Beyond the Cycle: Protecting and Empowering the Female Athlete
A call for sex-specific, female athlete-centred care for precision, protection and performance
When we protect the health of the female athlete, we do not reduce performance -
we unlock it.
Women athletes are stronger, faster and more visible than ever before. Yet, for too long, sports science and sports medicine have approached female athletes through models largely designed around male physiology. The result is a gap in understanding, prevention and care.
The female athlete is not a smaller version of the male athlete. She has distinct endocrine, metabolic, biomechanical, nutritional, psychological and oral-systemic health needs. Recognising these differences is not about limitation. It is about precision, protection and performance.
A woman athlete's physiology is influenced by fluctuating ovarian hormones, particularly estrogen and progesterone. These hormonal changes can affect energy use, thermoregulation, recovery, ligament laxity and soft-tissue response. Across the menstrual cycle, training tolerance, injury vulnerability and recovery patterns may vary. This makes it important for coaches, physicians, nutritionists and therapists to understand the athlete as a dynamic system rather than a fixed template.
At the same time, menstrual-cycle awareness should be individualised, not rigidly prescribed. Not every athlete responds in the same way, and current evidence continues to evolve. The practical goal is to create a safe environment where symptoms, recovery, nutrition, sleep and training load can be monitored without stigma, and where athletes feel comfortable discussing menstrual health as part of performance care.
One of the most important concerns in female athlete health is Relative Energy Deficiency in Sport, or REDs. When energy intake does not match training demands, the consequences can go far beyond fatigue. REDs can affect menstrual function, bone mineral density, hormonal balance, immunity, metabolism, mood and long-term career sustainability. Early recognition is essential, especially in young athletes, aesthetic sports, endurance sports and weight-category sports where under-fueling may be normalized.
Biomechanics also deserves special attention. Factors such as pelvic structure, Q-angle, muscle activation patterns and hormone-related ligament laxity can influence lower-limb movement. These differences may contribute to a higher risk of injuries such as anterior cruciate ligament injuries. This does not mean women are fragile; it means training must be intelligent. Customized neuromuscular conditioning, strength development, landing mechanics, balance training and sport-specific movement screening can significantly improve resilience.
Oral health is another often overlooked part of female athlete care. Hormonal changes may influence gingival inflammation, periodontal response and oral tissue sensitivity. In addition, frequent intake of sports drinks, energy gels and high-carbohydrate fueling products can increase the risk of dental erosion and caries. Oral inflammation is not isolated from the rest of the body. It may contribute to systemic inflammatory burden, affecting comfort, recovery and overall wellbeing. This makes the sports dentist an important member of the multidisciplinary team.
Psychological health must also be central to the conversation. Women athletes may face unique pressures related to body image, selection, performance expectations, menstrual health, injury recovery and social judgement. Disordered eating, stress, anxiety and under-reporting of symptoms can silently affect both health and performance. A supportive environment where athletes can speak openly is as important as any training program.
The way forward is not fragmented care, but integrated care. The female athlete benefits most when the team works together: sports physicians, dentists, nutritionists, physiotherapists, strength and conditioning coaches, psychologists, gynecologists and coaches. Menstrual health monitoring, nutrition planning, injury-prevention protocols, oral-systemic screening and psychological support should become routine parts of athlete development.
Empowering women athletes means moving beyond generic protocols. It means listening to their bodies, studying their physiology, respecting their challenges and designing systems that help them thrive.
The future of sport will not be built by asking women athletes to fit into male models. It will be built by creating science, care and performance pathways designed for them.
She is not a smaller athlete. She is a complete athlete - and her care must be complete too.
References
1. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994.
2. Angelidi AM, Stefanakis K, Chou SH, et al. Relative Energy Deficiency in Sport (REDs): endocrine manifestations, pathophysiology and treatments. Endocr Rev. 2024;45(5):676-708. doi:10.1210/endrev/bnae011.
3. Verhagen E, Towlson C, Elliott-Sale KJ, et al. UEFA consensus statement on menstrual cycle tracking in female football. BMJ Open Sport Exerc Med. 2025;11(3):e002769.
4. Crossley KM, Patterson BE, Culvenor AG, et al. Female, woman and/or girl Athlete Injury Prevention (FAIR) practical recommendations: International Olympic Committee (IOC) consensus meeting held in Lausanne, Switzerland, 2025. Br J Sports Med. 2025;59(22):1546-1559. doi:10.1136/bjsports-2025-110889.
5. Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The impact of menstrual cycle phase on athletes' performance: a narrative review. Int J Environ Res Public Health. 2021;18(4):1667. doi:10.3390/ijerph18041667.
6. de la Parte-Serna AC, Monticelli F, Pradas F, Lecina M, Garcia-Gimenez A. Gender-based analysis of oral health outcomes among elite athletes. Sports. 2025;13(5):133. doi:10.3390/sports13050133.
Submitted by:
Dr Reena Kumar
BDS, MDS(Orthodontics), Fellow, Sports Dentistry, Fellow Dental Sleep Medicine, Certified Team Dentist (ASD-USA), Certified Tobacco Cessation Specialist, Former Principal Dean & Post Graduate Chair Orthodontics, DJ College of Dental Sciences & Research, Academic Director, Indian Academy of Sports Dentistry (IASD-IDA), Regional Clinical Adviser, Special Smiles, Special Olympics (Asia Pacific), Member Affiliate Committee, Academy of Sports Dentistry (ASD-USA), Member, Education & Scientific Committee, European Association for Sports Dentistry (EA4SD), International Founding Member, Leading Women of Sports Medicine & Dentistry (LWSMD), Editor-in -Chief, International Journal of Sports Dentistry & Performance Science (IJSDPS), Editorial Board– Journal of Sleep Medicine, Journal of Special Care Dentistry, Section Editor -Journal of Indian Orthodontic Society