Per and polyfluoroalkyl substances (PFAS) are synthetic chemicals used to make products resistant to water, oil, and heat. Known as “forever chemicals” due to their persistence in the environment and human body, PFAS are increasingly linked to adverse health outcomes. In Australia, PFAS contamination has been detected in higher levels near defence sites, airports, and industrial zones, raising concern for communities and health-focused individuals.

PFAS Exposure and Health Risks

PFAS accumulate in the body over time and contribute to a range of health effects. For athletes and active individuals, these risks are particularly concerning due to the potential impact on immune function, hormone regulation, and cardiovascular health.

• Immune system suppression: PFAS exposure may reduce antibody response to vaccines and impair immune resilience (Bline et al., 2024).
• Hormonal disruption: Thyroid function and reproductive hormones, reducing energy levels, metabolism, and fertility (Teymourian et al., 2021). Evidence points towards delayed menstruation in girls, and earlier menopause.
• Neurotoxicity: Cognitive and behavioural changes, potentially affecting focus and recovery (Nannaware et al., 2024).
• Cardiovascular effects: High cholesterol, blood pressure, and risk of heart disease (Wen et al., 2023).
• Cancer risk:  Kidney and testicular cancers (Teymourian et al., 2021).
• Kidney issues: Higher levels of uric acid and reduced kidney function

Common Sources of PFAS in Daily Life

• Non-stick cookware such as Teflon pans
• Waterproof and sweat-resistant activewear and outdoor gear
• Stain-resistant carpets and upholstery
• Cosmetics including foundation, mascara, and lipstick
• Food packaging like grease-resistant wrappers e.g protein bar wrappers
• Cleaning products and firefighting foams
• Contaminated water from groundwater, bore water and seafood produced in contaminated water

Safer Alternatives to PFAS-Containing Products

Here are practical recommendations for switching to PFAS-free alternatives:

• Cookware: Choose stainless steel, cast iron, or ceramic-coated pans instead of non-stick varieties.
• Athletic wear: Opt for natural fibers like organic cotton, bamboo, or PFAS-free synthetics. Brands now label PFAS-free gear.
• Cosmetics: Use clean beauty products certified PFAS-free. Check ingredient lists for fluorinated compounds.
• Food packaging: Store food in glass or stainless steel containers. Avoid microwave popcorn bags and fast food wrappers.
• Cleaning products: Use eco-certified cleaners without fluorinated surfactants.

At present the Australian Government does not support testing of PFAS exposure through medicare. PFAS pose a significant health risk, especially for athletes and wellness-focused individuals. By understanding exposure sources and making informed swaps, you can reduce your PFAS burden and protect long-term health.  

Get in touch to discuss your current levels of PFAS and other toxin exposure. 

Sleep plays an important role not only in recovery, but also in regulating the menstrual cycle. If we rule out pregnancy, active females, can have many factors collectively contributing to lighter or irregular menstraul cycles, all of which are important to understand but also address. Let's recap some of the most common issues that contribute to lighter or delayed periods.

Why Periods May Stop or Become Irregular

High exercise volume or intensity. When training volume or intensity increases, the body may shift priorities and redirect energy away from reproduction and toward survival and performance. In simple terms, the brain tells the ovaries to take a break and periods can become irregular, delayed, or stop altogether. A recent systematic review found that approximately 32.3% of female athletes are impacted in this way.

Nutritional factors. Low energy availability (not eating enough to match output) and restrictive eating are the most common nutritional issues which impact the cycle.  When calorie intake does not match the high energy expenditure of training, the body conserves fuel by slowing reproductive function, and hormones such as oestrogen and progesterone start to decline. While many women boast a quality nutritional profile on the surface, the calorie intake or density can still be insufficient to match the demands of the individual.

Skipping snacks or having lighter meals can easily tip athletes into the red. Prolonged energy depletion can lead to issues such as Relative Energy Deficiency in Sport. Athletes with or without an eating disorder may choose to restrict food intake during a determined window to make weight or enhance performance for a key event. This can impact body fat, hormone signalling and extend the cycle, lighten cycles or stop them altogether.

Emotional stress and anxiety

Emotional stress, travel, competition anxiety, or personal challenges can elevate cortisol and disrupt the hypothalamic-pituitary-ovarian (HPO) axis. The pressure to perform, coupled with life stressors, can compound physical strain, further suppressing hormones that regulate menstruation. Stress of any kind raises cortisol, directly suppresses the HPO axis, and reduces hormones such as progesterone, leading to missed cycles and functional hypothalamic amenorrhea. A condition where the brain suppresses reproductive function due to perceived stress or energy deficiency.

Low Iron

Iron deficiency can indirectly contribute to lighter cycles. Iron deficiency elevates cortisol and inflammatory markers and has effects on the HPO axis as explained above. Estrogen levels may then drop, especially if iron deficiency is paired with low energy availability. The cycle can then start to pitter out. Energy production can also be impacted despite meeting calorie needs.

Poor sleep and recovery habits

Sleep is when the body recalibrates its hormonal systems. During deep sleep, the HPO axis relies on stable circadian rhythms to regulate the release of gonadotropin-releasing hormone (GnRH). This hormone triggers the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for ovulation and menstrual regularity.

When sleep is fragmented or insufficient, cortisol levels rise, melatonin drops, and GnRH pulsatility becomes irregular, disrupting circadian rhythm and impairing ovulation. This vicious cycle contributes to irregular cycles. Poor recovery from poor sleep also dysrupts the HPO axis and cases light or missed periods.

This feedback loop can persist unless addressed through improved sleep hygiene, balanced nutrition, and structured recovery strategies.

Why It Matters

Menstrual irregularities are not just about missed periods. They can affect bone density, cardiovascular health, mood, and fertility. For sportswomen, understanding this connection is empowering. It allows for proactive choices such as adjusting training, improving nutrition, and seeking guidance when needed.

A delayed period is useful feedback. It is the body’s way of saying, “I need more care.” By listening, adjusting, and supporting our hormones, we create space for both strength and sustainability.

At Athlete Sanctuary, we believe that performance and health are not opposing forces. They are partners. If you would like to improve your report card, we are here to help.

PCOS is Not One-Size-Fits-All

The common misconception is that PCOS is a singular entity, a simple diagnosis. In truth, it presents in various forms, each with its own nuances and potential implications. It certainly isn’t as simple as seeing follicles on an ultrasound. Understanding the distinctions between the subtypes of PCOS is crucial for tailored support and effective management.

Insulin-Resistant PCOS

One prevalent type is Insulin-Resistant PCOS. Here, the body's cells don't respond efficiently to insulin, leading the pancreas to produce more of this hormone. This excess insulin can then trigger the ovaries to produce more androgens, such as testosterone and DHEA.

For an active woman this could manifest as persistent fatigue, difficulty managing weight despite exercise, or poor exercise recovery. These could be signs of insulin resistance at play, and impacting how the body utilises fuel.

Inflammatory PCOS

Systemic inflammation can exacerbate hormonal imbalances, contributing to symptoms like irregular periods, acne, and increased hair growth.

Women experiencing inflammatory PCOS might notice prolonged muscle soreness, slower recovery from injuries, or simply a feeling of overall "heaviness" that impacts agility and endurance.

Adrenal PCOS

Adrenal glands, rather than the ovaries, can be the primary source of excess androgens, often triggered by chronic stress.

This might be particularly insidious for women. Active women may further exacerbate stress through high-intensity and high-volume training loads.  

Symptoms might include persistent fatigue, anxiety, and brain fog that affects focus and decision-making. Others may have uncharacteristic irritability and mood swings. 

Post-Pill PCOS

Finally, Post-Pill PCOS can emerge after discontinuing hormonal birth control. While often temporary, it can mimic other PCOS symptoms as the body re-establishes its natural hormonal rhythm. This highlights the importance of individualised assessment and patience as the body recalibrates.

The Ripple Effect  

Irregular periods, weight fluctuations, and other visible symptoms can erode self-esteem and lead to significant emotional distress. A study revealed that women with PCOS report higher levels of depression and anxiety compared to other women. 

For a sportswoman, this can manifest as a diminished passion for their sport, difficulty staying motivated, or even body image issues that impact on confidence. 

Nurturing Resilience: Practical Support for Women with PCOS

While there's no single "cure" for PCOS, effective management strategies can empower women to reclaim their health.  A holistic approach is paramount, combining evidence-based lifestyle interventions with targeted support. Addressing PCOS requires a comprehensive strategy:

Nutrition:

Adopting a balanced diet rich in whole foods, lean proteins, healthy fats and unprocessed foods, can significantly improve insulin sensitivity and help regulate hormone levels. For instance, reducing refined sugars and processed carbohydrates can mitigate insulin spikes, thereby dampening androgen production.

Magnesium plays an important roll by signalling over 300 enzymatic reactions in the body and is critical to insulin signalling, glucose metabolism and bone health. Many women with PCOS are found to have magnesium deficiencies and clinical trials have shown supplementation may improve insulin and metabolic issues in PCOS and potentially alleviate symptoms like anxiety and muscle cramps.  

Exercise:

Regular, appropriate exercise is another cornerstone. While high-intensity training is often a part of an athlete's routine, incorporating a balance of strength training and moderate-intensity aerobic activities is beneficial. Resistance training, for example, can enhance insulin sensitivity and promote healthy muscle mass, which further aids glucose uptake. The key is finding a sustainable, balanced and enjoyable exercise plan that supports, rather than depletes, the body.

Stress Management:

Practices like mindfulness, yoga, and adequate sleep can reduce cortisol levels, positively influencing hormonal balance.

At the Athlete Sanctuary, we believe in stripping away the shame and leaning into the discomfort of open, honest dialogue. It’s about acknowledging the unique challenges, embracing the journey of discovery, and building a supportive team around you.

Genetics

Mothers and daughters may experience a similar menopause transition. While this may be true, it’s not a guarantee. Studies indicate that approximately 50-85% of the variability in the age of menopause is due to hereditary factors. Genetics play a significant role in determining when menopause begins; however, your symptoms may vary if your environmental influences, such as stress, have been different. Lifestyle choices (such as smoking, diet, and exercise) and medical conditions can also influence the timing and experience of menopause. So, while family history gives some clues, it’s not the only factor. Typically, women start to notice changes in peri-menopause, which kicks off commonly between 45-55 years.

Stress

Stress plays a significant role with menopause. Stress can influence menopause in several ways. Chronic stress raises levels of cortisol, the body’s primary stress hormone. Elevated cortisol can interfere with the balance of reproductive hormones like estrogen and progesterone. This hormonal imbalance may lead to irregular menstrual cycles or even an earlier onset of menopause for some women. Stress will also further worsen symptoms associated with menopause, such as sleep, brain function, mood changes and fatigue. Managing stress through adaptogens (natural medicines that help the nervous system adapt to stress), mindfulness, balanced exercise, and relaxation techniques helps to rebalance the nervous system and reduce many symptoms associated with the menopausal transition.

While these truths exist, there are also a plethora of false myths around menopause that can lead us down the wrong path.

Five menopause myths

1. All women experience hot flushes: Although the Australian Longitudinal Study on Women's Health reported that 70% of Australian women experience hot flushes, not all women will experience them. The severity and frequency of hot flushes vary. Some women get the occasional sensation of heat, while others have frequent nighttime hot flushes that drench the bed linen. If untreated, some women report hot flushes for over 7 years. Naturopathic interventions and conventional support can be very effective at reducing hot flushes. As mentioned in a recent blog, cold water therapy is also one of our favourites.
2. Menopause means the end of sex life: While some women experience changes in sexual function due to hormonal shifts, vaginal dryness, and infections, this doesn't mean the end of a fulfilling sex life. Many women manage symptoms like vaginal dryness or lowered libido with natural treatments or lifestyle adjustments and enjoy a healthy sex life well into their senior years.
3. Menopause causes weight gain: While hormonal changes can influence metabolism and fat distribution, weight gain is not inevitable. Some women lose weight after finding suitable treatment and adopting healthy lifestyle changes. We can’t blame hormones for everything! Our food and alcohol intake, stress management, over-commitment to helping others, and subsequent lack of self-care can amplify metabolic changes and contribute to weight gain. Mental health issues and metabolic changes related to blood sugar control and insulin also make women more susceptible to central weight gain.
4. Menopause only affects physical health: While menopause is often associated with physical symptoms, it also includes a complexity of emotional and mental health components. Mood swings, irritability, mental fatigue, anxiety, reduced ability to cope with everyday situations, and depression are common in this life transition. For some women, it brings about a sense of freedom from the responsibilities of raising a family, while for others, it triggers grief over the loss of their youth. Sleep issues may further contribute to mental health challenges. Many women find a holistic support team is very beneficial for the mental health aspects of menopause.
5. I won’t fall pregnant once menopause starts: Until menopause is complete (defined as 12 consecutive months without a period), it's still possible to become pregnant during perimenopause. Although the rates of conception significantly reduce after 40 years, women can and do fall pregnant during this life transition. We encourage you to discuss this with your partner and plan accordingly.

Menopause is often a time of significant life changes, during which several important aspects of a woman’s life come up for review—health, career, personal relationships, and family. On top of the emotional demands, it can be very challenging for women to experience uncomfortable or embarrassing physical and psychological symptoms that may impact their work and personal lives.

Nutritional needs also shift during menopause, and key nutrients such as protein and iron can be affected by changes in gut health, which is often influenced by stress, hormone fluctuations, and dietary habits. Maintaining regular intake of protein and iron is crucial for energy, brain function, and overall vitality. Include iron-rich snacks and recipes like the ones we prepared for you in our Iron Rich Snacks e-recipe book to support your body through this transition.

The good news is that this time also presents an opportunity for lifestyle changes that improve long-term health outcomes. At the Athlete Sanctuary, we offer comprehensive support and a balanced and open perspective for women undergoing this transition. We aim to help you navigate this life stage transition with minimal interruptions to your lifestyle and with positive long-term health outcomes.

For personalised support and further information, book an appointment.

In my hometown of Torquay, cold water therapy boomed during COVID lockdowns. Groups such as “Torquay Ocean Waders”  became conduits for community connection through ocean dipping and then coffee sipping outside the local Salty Dog café. This sense of community, based on an ethos of adventure, social connection, and a positive attitude, has grown to 1800 members in just three years, offering a supportive network for all.

The number of local female participants in this group intrigued me. I initially wondered if the group's growing popularity was more about connection than the benefits of cold-water therapy. However, over time, the scientific evidence supporting and validating the health benefits of cold-water therapy has grown, providing reassurance and confidence in its effectiveness.

Cold water therapy and menopause

The menopausal transition adds another layer of complexity to health and fitness. Hormonal changes can affect metabolism, energy levels, and body composition. Despite sound nutrition and plenty of exercise, women in this life stage often complain of central weight gain.

Over 75% of Australian perimenopausal or menopausal women will experience vasomotor symptoms (hot flushes and night sweats). Many women also experience sleep disturbances, mood changes and fatigue, as mentioned in our blog post: Help For Menopause.

Cold water therapy is linked to improvements in exercise recovery, hormonal balance, and the management of symptoms such as hot flushes associated with menopause. This knowledge empowers women to take control of their health and well-being.  Additionally, nutritional needs shift during menopause, and iron absorption can be affected by changes in gut health, stress and hormone fluctuations.  Maintaining optimal iron levels is crucial for energy, brain function, and overall vitality.  Incorporating iron-rich snacks and recipes, like those in our Iron-Rich Snacks e-recipe book, can help support your body during this transition.

Cold water therapy can offer many long-term benefits.

1. Regular exposure to cold water can help reduce inflammation.
2. In a study conducted at the University College of London, women reported cold water therapy reduced levels of anxiety, mood swings and depression.
3. Cold water therapy can improve your immunity. Following exposure to cold water, the body releases catecholamines such as epinephrine and norepinephrine, which stimulate the immune system.
4. Cold water immersion post-exercise for active women can aid muscle recovery, reduce soreness, and enhance overall physical resilience.
5. Cold water therapy has also been suggested to reduce the frequency and severity of hot flushes.
6. Regular exposure to cold water therapy may reduce cortisol levels associated with stress.
7. Exposure to cold water is a habit spreading for the selective reduction of adipose tissue, improvement in insulin sensitivity, and is popular with anti-ageing proponents.
8. Cardiovascular risk factors associated with heart disease are also reported to be reduced after just three weeks of cold-water therapy.

The evidence is clear- regular cold-water therapy holds many long-term benefits. The latest research indicates cold water therapy is also beneficial specifically for women experiencing symptoms associated with menopause.

Visit the Athlete Sanctuary for more personalised advice and resources. We support athletes in achieving their best selves through tailored strategies and a compassionate community.