates
• Decline in performance despite consistent effort
• Repeated minor illnesses
• Difficulty recovering between sessions
• Recurrent injuries

These symptoms should never be dismissed as laziness, poor attitude, or a “rough patch.” They may be early signs of RED-S or HA.

Treatment and the Road Back to Full Health

Recovery from HA centres on reassuring the hypothalamus that the body is safe. This typically requires:

• Increasing overall energy intake
• Fueling before and after training
• Reducing training load temporarily
• Addressing psychological stress
• Prioritising rest and sleep

Greta emphasised that recovery timelines vary widely, but research suggests a typical window of three to five months when athletes go “all in” pausing structured training and focusing fully on fueling and rest.

This timeline can feel daunting for competitive athletes and for the staff supporting them. One of the biggest challenges practitioners face is deciding whether players can continue training or playing while recovering. For some, carefully managed participation is possible. For others, stepping away from sport temporarily is the safest path.

A helpful mindset shift is to treat HA as a physical injury. You would never send a player back onto the pitch with a broken leg simply because they felt okay. The same principle must apply here.

Prevention: The Real Opportunity

Preventing HA is far easier than treating it. Key steps include:

• Education for athletes, coaches, and parents
• Clear team messaging around fuelling and body image
• Encouraging menstrual cycle tracking
• Normalising discussions about menstrual health
• Ensuring athletes understand the demands of their sport and the energy needed to support it
• Avoiding comments about body shape, weight, or food choices

Simple practical measures, like designated snack areas in team environments, can make a surprising difference.

Creating a Supportive Future for Female Athletes

The conversation around menstrual health in sport is improving, but there is still a long way to go. The more we talk about HA, the more athletes can access the support they need before long-term damage occurs. Every coach, therapist, parent, and player has a role to play in breaking the silence and shifting the culture.

The message is clear:
A missing period is never normal for an athlete.
It is never something to be ignored.
It is always worth talking about.

This blog was created from the podcast with the assistance of AI, then fully checked and edited by the podcast host.

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