Press Release – 26 June 2023

‘Concerning’ lack of awareness of how best to reduce risk of stress fractures in female athletes and dancers, a year after change in NICE guidelines

Despite NICE (National Institute of Health and Care Excellence) guidelines being changed last year, there is a still a concerning lack of awareness about the best way to protect bones and reduce risk of bone stress injuries, including stress fractures, in female athletes and dancers whose periods stop as a result of any combination of nutritional under fuelling and overtraining.  That’s according to Dr Nicky Keay, the Medical Advisor at Scottish Ballet.

Dr Keay, a leading medical expert in hormones and exercise and the author of ‘Hormones, Health and Human Potential’, is a member of the British Association of Sport and Exercise Medicine (BASEM).  She wrote to NICE to raise the issue when it became apparent that many doctors were prescribing the contraceptive pill believing this would be helpful and beneficial for bone health in female exercisers whose periods have stopped.  However, she says, it only masks the problem, it does not protect bones and that HRT is a better option, as the guidelines now state.

“More needs to be done to get the message out. While we know that exercise is good for bone health, too much exercise relative to nutrition has a detrimental effect on bone health and increases the risk of stress fractures.  Having your period is a barometer of hormonal health so in female exercisers, a warning sign of imbalance is that periods stop, in the absence of being pregnant or any other medical condition. Of course, this is not confined to elite dancers and athletes. It is true of anyone doing a lot of exercise.”

Dr Keay says that “the pill” is frequently given in the mistaken belief that it will regulate periods and protect bones, but neither is correct. The pill, in fact, switches off the production of your internal menstrual cycle hormones and is NOT bone protective. She continued:

“After writing to NICE, the guidelines were altered, in line with the Endocrine Society and International Olympic Committee (IOC), that where periods have stopped due to unbalanced behaviours, the pill should NOT be given, as it is a masking agent and not bone protective. Instead, HRT (body identical hormones) should be considered for bone protection, while the hormones are rebooted through an altered exercise and nutrition regime, which takes time. However, despite the guidelines being changed, women are still being prescribed the pill in these circumstances and are coming to me with stress fractures.

“There is a common misconception that the withdrawal bleed you get on the pill is a menstrual period, but it is not. Psychologically, both the exerciser and prescribing doctor feel that something positive is being done by taking the pill. However, it is just a ‘sticking plaster’ that does nothing to aid hormone healing.”

BASEM is very proud to be leading the way internationally, raising awareness on their dedicated website about Relative Energy Deficiency in Sport (RED-S) for all those involved with exercise training, sport and dance.

Lynda Phillips, Chief Executive at BASEM, the leading multidisciplinary sport and exercise medicine membership organisation in the UK, said:

“Getting the balance between correct nutrition and training is imperative in order to maintain good health and hormones. This is such an important message for all girls and women.  We hope that by raising this issue now, it will resonate amongst those treating women, regardless of their age or level, who are participating in sport and exercise, to read the revised NICE guidelines that were changed last year.”

Dr Keay will speaking about her work with Scottish Ballet alongside a physiotherapy colleague and head of performance medicine at Scottish Ballet at the BASEM conference in October.

For more information about BASEM, please visit https://basem.co.uk/

For more information about Relative Energy Deficiency in Sport (RED-S), please visit https://health4performance.basem.co.uk/

 NOTES TO EDITORS:

1. For more information or requests for press interviews or photos, please contact Fiona Dwyer at FDPR on 07515 631299 or email fiona@fdpr.co.uk.
2. Two jpeg photos are attached for use in all publications, on websites and social media channels.Photo 1: Dr Nicky Keay, leading medical expert in hormones and exercise and Medical advisor at Scottish Ballet.
   Photo 2: Dr Nicky Keay coaching a dancer. 
3. The British Association of Sport and Exercise Medicine (BASEM) is the leading multidisciplinary sport and exercise medicine membership organisation in the UK with a core responsibility of providing leadership, education and support for all those involved in sport and exercise medicine, across many disciplines including doctors, allied health professionals, sport coaches, nutritionists and scientists. BASEM is also committed to leading on issues related to Equity, Diversity and Inclusivity, striving for diverse and inclusive environments within its own organisation and the wider SEM community.

    

4. About Dr. Nicky Keay BA, MA, MB, BChir (Cantab), MRCP
   Dr Keay is a Sports and Dance Endocrinologist
   She holds the following positions:
   Medical Advisor, Scottish Ballet
   Honorary Clinical Lecturer in Medicine, University College London
   Member British Association Sport and Exercise Medicine
   Member British Menopause Society
   National Institute of Dance Medicine and Science and International Association of Dance Medicine and Science
   She is also the author of Hormones, Health and Human Potential.