Female athlete health

Body image is how you think and feel about your body, not just how it looks. It can change every day because of:

• your mood and stress
• your relationships with other people
• what you see on social media
• feeling like you need to look a certain way in sport

You’re not alone. According to the Female Athlete Health Report 2023:

• 74% of female athletes have felt like they “don’t look like athletes”
• 43% of female athletes say their body image has made them enjoy training less 

Athlete advice

Your body is so much more than how it looks. The part of your body you like the least may be the part that powers your sport and health the most. Different body types and shapes are a strength in different sports.

Try asking yourself:

• what does my body allow me to do?
• how have I improved - am I stronger, faster, more skilled?
• how does this body part help me perform - for example, “Would I be as explosive without strong thighs?”
• would I trade performance for a so-called ‘ideal’ look? 

Social media

Social media can play a significant part in negatively affecting your own body image. If you engage with content that focuses on the way you look, you’ll be shown more of that content. Try:

• unfollowing accounts that focus on the way people look
• following accounts that talk about performance, health, passion or real bodies
• avoiding posts like ‘What I eat in a day’, as these often lack context or contain misinformation
• watching this Instagram reel of England rugby player, Sarah Bern, celebrating her strong body

Some good accounts to follow include:

@swpnutrition

@ellekellynutrition

@thenutritiongem

@alexlight_ldn

@clara_theexerpsych 

Coaching advice

Focus on performance, not body shape. Athletes’ body shapes and weight change throughout their lives. Due to growth, development and training adaptations.

You can try:

• using objective performance metrics, not assumptions based on body shape
• recognising natural weight and shape fluctuations
• adjusting body composition goals to individuals - avoiding comparisons between athletes
• avoiding comments that emphasise weight or restrictive eating
• focusing on supportive comments about health, energy and balance 

The pectoral muscles behind your breasts do not provide much support to your breasts. Skin is the only structure holding the breast tissue. So if you do physical activity with poor breast support, your upper body muscles have to work harder. This requires more energy, making exercise feel harder and affecting the way you move.

Wearing a correctly fitted sports bra can:

• reduce risk of injury to breast tissue and other parts of the body
• prevents breast movement from being a distraction or blocker to training and performance
• make breathing during exercise feel easier
• help you use less energy, making exercise feel easier

Breast Health Australia have an online tool to help you choose the best sports bra styles for your body.

Menstrual cycles are natural and can be a sign of health. But they can also get in the way of daily activities and training. 78% of teenage females avoid sport when on their period. We want to change this statistic. We want to ensure you get the most from your cycle and your training.

Visit NHS Wales for information about managing symptoms related to your menstrual cycle.

The nutrition section on this page also contains advice related to the menstrual cycle.

Injuries

• If you find you're more prone to injury at certain points in your cycle, you can try:
• spreading high-intensity sessions evenly across the week
• being aware that at the mid-point of your cycle you’re more likely to be prone to injury
• working out what intensity level of training is best for you at different points in your cycle
• always warming up before and after training
• adding collagen and vitamin C to your diet to support with repair and recovery 

Fatigue and reduced coordination

You may experience fatigue, feelings of clumsiness or reduced coordination during your cycle. If you do, you can try:

• increasing the length of your warm-up the week before and the week of your period
• monitoring how much training you are doing the week before your period to avoid fatigue
• increasing rest between sets of exercises if needed
• working on reaction times pre-training
• including carbohydrates during any training you do to see if this helps
• adding balance skills into your training, such as single leg squats or balances 

Tracking your cycle

Tracking your cycle can help you identify when in your cycle you are training well, recovering better or feeling stronger. It can also help you better understand where you get any symptoms within your cycle.

It can be useful to track your cycle alongside your training notes. That way you can link any differences in your cycle to any:

• changes in your training
• significant competitions during a cycle

Useful tracking apps include Clue, FitrWoman or Apple Health. 

Hormonal contraceptives

Hormonal contraceptives are mostly used to avoid pregnancy. However, you can also use them to control symptoms that may affect your training. Symptoms such as abdominal cramps and mood swings. You may also be able to use them to prevent having a period during training or competition.

Visit NHS Wales for more information about contraception options. 

Conversation advice for coaches 

Not all athletes and coaches will feel comfortable talking openly about menstrual cycles. This may be related to:

• feeling it’s outside of the coaching role or an invasion of privacy
• not having resources or education to know what to say and when
• cultural taboos resulting in shame and embarrassment
• not wanting to talk about it with someone they’re not familiar with

There are many ways as a coach you can make these conversations more comfortable. You can:

• be aware of signs, symptoms and consequences of the menstrual cycle
• ask athletes how they might like to discuss their experiences with you
• agree a setting and whether they’d like someone else there – such as another coach or a practitioner, family member or carer
• know about different sources of support available
• take a supportive approach when speaking to the athlete
• avoid using euphemisms - use correct terms: ‘the menstrual cycle’, ‘menstruation’ and ‘periods’

You can also use the 'Openness and conversations’ module of our ‘Menstrual cycle in sport’ course. 

The menopause doesn’t mean you need to slow down or stop doing sport. Many women continue to train, compete and enjoy being active throughout this stage of life.

You should speak to a healthcare professional before making changes to training. Visit NHS Wales for more information about the menopause.

Training during menopause

Oestrogen plays an important role in muscle strength, joint health and recovery. As levels change, training may feel harder. But regular activity can support long-term health during menopause.

Recommended training includes activities that are:

• weight bearing, such as walking, running and hiking
• low impact, such as pool walking, aqua aerobics and step-ups
• focused on flexibility and mobility, such as Pilates, yoga and swimming
• good for strength training, such as gym, resistance bands and home workouts

It’s also important to:

• understand what’s happening with your body to adapt your training
• speak with your GP about symptoms and treatment options
• keep a simple symptom diary to identify patterns that affect training or competitions
• rest, relax and be mindful as much as possible

Nutrition during menopause

Nutrition becomes a key training tool during menopause. Ensure a balanced diet that includes sources of:

• calcium and vitamin D for strong bones
• fibre and antioxidants
• omega-3 for heart and brain health
• magnesium
• vitamin B6 for hormone support
• zinc for immunity

Muscle decreases naturally with age, so your body may need fewer calories. Try eating smaller portions. As well as swapping sugary snacks for foods high in nutrients and protein.

Around half of women struggle with sleep during menopause. Certain foods contain nutrients linked to calmness and rest. These include nuts and seeds, cheese, poultry, fish, tofu and eggs. 

Good nutrition helps with the increased demands put on your body from exercising or training regularly. This means getting the right balance of carbohydrates, proteins, fats and micronutrients.

There may also be times during the menstrual cycle where you need to pay more attention to nutrition.

Energy balance

You need to get enough energy through your diet to support your training. Changes to your menstrual cycle can suggest you do not have enough energy for training and exercise.

Carbohydrates

It’s helpful to:

• include starchy carbohydrates with all three meals (even if you aren’t training on that day)
• aim for a carbohydrate containing meal 3 to 4 hours before a training session
• have a carbohydrate snack 1 to 2 hours before training, such as a banana, cereal bar or toast
• include carbohydrates during longer or high intensity sessions, such as a banana, fruit juice or energy gels
• include some carbohydrates within 30 minutes of finishing any training

Recovery

Getting plenty of protein at all times is important for recovery.  

Additionally, in the second half of your menstrual cycle, you may break down more protein. To counteract this, you should aim to have 20g of protein every 3 to 4 hours.

Reducing inflammation

You can reduce inflammation by consuming:

• 7 to 10 portions of fruit and vegetable a day
• sources of omega-3, such as oily fish, chia seeds, flaxseeds and walnuts
• wholegrain foods
• curcumin, found in turmeric and available as a supplement
• vitamin D supplements

Food cravings

If you’re having food cravings:

• check that you're getting enough carbohydrates around training
• include protein and carbohydrate within snacks
• avoid going longer than 3 to 4 hours without eating
• try liquid nutrition if eating is difficult, such as milkshakes and smoothies 

Pelvic health refers to the function and wellbeing of the pelvic floor. As well as the associated organs of the bladder, rectum and uterus.

Approximately 1 in 3 females experience symptoms of pelvic floor dysfunction (PFD). With this number reported to be higher among athletes. Symptoms include:

• leaking urine
• losing control of wind or bowel motions
• bulging or heaviness sensation in the vagina
• pain in the pelvic region

Whilst commons, these symptoms should not be considered normal. They can impact training and performance. Having a negative impact on mental health and involvement in sport.

Improving pelvic health is important in preventing PFD. Appropriate support can prevent and manage symptoms. And remove barriers to training and performance.

You should speak to your GP about any of these symptoms. You can also access England Rugby’s pelvic health toolkit on their female health and wellbeing page. 

During puberty, your body starts to mature and develop into a female adult body. Including changing physically, emotionally and hormonally. Staying in sport and being active can be supportive during this time.

Benefits of puberty for sport

During puberty, bone and muscle growth and newly circulating hormones can increase your:

• bone strength
• heart and lung capacity
• muscle strength and power levels
• flexibility

Advice for sport during puberty

You can try:

• trying different period products to see what works best for you whilst taking part in sport – such as periods pants, period swimwear or menstrual cups
• finding the right-fitting sports bra
• choosing clothing types and colours that do not negatively affect your comfort
• be open to conversations about how you’re feeling

Parents and carers can also watch our video. It gives tips on how to help your child stay in sport and be active during puberty. 

VIDEO

Sport and exercise during pregnancy can be safe, in most cases. It can help:

• reduces risk of high blood pressure and diabetes
• manage healthy weight gain
• improve mental health and sleep
• supports faster recovery and reduced injury risk after birth

We offer advice to female athletes who are planning or going through pregnancy. You should speak to a healthcare professional before making changes to training. Visit NHS Wales for more information about pregnancy.

Planning a pregnancy

If you are an athlete planning a pregnancy, we recommend:

• speaking to your coach, doctor or support team
• seeking medical guidance from a sports medicine or women’s health specialist
• checking contracts or sponsorship agreements for pregnancy and maternity policies
• consider factors that may affect fertility – such as body weight, nutrition, stress and international travel
• taking folic acid before conception and for first 12 weeks of pregnancy

During a pregnancy

You can use a get active questionnaire for pregnancy to identify any issues to consider before exercising. You should adapt your training to your individual needs and stage of pregnancy.

First trimester

You should:

• avoid early sessions if you're struggling with morning sickness
• train when your energy is highest 
• train at 60% to 70% max heart rate – and expect an increase of 10 to 15 bpm in your resting heart rate
• adjust your nutrition – you’ll need an additional 90 kcal per day
• wear a well-fitting sports bra and adjust workouts if you get breast pain
• sleep, rest and recover
• be open with your emotional health

Second trimester

You should:

• take care during balance-based movements – your baby can change your centre of gravity
• expect a shortness of breath
• avoid lying flat on your back during workouts after 20 weeks
• be careful when standing up to avoid dizziness
• start or continue pelvic floor training – 8 to 12 reps, 3 times per day
• adjust your nutrition – you’ll need an additional 290 kcal per day
• update your sports bra and sportswear as your body changes

Third trimester

You should:

• adjust training to avoid stress on your body
• take care when exercising as your joints will be more unstable
• manage back pain by jogging or doing aerobics at least 3 times a week
• adjust your nutrition – you’ll need an additional 470 kcal per day

Pregnancy loss and miscarriage

Light to moderate physical activity does not increase miscarriage risk. Although there is limited evidence on the effects of intense training during the first trimester.

If you experience a miscarriage:

• take time to recover physically and emotionally
• ease back into training, only when you feel ready
• get support from friends, family, teammates or coaches

Post-pregnancy

You can use a get active questionnaire for postpartum to help you decide when to return to training.

You should:

• always get GP clearance, especially if you’re experiencing complications
• listen to your post pregnancy body and go at your own pace - do not compare yourself to others
• not run until 12 weeks after birth for safety
• do pelvic floor exercises to strengthen and reduce problems
• talk to your support network about your mental health

Breastfeeding

Breastfeeding does not increase injury risk during exercise. You should:

• feed or express before workouts for comfort
• wear a sports bra designed for lactating breasts
• eat and drink enough each day to recover well and support milk production – an additional 500 to 600kcal, 25g protein and 900ml fluids