Table 3

Female health domains, with athlete quotes on their lived experience with domains

Health domainAthlete quotes on their lived experience with the female health domains
D-MG“If I reflect early in my career, there wasn’t really anyone to talk to. And I guess that is probably why a lot of our athletes, myself included, had issues with having no periods, you know. Or it was like celebrated that you didn’t get a period”.
“Early in my career, I didn’t marry up the relationship between high performance sport and your menstrual cycle or your female health, I guess. This was a bit dangerous in hindsight because you, you know, think, oh, missing a period’s great. But actually, what that means is you probably did not recover properly, or you probably did not eat the right foods. Or you, you know, it could be a multitude of things”.
“Even little things when you got your period, I do a water sport, and the logistics around that is awkward. Even uniform stuff, like, can we have black tights? You know, and we were getting these like really light-coloured green tights. Not doable. And then once we started to talk about it more, I think the first time it kind of came across our table was because one of the girls in our squad had not had a period for, I think it was nine months or something”.
“My iron levels didn’t go up. And I think it, it was in that time that we discovered that the tablets that I was taking didn’t up my iron levels. So, then the next step was to get infusions. And then it was like, okay, cool, how can, how can we prevent your iron from dropping even more? And then a natural way was just to stop my period”.
D-AR“I’m lucky I guess that I was able to fall pregnant quickly and easily and there was no issues. Obviously, if you have an irregular period or you have, you know, something else going on, It might be harder for you to fall pregnant. And I think that that conversation isn’t happening within sport”.
“As an older athlete, I spoke with my husband the other day. If I wanted to keep going after Paris, I don’t think I want to, but if I do, how about freezing eggs? Like how does that work? what does that look like? Because I mean, in some sports you probably can’t spend the time to be pregnant and have a year off. Or financially you might not be able to, or you know, you’ve only got a small life span in sports. I mean obviously that’s an away from sports thing, but how does that impact, or how does that work in with a training cycle or a competition cycle”?
“that was also the first time like when I went and met with a woman’s health specialist while I was being diagnosed with anorexia in 2020 and this doctor Women’s Health doctors it’s like. Did you like thought about family planning? what’s your plan for having children? Do you know if you’re fertile? All of those questions that like no one had ever asked me before that was kind of like, wow, why don’t we talk about this more”?
D-PR“They'll fund you for two years from your last event. So basically, I’m funded from Tokyo through to August next year. So, I have to raise a major event within that period. Our world championships are August next year. So, I mean, that helps because if you don’t have that if you fall pregnant you just lose everything”.
“The recommendations that were given to us had not a lot of research behind them, but I liked having something. I know they were giving them to us being cautious. And so, I knew that, like the 90% heart rate rule of max heart rate was okay, because they’re not going to give me a number that is unsafe and get everyone into trouble”.
“In the first two trimesters, I didn’t really start showing. So, I just looked like my normal self, and people were treating me like normal. And then, yeah, when I started to have that big bump, no one wanted to help me that much really”.
“I guess what I struggled with a little bit, and I guess maybe other women might struggle with it a bit more, are the changes in your body. As athletes we are so used to being in a peak condition. Particularly, I guess most athletes in Olympic sports and Paralympic sports, will try to fall pregnant straight after the Games. And so, you go from, you know, the fittest and strongest you’ve ever been to pregnant and that changes the body a lot”.
“One of my training partners, for example, he had a baby. But I mean, he wasn’t the one carrying it for nine months and nurturing and everything. Or put like his whole career on hold. He could have a baby, but I obviously had to make a choice”.
“It’s funny because as professional athletes you think, or as you say as an adult you would think, that there would be more conversation and more understanding behind pregnancy. Because we are human. Our bodies were meant to have babies. It is very interesting that there is a lack of understanding on that side. Is it ok for female athletes to take breaks and to start a family? If we can’t have babies, if it’s adoption, if it’s IVF? We have love to have a maternal instinct. It is just very interesting to me there is a lack of guidance that comes from sport”.
D-PO“In the postpartum period everyone’s like, you know, do you have to stay under, what are the rules? And it’s like, there are no rules. And I think this is wrong. We are treating it like a return from an injury. And it feels wrong to say that, that it’s a return from injury, but, you know, it’s a pretty big injury”.
“Not that many athletes get pregnant and come back. Most retire. And I think that’s probably to do with our funding. But to see so many international people that I raced against do it, I was like, okay, well, you know, happy days. It’s doable”.
“We got to Tokyo, and in my sport, kayaking, every podium had at least one mum on it”.
“I think for some moms it is tough. I mean, in the beginning I was struggling, you know, like with traveling all over and, you know, competing and obviously having this goal. And suddenly, I’m at home, with a baby and this is now life. I obviously enjoyed it, but I think that transition may be for some athletes quite tough. Being just a mom, and that’s maybe why they want to get back”.
D-ME“I slammed into some of these changes head on. It felt almost like going over your handlebars on your bike when you don’t see it coming. All of a sudden, I was like: Where did my muscle tone go? Where did this weight come from? Why everything seemed to change? I’m sure it was not overnight but it sure felt that way”.39
“I have very quickly gained three kilograms at the end of this year. Out of nowhere. Bear in mind, I’m exercising six days a week. I’m very conscious of what I eat, and very strict and disciplined with my nutrition. It was not through eating. I am having difficulty sleeping and I have joint pain which makes it very difficult for me to do what I want to do to support my cycling”.40
D-BH"I suffered an injury this season, where they suspected there might have been some slight tearing from the breast tissue. At the time, I didn’t report it. Only recently, coming up to this level. My most recent injury, I reported that one”.41
“I wish I knew more about these injuries when I began playing because I think a lot of damage could have been prevented”.41
D-PF“I felt embarrassed. I went to the loo and sorted myself out and changed my leotard. People probably knew what had happened”.42
“It causes a bit of uncomfortableness and anxiety, which can obviously be distracting and can throw you off”.
“Yeah, I had two C sections so that is different than obviously having the childbirth and I think that’s important to recognize like how soon or not soon you can train afterwards and then how carefully you need to be. So that was a big thing for me to be monitored by a osteopath and physiotherapist from a scar tissue perspective but also from a strength perspective with pelvic floor and you know reengaging my abdominals and things like that so taking care of the strength and kind of putting my body back together before I started to do full training”.
D-BP“I stopped breastfeeding a few weeks ago and more so because I just felt I was struggling. Towards the end I was getting annoyed, or more so, frustrated. Because I felt like I couldn’t fuel myself. I was getting back into a higher training load while trying to breastfeed, and I was noticing my supply was just dropping. I spoke to my dietician and stuff, but I just couldn’t seem to get enough in. And then you are trying to balance the whole weight thing as well, which I was fine with and obviously breastfeeding took precedence, but I just couldn’t, I just couldn’t seem to lift my supply back up”.
“I take my hat off for girls or females that have families and are still doing their career. As with breastfeeding, caregiving, and like sleeping. You need to get your recovery. All of that. You think you’re missing out. You’ve got mama guilt, you know. All of those things”.
“That was a big one for me. Just having somebody for two or three hours a day to come in and take care of my three week old. I could just go out for a walk and then a bike ride and then a run. Having family or some people that you trust to take care of your very little baby”.
D-MH*“I thought like, eating disorders, or what teenage girls do to themselves to be skinny. They didn’t understand that it was an actual mental health disorder. It really wasn’t until I went to treatment for it that I started to grasp how intense it actually was. That is where I wish that in becoming an elite athlete, there is some educational onboarding to teach you this can happen and it’s not your fault”.
“The separation in my opinion was valuable. To remember that I was more than an athlete. Because most of what fueled my eating disorder was the desire to be a perfect athlete”.
“I just felt like everything was out of my control and the voice of that, the body image issues, came to the forefront. You can just start controlling what you’re putting in your body, it will make you healthier, it will make you a better athlete, and so yeah, that just really took over my brain. It happened really quickly and really powerfully”.
“So there are physical signs that are pretty well documented from a low energy deficit perspective. I think the things that I saw were deceptive. Athletes saying that they were only running this amount, but then you talked to their teammates. They ran double the minutes they told you. Or you tell them to run on that day and then you see them out running on another as well. Or you tell them that they need to increase their calories, but you can tell that they’re not gaining any weight. You can just see that they’re lying or that they are hiding things. That is a very big sign that they are not engaging in the process of health”.
D-SE*“I think it is important to create a family environment where you feel safe and comfortable. We were a group in a cell, and I had a female coach. It was easy to relate with her. We were nine para athletes training together on a high level. We were only with two girls and the rest was male, but everyone always supported each other. There were no comments or degrading like, you know, male, female, kind of, you know, stuff. So, I think that was like a major thing in my career. That’s like a positive”.
“I actually didn’t really know of any female practitioners growing up”.
“I think social media plays some role in it. The ability to compare yourself with many other athletes. I would see track athletes and think they were so jacked. That was the athletic body that I wanted. I was unable to be compartmental and say I want a body that makes me the best ski racer. I also wanted a body that fits this societal model. That wasn’t a conversation that was happening around me. I mean, how do you want to feel vs how you want to look. My teammates and I would joke about our belly fat and pick that apart in a way that I thought was healthy, but it was getting into my head. People weren’t having constructive talks about body image and about being proud of ourselves as athletes”.
None of the approached athletes spoke about, or were willing to share their experiences with, harassment and abuse in sports. However, there are publicly available records of female athletes’ lived-experiences with this domain.
  • For domain abbreviation, refer to table 1.

  • *This health domain is particularly prevalent but not unique to female athletes only. Consideration should be given to all athletes.