A very topical issue in the media at the moment is female athlete health and the damage we can inflict on our delicate bodies through our obsessive love of sport. Unfortunately, like many others I have fought this long and often devastating battle. It nearly destroyed my health and running career until around two and half years ago…

In September 2015 I joined Team New Balance Manchester. I was relatively unfit (for me) and stuck in the rut of the often career ending Female Athlete Triad. My coach Steve took a risk and agreed to coach me, however he explained there was my health to focus on before we even thought about a training and racing plan. We are now in 2018 and yes Steve and I have had our ups and downs with injury and races disappointments like any other coach athlete relationship but our biggest achievement so far is my improved health.

In my early to mid teens I would eat anything and everything, but then I started to suffer from acne. It became something that would torment me on a daily basis. My Mum and I researched and tried everything to no avail (except roaccutane which I wasn’t keen on after discussions with my dermatologist at Alder Hey). My last resort a clean eating book; a book that told me if I altered my diet my skin would improve. I gave it a go, it was tough, I struggled to eat enough calories with the limited food types I could continue to eat from my normal diet. My acne cleared up but my weight plummeted and unsurprisingly my periods stopped… for 9 years. A seed had been sown, ‘healthy’ eating was now on my radar. I stopped the ‘clean eating’ after 12months and resumed my normal diet as my lack of periods now became a slight worry. I never went on to develop an eating disorder but over the next few years I suffered ‘disordered eating’ (EDNOS). I liked (and still do!) to be in control of things and this was something I could control when things got tough. Trying to achieve 100% in my A-levels and then going on to combine medicine and running at university was especially tough at times for the perfectionist in me.

Image result for lauren howarth
2008 Lauren
2017 Lauren


My weight dipped as low as 41.5kg during my first year of university. By this time I had serious issues. But I wasn’t injured and I was running well, very well. I was happy and loving life in Birmingham, did the weight really matter? I had achieved my first GB vest over 3000m at the World Junior T&F Championships in Poland, medalled individually at the European Cross Country Championships in Belgium, and gone on to be top British finisher at the World Cross Country Championships in Jordan. Then on April 21st 2009, my 19th birthday, stress fracture number one hit. It was horrible and I didn’t run another step for 5 months. I put some weight back on and was happy being anywhere between 45-47kg for the next 6years. During this time I had a DEXA scan showing osteopenia and was initially put on the oral contraceptive pill to get some oestrogen back in my body, but this hid the fact I was underweight with “fake periods” (withdrawal bleeds). Further more I was abruptly taken off when I admitted I suffered from migraines with aura (the medical student in me had no idea this was an absolute contraindication, to me they weren’t regular migraines). During my early 20’s I was on and off other forms of contraceptives that you often don’t have periods on (POP and implant) but had more issues with this when a Sports Doctor suggested this might be having a further negative impact on my bone health with progesterone only forms of contraceptives (the depot injection in particular) being linked with osteoporosis. Was I actively making my already delicate osteopenic bones worse? By this time I had accumulated another 3 or 4 stress fractures ranging from fibula to sacral. I needed oestrogen and believed I needed medication for it. It still hadn’t occurred to me that the best and most simple way for this cycle to end was to put weight on and have periods naturally. In my mind being heavier would make me slower and I convinced myself that at least I wasn’t as skinny as I used to be. Following this advice I had further doctors appointments, a referral to a specialist in Liverpool, and was back on the OCP having been migraine free for 5 years.

When I joined Team New Balance Manchester I was 47kg, mid-way through my medical Foundation Years training and pretty lost with running. Working with Steve we changed so many things. I was enjoying running again, and had more focus and structure to training. My health became the priority, PBs could follow later. I stopped any form of hormonal contraceptive and was now surrounded by a group of a healthy female athletes. Within 3 months I achieved a GB vest at another Euro Cross, my first one in 2 years.

However, in January 2016 injury struck again, another stress fracture, the damage I had done in my previous life coming back to hurt me once again. But this one had a silver lining, I had put more weight on and was now over 50kg, the heaviest I’ve ever been, but also the healthiest. And most importantly, during my rehab I had my first period in years. I cannot describe how happy I was. I turned up to the next session and told the girls and Steve. Steve put his arms around me and it felt as good as any GB vest.

This is something that as girls we are happy to talk about with Steve as periods are such an important marker for our health, over-training, sessions and race performance/planning. The first period felt life changing, but more important it continued. I have now had a period approximately every 4-5 weeks for the last two years. I’m amazed at how regularly they returned and would never want to be without them again. Currently my weight has stabilised at 51-53kg, 10kg heavier than the wide-eyed fresher who had just achieved her first GB vest. In this time I’ve run the fastest I ever have, achieved PBs in 3km/5km outdoor track, and topped the UK rankings in road 5km and 5 miles. Yes I still break down occasionally but I’m now learning to manage none-bony injuries rather than catastrophic stress fractures. I know I will continue to have bony injuries in the future, I have to deal with the long-term and possible irreversible damage I caused myself as a student. Yet slowly I believe things are improving. I have to adapt the training load during the week as my body isn’t strong enough to handle the mileage of many others. But fingers crossed my injuries will continue to get less frequent as I get healthier, stronger and faster.

Steve and I are still trying to work out the best way to balance my training. Currently I average around 50miles a week, I don’t run more than once a day (unless I do a 15min pre-race shake out). I also have a full day off running once a week, and will add in cross training once or twice a week (bike, elliptical or pool). This means I only do 6 runs/sessions a week. In addition I do a strength routine in the gym with “baby” weights, the bar is yet to become my friend. We have tried adding in more cross training but this just often makes me tired and further contributes to the risk of injury. I do sometimes struggle to get my head round my low volume training with everyone in the team often doing more miles than me including the 800m runner of the group! But its something I’ve got to accept if I don’t want to break down, consistency is key. Also, when I have a busy week at work we will cut back my training as the injury risk will be much greater if I’ve been on my feet running around the wards all day.

Typical training week:

  • Monday:   Rest day or 45-60mins pool or cross trainer (alternate weeks rest/xt) and Core routine (20-30mins)
  • Tuesday:   Session e.g. 6 – 8km of volume on the road/track or a hill session.
  • Wednesday:   60min run and Gym strength work (1hour, light weights and core)
  • Thursday:   50min run and hill strides and 35min spin
  • Friday:   Session e.g 6 miles worth of tempo
  • Saturday:   50min run and Gym strength work (1hour)
  • Sunday:   70-80min hilly long run



After the fantastic articles in Athletics Weekly from Jen Walsh and Bobby Clay, in addition to Bobby Clay’s hard hitting national coverage it feels like we’re starting to shine a light on what is a very difficult subject. So often we see younger athletes running well but it is evident to everyone that they’re doing long term damage to their body for short term successes. We need to keep raising awareness of the Female Athlete Triad for parents, coaches and athletes.

I hope my blog provides some insight and I would be more than happy to speak to anyone about this in more detail. There is a way back without turning away from the sport.

Lauren Howarth