Female health issues that can impact performance

Globally there is low understanding around female athlete health issues impacting performance, and alongside an avalanche of social media misinformation, this can mean athletes do not seek early help for health concerns or miss early warning signs.

The impact on female athlete performance can be significant with reduced ability to complete trainings, lowered performance gains and at times leaving sport and competition altogether.

Common female-specific conditions affecting athletes include breast pain and injuries, menstrual cycle changes and pelvic floor issues. Increasing research on female athletes also highlight issues such as iron deficiency, bone stress injuries and low energy availability.

HPSNZ Acting Head of Performance Medicine and Athlete Performance Support Lead Dr Helen Fulcher says high performance female athletes will benefit from the growing education and research on the performance gains of optimal health management.

“Awareness is the first step towards change,” Helen says. “It’s about understanding how common these issues are and having the right knowledge and health support available to help manage any concerns.”

“Health and wellbeing are very specific to an individual. If you have symptoms that are really impacting your life and ability to carry out your daily activities, then that is significant. Nobody should be putting up with symptoms or concerns that are stopping them from thriving in their life.

“Female athletes can find the common symptoms of breast, menstrual or other issues get in the way of their job as an athlete. Being available to train or compete can be impacted, and we need to increase the understanding that they don’t need to put up with concerns, help is available to support them to perform as best as possible while also feeling well,” Helen says.

“Specific health conditions such as endometriosis can be difficult to diagnose with highly variable and individual symptoms. This can lead to a delay in diagnosis for many females, especially if they are missing early warning signs. It is not until the disease progresses and symptoms start to impact their daily life that people often seek help, despite having symptoms for some time.

“Shared decision making with a trusted health professional around the right management for a female athlete’s concerns is crucial to maximising their health alongside their performance.”

Para athletics world 100m and 200m champion Danielle Aitchison is one who has had her own breast health challenges and is happy to talk about them in the hope of helping other athletes.

Having discovered multiple lumps in her breasts, Danielle approached HPSNZ’s medical team who referred her to a breast surgeon.

“I’ve had ultrasounds and chose to have surgery at a point where my performance wasn’t at a high point.”

Danielle’s journey of discovery included the fact that having multiple, non-cancerous lumps in the breasts is very common among young women.

She says getting checked out and treated was a huge weight off her shoulders. “It was like, okay, I can breathe now!”

Danielle describes her recovery process and returning to training as a collaborative process with multiple members of her support network, including her surgeon, Helen, her coaches, and her Cambridge based high performance doctor.

“I’m really grateful that getting checked out, getting the surgery and getting back to training was for me a whole process of learning about breast health.”

Danielle has gone on to win multiple Paralympic medals, break world records and earlier in 2025 she became a double world champion.

Listen to more of Danielle’s story here.

Auckland-base swimmer Hazel Ouwehand tells her story of painful periods leading to endometriosis here.

And you can hear more from Dr Helen Fulcher on Breast Health here.

You can watch, listen or read – with more athlete stories, health topic interviews and focus topics with information from Aotearoa and around the world of sport in HPSNZ’s athlete performance Library.

Keep your eye out in 2026 for more athlete stories and workshops with our next topics prioritised through athlete voice:  hormonal medications (AKA hormonal contraception) and planning for pregnancy.