This article contains references to disordered eating.
Megan Roche M.D. ’18 Ph.D. ’23 is a professional trail runner, Stanford epidemiologist and self-proclaimed pizza-lover. But in between bounding up mountains, being a mom and co-hosting the podcast Some Work, All Play, Roche is the lead researcher at the Female Athlete Science and Translational Research program, or FASTR for short.
FASTR is a Stanford Wu Tsai Performance Alliance powered research team focused on filling the “large research gap” in both women’s health and sports science research.
As an epidemiology Ph.D. candidate, Roche studied female athlete health. While Roche says that female participation in sport is “growing and booming,” the research isn’t following as fast. Only 6% of sports science research focuses on female athletes, according to University of Chester Senior Lecturer Dr. Sam Moss. Roche says that there are plenty of factors that have contributed to this disparity.
Roche was brought on to FASTR by Emily Kraus, who is currently an Assistant Professor at Stanford’s School of Medicine as well as the program director at FASTR. Roche researched under Kraus as a med student.
“It’s been fun to piece this program together,” she said. “For me, it worked perfectly, because I was finishing up my Ph.D. in epidemiology. My Ph.D. focuses on female athlete health and research, so I was able to take on the role of research lead in this program and finish up my Ph.D.”
The gender gap in sports science
One major factor that’s perpetuated the gender gap in sports medicine research is how recently women have been allowed and encouraged into participating in athletics. (From 1928 to 1960, women were banned from running anything more than the 200m in the Olympics.)
Another factor is that researchers are hesitant to engage with female physiology, due to how hard it is to control for the menstrual cycle’s impact on performance-based studies.
“[The menstrual cycle] has been thought of as a confounding variable for a long period of time,” said Roche.
But, to Roche, that isn’t enough of a reason to back off from this research. “I think the more that we dive into menstrual-specific research, we’re realizing that it’s not as related to performance as directly as we thought it is and that it’s better to include to female athletes in studies than exclude them due to factors like the menstrual cycle.”
Varsity Stanford Lacrosse goalkeeper Olivia Geoghan ’25 concurs.
“There is this stigmatized idea that the female body is too complex and complicated, dissuading researchers from wanting to dissect all of the complexities,” she wrote.
Stanford Tennis player Alexandra Yepifanova ’25 adds another reason for the increased number of women in sports: equal pay.
“For centuries, female athletes were paid much less than their male counterparts, so fewer women were inclined to compete in professional sports,” she wrote. “Therefore, until very recently, there has been much less data collected and less research about female athletes.”
FASTR’s focus and mission
A major focus of FASTR’s research mission is the topic of low energy availability (LEA) and Relative Energy Deficiency in Sport (RED-S).
Roche defines low energy availability as “an athlete not getting enough fuel to support the activities that they’re doing.” She says this can happen “inadvertently” through an athlete “exercising too much or not fueling their exercise quite enough.” Or it could root itself in “disordered eating or eating disorders.”
“But then we know there’s long-term health consequences associate with that,” she said.
When calories consumed do not match energy used overtime, low energy availability can develop into a syndrome called RED-S. This syndrome is associated with increased injury risk, impaired bone health, missing or irregular menstrual cycles and more.
RED-S isn’t a gender specific syndrome, although women seem to present the symptoms of RED-S (menstrual cycle irregularity, disordered eating) more often. RED-S has also been referred to as the Female Athlete Triad, which refers to the triad of low energy availability, decreased bone health and menstrual dysfunction (although some athletes and health professionals criticize this label as outdated and gender-exclusive.)
According to their website, FASTR believes it is important to prioritize “early identification and intervention of the Female Athlete Triad and Relative Energy Deficiency in Sport that is increasingly common in young women.”
One way to do this is by arming coaches and mentors with knowledge.
“There’s so much research growing in the female athlete science landscape that there’s a ton of knowledge accessible. Be hungry for knowledge,” Roche advises coaches. “Practice evidence-based coaching. Really learn to support female athletes the best.”
Katie Duong ’23, Stanford women’s soccer player and 2022 student researcher at FASTR, said her experience working with the group was focused mostly on bone health.
“My main project was taking MRIs at different stages of tibial bone stress injury recovery,” she wrote. The goal of the study was to “use the findings to eventually better inform return to play protocols and see if findings in the recovery process were related to female athlete triad symptoms.”
Geoghan, who participated in a talk with the FASTR, is grateful for the program’s research mission.
“By educating female athletes, along with their coaches and athletic trainers, with important information surrounding mental health, fueling, recovery, menstrual patterns and effects, while also encouraging women to be beautifully strong and unique, FASTR enables all female athletes to be at their best,” she wrote. FASTR’s mission has also helped Geoghan in her personal mental health journey.
Hope for the future
To female Stanford athletes, a research team like this means a lot. Yepifanova, who wants to see more research on how female athletes develop over the years, wrote that “progress in this field would be a huge step for all women.”
According to Geoghan, this type of research will be major for the health of female athletes.
“More research on female athletes would be super important not only for enhancing performance […], but also continuing to ensure their health and preventing injury,” she wrote.
She echoes Roche’s emphasis on equipping the relevant people in a female athlete’s life with knowledge.
“[More research] will allow female athletes, coaches and doctors alike to recognize risk factors of injury and take preventative measures earlier,” she wrote.
Duong wrote that more research on female athletes and sex specific differences could “lead to more optimal training and treatment for female athletes.”
And in terms of closing the gender gap, Roche thinks that “huge strides” are being taken. “I think, within ten years, we’ll be at a place where female athlete research is really, really closing in and catching up,” she said.
Advice for female athletes
Roche encourages female athletes to think of themselves as “long-term” athletes. She says that young female athletes too often get caught up in the “here and now.”
“Think about being an athlete in your twenties, thirties, forties and fifties. In order to do that, we need to treat our bodies well,” she wrote. “We need to feed our bodies well. We need to recover. We need to stay up-to-date on all the top knowledge.”
Duong advises female athletes to “do things outside [their] comfort zone.”
Whether that be joining a new team, learning a new skill or pushing a physical limit, she says she “truly believe[s] that your mind and body can adapt to almost anything.”
Geoghan urges female athletes to remember they are people, not just athletes.
“[…] recognize that you are human. Being a human entails emotions. It is ok to take a step back sometimes and take care of yourself,” she wrote. “I went through a period in my sophomore season where my mental health got so rough that I had to take a brief step back from lacrosse, and that was totally ok. You always come first.”