Balanced
Female Health
A R E S O U R C E F O R A D U LT S S U P P O R T I N GYOUNG PEOPLE IN COMMUNITY SPORT

In collaboration withP U B L I S H E D M AY 2 0 2 3

BALANCED FEMALE HEALTHThe New Zealand Government’s Women and Girls in Sport andActive Recreation Strategy supports more women and girls
to be physically active through sport and recreation. SportNew Zealand’s Women and Girls Action Plan - Our Roadmap
to 2024 has a focus on partnering with relevant organisations
to develop and share resources that showcase good practicefor supporting women and girls.
The Balance is Better philosophy is about creating quality
experiences for all young people to keep them active andinvolved in sport. Sport NZ recognises that the needs of young
women in community sport are unique.

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Contents

4

7

11

20

27

32

39

41

Introduction

Maintaining
energy in sport

Understandingbalanced healthSupportingbalanced healthPuberty anddevelopment

Resources

The menstrual
cycle

Acknowledgements

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Introduction

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Introduction

About this resource
Developed by health professionals working in the sport sector, this resource provides
information and practical tips on topics such as changes throughout female puberty, themenstrual cycle, and factors that impact young people’s physical and mental wellbeing.
While many people who menstruate identify as a girl, woman or female, not everyone does.
Some people who menstruate are trans men, non-binary or intersex.
We have endeavored to use non-gendered terms throughout the resource. However,some sections are specific to female physiology or research.
We recognise that young people in Aotearoa New Zealand are not all the same, andsome groups of young people may require different considerations, culturally, physicallyand emotionally.
Sport NZ acknowledges the pioneering work of Netball New Zealand and NetballSmartwith funding from ACC, in the development of the NetballSmart SmartHealth resource.
Sport NZ has worked in collaboration with all parties in producing this handbook.

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Introduction

Who is this resource for?
Balanced Female Health is designed to support coaches, instructors, and parents to understandthe health and development of young people who are physically active through community sportin Aotearoa New Zealand.

This resource will help you to:• understand what defines balanced female health in community sport• strengthen your knowledge and understanding of female-specific development throughout
puberty and adolescence• understand the importance of the menstrual cycle for health and performance, both mentallyand physically• gain practical tips to support balanced health, reduce the risk of illness and injury, and raiseawareness of female-specific health issues• strengthen your knowledge and understanding of nutrition and recovery principles that
support energy demands during participation in sport• gain awareness on how to best support mental wellbeing in sport• learn skills to identify at-risk individuals and provide practical tips and resources to support
those requiring further assistance.

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Understandingbalanced health
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Understanding balanced health

What does balanced health look like?
A young person with balanced health:balances training
with recovery

has a healthy and regularmenstrual cycle

gets 8+ hoursof sleeprarely has injuries
or illness

fuels adequately tomaintain energy

has time for hobbies, relaxationand social connection

Each of these topics will be covered in more detail throughout this resource.

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Understanding balanced healthFemale-specific needs in sport
Historically, research in sport science has been conducted on male athletes and the findings
were applied to female athletes for many years. Current and future research looks tounderstand the unique female needs in sport and physical activity.
Key differences in females that affect health and wellbeing:• Females are unique because of their menstrual cycle and the hormones that are produced.
The menstrual cycle is an important indicator of health.
• Females change (and move) differently during puberty and need to be supported during thistime of life.
• Females have different injury risks and challenges, particularly with bone health and major
ligament injuries (ACL).
• Females respond differently than males socially and emotionally in and out of sport, which
affects ongoing engagement in physical activity.

Consider thisUnderstanding female
health is critical to being
able to respond to theneeds of young womenand provide support forthem to be physically
active in a way that
promotes their healthand wellbeing.

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Understanding balanced health

Benefits when there is balance in sport
Within the right environment, participation in sport has positive effects on physical, mental and social wellbeing.

Consider thisBenefits forphysical wellbeing

Benefits formental wellbeing

Benefits forsocial wellbeing• Increased neuromuscular,
cardiovascular and respiratory
function• Improved immune system• Improved metabolism• Optimal bone health• Prevention of chronic disease• Increased self esteem andbody confidence• Improved mood andconcentration• Improved sleep qualityand duration• Reduced symptoms ofanxiety and depression• Improved communication
and relationships• Promotes collaboration• Helps to develop a senseof belonging• Helps to build resilienceand leadership qualities

By helping young people
understand the positive
benefits of participatingin physical activity,
you can ensure they
have positive sporting
experiences, andare supported to bephysically active for life.

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Puberty anddevelopment
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Puberty and development

Understanding puberty
Puberty marks a time of transition and transformation fromchildhood to adulthood, known as adolescence.
During adolescence young people are building a body that is more
physically and mentally capable than ever.
Navigating puberty, and learning to adapt to changes within theirbodies, may alter the experience of and performance in sport,
particularly in females.
Research shows that young women want to be active and they
understand why physical activity is important for their health.
However, during puberty and adolescence, they experience acomplex range of personal and social factors in their lives that
influence their involvement in sport and exercise.
In New Zealand, there is a drop-off in participation andengagement during puberty, more so in young women aged 12-17.

Consider this
It is important toencourage and support
young people to maintainparticipation in physicalactivity in ways that work
best for them. Create safe
spaces for young people
to have conversations
about their health andwellbeing and to share
their experiences andlearn from each other.

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Puberty and development

Understanding mental wellbeing
Adolescence and early adulthood are key phases during which mental illness and mental
health issues can develop.
When working with young people incommunity sport as coaches, instructors,
or parents, it is important to build yourunderstanding of how you can support
young people’s mental wellbeing.
Understand the conversations that young
people may have with themselves suchas ‘people judge me’, ‘I don’t belong’, or‘ it’s hopeless’.

Learn more

Research has shown that building five actions into
day-to-day lives is important for the wellbeing ofindividuals, families, and communities.
•
•
•
•
•

Connect, me whakawhanaunga
Give, tukua
Take notice, me aro tonu
Keep learning, me ako tonu
Be active, me kori tonu

Five Ways to Wellbeing I Mental Health Foundation

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Puberty and development

Supporting mental wellbeing
As coaches, instructors or parents you can:Encourage young people to know
when they need help
Help them to develop self awareness of
their own needs. Advise them to seek help
when they are experiencing challenges
to their wellbeing.

Know that everyone has bad days
It is common for moods to go up and down.
Make bad days and challenges part of “normal”
life. If low mood persists, encourage them tobe brave and meet with a support person to
discuss their feelings and develop practicalstrategies.

Identify their support people
Encourage and support young people tohave key people in their lives whom they
trust to discuss their health and wellbeing
with. This may be friends, whānau, teachers,
instructors or coaches, or yourself.

Encourage good sleep andrecovery habits
Good sleep is vital for young people. Lack ofsleep is one of the greatest contributors to poor
mental state/health. Encourage at least one dayof rest from hard physical activity per week.

Acknowledge that it’s OK to
not be OK

Support them to be active in waysthat benefit their mental wellbeing

Mental wellbeing matters and seeking help
and support is a sign of strength and courage.
Encourage young people to be proactive inseeking medical advice as they would forillness or injury.

Take time to understand their motivations,wants, concerns and fears and whether theircurrent activities support their wellbeing or add
more worries and pressures to their lives.

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Puberty and development

Understanding body changes
The brain signals the start ofpuberty by producing female
sex hormones.

Periods (menses) start between
8-16 years. In New Zealand, theaverage age is 13 years old.

Did you know?
The rate of growth and development
is the highest during puberty. The
growth spurt between 10-15 years oldmeans adolescent females will growon average 5-7.5cm over 1-2 years.

Hormones stimulate breast
budding (8-13 years), pubic andarmpit hair, sweating, acne, andthe onset of periods (8-16 years).

Puberty is the key time for bones tostrengthen. Female hormones aid thisbone strength. Muscles and tendons
lengthen toward adult levels.

Females have unique body shapechanges. Hips widen, breasts
develop, and body fat increases.
It is a complex time for body
image and self-confidence.

During puberty, themusculoskeletal andreproductive systems
develop and mature.
The same changes
happen to everyone,
they just happen at
different rates.

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Puberty and development

Understanding movement andperformance changes
During puberty, rapid upward growth (the growth spurt) and altered body shape challenges
the co-ordination of young people. Young people may experience changes to:• Running and landing mechanics• Co-ordination and reaction times• Strength and movement control
This is because the brain takes time to catch up with the physical changes and improveparticipant skill development. Challenges to physical capabilities may affect females moreso than males due to strength differences (from testosterone) that support changes to body
shape and movement control.
Puberty can temporarily affect performance in sport. This is more prevalent in females
and can be a time of confusion and frustration for the young person, as well as coaches,
instructors, and parents.

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Puberty and development

Supporting physical wellbeing

As coaches, instructors or parents you can:Normalise conversations
about female body changes
and development
Coaches, instructors or parents(and especially males) don’t haveto be passive when learning about
or engaging in conversations
about puberty and development.
Encourage open communication
and use of support people ifyoung people need to talk.

Create environments
where young people
can feel safe, happy,
confident and valued
Most young women have hadan adult comment on theirappearance or physicalsuitability for an activity atsome stage in their life.
Provide young people
with positive messages onbody image.

Focus on long-term
development
For coaches, this means
focusing on developing thefundamentals of movement andenhancing skill development.
It is vital to avoid overloading ayoung musculoskeletal systemthroughout the stages ofgrowth and development as
this increases the risk of
injury and ill-health.

Did you know?
The grow spurt occurs
quicker in females thanmales but, as their bones
grow longer, they don’tnecessarily grow stronger
at the same rate.

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Puberty and development

Understanding emotional andsocial influence changes
Young women may choose to participate in sport or be physically active less frequently
during adolescence for a range of diverse reasons.
Changes to participation can be due to:
•
•
•
•
•
•
•

Being busy, too tired or lacking motivation for physical activity
Feeling unsupported or unsafe in their environments
Altered confidence around physical capabilities
Changes to body image and body confidence
Perceived social judgement or acceptance
Changes within social groups and friends who engage in sport and active recreation
Feelings that activities are less fun or too focussed on performance

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Puberty and development

Supporting social wellbeing

As coaches, instructors or parents you can:Be an ally or an advocate
Support young people to feelempowered about having a
conversation about their bodies.
As key adult influencers, youhave an important responsibility
to role model what ‘healthy
conversations’ look, feel and soundlike. Open up the space to havethe chat and help to guide young
people through this importanttransition period.

Support young people
to make smart choices
Understand that young
people are not mini-adults,
rather individuals who are
cognitively, physically, andsocially developing. Youngpeople cannot do everything
adults can do so ensuring
sport opportunities aredevelopmentally appropriate
is critical.

Encourage and foster
positive peer relationships
and team culture
During adolescence (around13-19yrs) peers and rolemodels are likely to influenceadolescents the most and young
people at this stage are likely
to be pre-occupied with howthey appear to others.
Ensure physical activity remains
fun and sociable.

Consider thisEncourage downtime
outside of sport andsupport other hobbies,
relaxation and social/family connections.
Time away from sport
helps with recovery andmaintains enjoyment
and enthusiasm.

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The menstrual cycle

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The menstrual cycle

Understanding the menstrual cycle
The menstrual cycle should occur
regularly (every 21-35 days) and is an
important measure of health – like amonthly report card.

Symptoms in and around the period such as blood loss,
abdominal cramps or pre-menstrual symptoms should
not stop enjoyment of or engagement in school, work,social or physical activity.

The menstrual cycle can give insights
into the ability to cope with the multiple
aspects of a person’s life, including
fuelling, training load and recovery.

Changes to the menstrual cycle such as irregular orabsent periods, or heavy or painful bleeding, may indicatethat the body is under stress with an imbalance between
the physical and psychological demands.

Luteal Phase
Follicle Stimulating Hormone
Estrogen
Luteinizing Hormone
Progesterone

01

07

14

Menstruation (The Period):
The average period (days bleeding)lasts 3-7 days.

Ovulation:
Ovulation is the main event of themenstrual cycle, as it produces thefemale sex hormones (around day 12-14).

Ovulation
Follicular Phase

Key Terms

21

Hormones:
The two key hormones made are
Oestrogen (Estradiol) and Progesterone.
They support and influence many bodysystems and are vital for female health.

28

Menstration
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The menstrual cycle

What is a healthy menstrual cycle?
Healthy

When to see a Doctor

Age

Average age of first period is 8-16 years.

Delayed onset of the first period. A GP consultation isrecommended if there no sign of the first period at 15 years of age.

Lengthof period

Average length is 3-7 days.

Bleeding that lasts longer than 7 days.

Lengthof cycle

Average length is 28 days but can be between 21-35 days.
(From Day 1 of one cycle to Day 1 of the next cycle)

Irregular (longer than 35 days), frequent (shorter than 21 days) or
absent periods.

Blood
Loss

Average 2-4 tbsp (30-60ml).
Changes to period products 3-4 hourly.

Heavy bleeding, leaking and large clots requiring very regularchanges to period products. This can lead to low iron stores or
may be a sign of underlying issues.

Pain

Abdominal cramps, pelvis and low back pain are normal.
However, they should not limit everyday life.

Symptoms which are not managed with over-the-counter
medication and / or interfere with daily life.

Pre-menstrual
symptoms (PMS)

Before your period, lower back pain, abdominal cramps,
bloating, fatigue, mood changes and food cravings are common.

Symptoms (such as major mood changes, fatigue, excess pain)
which interfere with daily life should be assessed.

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The menstrual cycle

Exercising during the period
Physical activity during the period is safe and the body can perform well.
Female physiology is amazing. The female
hormones oestrogen, progesterone andtestosterone support physical activity
and health.

Exercise and movement can help ease themental and physical symptoms experienced
in and around the period, such as low mood,
abdominal cramps and low back pain.

During the period, due to low hormone levels,
muscles recover well from physical activity.
There may be an experience of increased
strength, speed and power.

In the days before the period, mood changes
may occur due to falling hormone levels(progesterone). Once the period begins andhormones are more even, there may be a timeof calm and better moods.

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The menstrual cycle

Changes to the menstrual cycle
Menstrual cycle variability refers to changes in the length between cycles, as well as changes in the frequency oramount of blood loss. Exercise alone should not cause irregular or absent menstrual cycles.
Some factors that can cause changes to the menstrual cycle are:Stress and imbalance between
load and recovery

Under-fuelling andunder-recovery

The menstrual cycle can be affected byemotional/social stress.

These are common causes ofirregular or absent menstrual
cycles as hormone productionis altered.

When the onset of the period(menses) first begins, themenstrual cycle can besomewhat irregular. Thismay occur for 1-3 years.

Pregnancy

Other

The phases during andafter pregnancy, whilst
breast feeding, or with a
miscarriage can cause
variability or absence of themenstrual cycle.

Common causes of
menstrual cycle variability
are long distance travel,
sleep disorders, shift work,
medications or medical
reasons.

Birth control
Many types of hormonal contraception
affect the menstrual cycle, often preventing
ovulation. The introduction of, and / or
stopping hormonal contraception result inchanges to (ovulatory) cycles. If after stopping
hormonal contraception, the menstrual cycle
does not regulate, an assessment by a GP is
recommended.

Age

Did you know?
Not having a period is notnormal, even with hard
exercise. Absence ofthe menstrual cycle can
impact on bone healthand injury risk due to thealtered production ofmany important healthhormones.

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The menstrual cycle

Other causes of menstrual cycle variability
Polycystic Ovary Syndrome (PCOS)• Presents in 6-20% of females.
• It is a hormonal condition characterised by an absence of ovulation and high levels of male
hormones.
• Symptoms include irregular periods (late or many days of bleeding), excess facial or bodyhair, acne, hair loss, weight gain.
• Commonly misdiagnosed or undiagnosed for many years.

When to see
a Doctor

Endometriosis

There may be othercauses of menstrual
cycle abnormalities.

• Presents in 10% of females and can take many years to diagnose.
• It is an inflammatory condition with immune system involvement.
• Occurs when cells from inside the uterus (endometrium) grow abnormally outsideof the uterus.
• The main symptom is pain (often severe) which may be present between periods andmay include nausea and vomiting.
• Other symptoms include bowel and bladder problems, digestive system issues including
abdominal bloating, bleeding between periods, headaches and low-grade fevers.

If a young female isexperiencing any of themenstrual cycle related
symptoms noted, orother symptoms whichalter quality of life andparticipation in physicalactivity, please encourage
a medical assessment.

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The menstrual cycle

Supporting a healthy menstrual cycle
As coaches, instructors, or parents you can:Encourage overall balance in the
lives of young people

Provide positive messagesaround menstruation

This includes proper sleep, recovery, a mixof activities and connections (both socialand emotional) and proper fuelling andhydration before and after physical activity.
Encourage young people to eat a wide
variety of nutrient dense meals, from all foodgroups. This optimises health and helps to
support a regular menstrual cycle.

Have a variety of period products
available at school, home andin recreational facilities orenvironments. A group or teamperiod kit can be a great way tostart a conversation.

Support pubertal change
Support pubertal changewith open communication
about menstrual cycle related
issues. Encourage the advice
and support from a registered
medical professional where
necessary.

Encourage individuals to learn about their bodies

Provide open communication

Encourage individuals to track their menstrual cycle. Monitoring
their individual symptoms throughout the menstrual cycle and theways in which it affects their physical activity supports a greater
understanding and facilitates a menstrual “prehab” approach.
Use this awareness to help with planning, preparation andperformance in their chosen activities.

Provide open communication around how they
are feeling and their ability to exercise withmenstrual cycle related concerns. Encourage
young people to seek medical advice if theirmenstrual cycle is interfering with their daily
life, sport or chosen form of exercise.

Consider thisEveryone experiences
their menstrual cycle
differently. Support
decision making
around young people’s
individual experiences
and symptoms.

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Maintaining energy
in sport
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Maintaining energy in sport

Understanding energy demands of young people
The human body requires energy (nutrition and recovery) to support all the key body systems.
Energy demands naturally increase during puberty and adolescence due to the increased requirements for
growth and development.
During this time, it is important to support a higher food intake.
It is important for young people to eat nutrient dense foods from a variety of food groups, including fruit andvegetables. Additional calcium (to support bone growth and strength) and iron (to support menstruation and leanmuscle mass) may be required.
Additionally, puberty usually coincides with a time of high energy output of young people who may be involved in
multiple sports or physical activities, increasing academic work, part-time jobs and social interactions. Therefore,
young people need to fuel for the total energy demands of their lives.

Training

Physiological
Function

School / WorkSocialPuberty

Total Energy
Demands

Consider thisEncourage young people
to get 8+ hours sleep
per night to reduce therisk of illness and injury
and aid recovery. Sleep
also plays a major partin mental wellbeing.
Monitor the number of
early morning (or late)sessions or activities
which impact sleep
duration.

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Maintaining energy in sport

When to fuel throughout the day
Overnight, the body uses energy for many body processes
including growth and development and adaptation to
training or exercise. We wake in a small energy deficit
every day.
Our energy requirements increase as soon as we wake up,
so fuelling should occur early in the day to help restore thismorning energy deficit.
Sport can further increase energy deficits if not supported
well through appropriate fuelling, so it’s important to fuelboth before and after physical activity. Timing matters forboth performance and recovery.

Consider thisEncourage young
people to eat a balanced
breakfast and before
and after physicalactivity to support
their energy needs
throughout the day.

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Maintaining energy in sport

What happens when energy needs are not met?
Meeting energy demands can be a challenge for young people When there is insufficient energy available tofuel the body systems and energy demands it’s called Low Energy Availability (LEA). This can occur due tounder-fuelling or under-recovery.

Under-fuelling

Under-recovery

can be caused by:

can be caused by:Consider this

• Lack of awareness of the fuel required to meet totalenergy demands.
• Inadequate planning for the daily activities.
• Poor food preparation.
• Lack of time to consume adequate energy (e.g., little or no
food before early morning sessions).
• Purposefully restricting the amount of food eaten or foodgroups within the diet.
• Reducing the frequency of meals / snacks.
• Fuelling based on a reward system of activity performed.

• Over-scheduling of sport and otherextra-curricular activities.
• Lack of awareness of the demands ofother non-exercise related activity(e.g., study, part-time jobs).
• Over-exercising (e.g., adding additionalsessions).
• Reduced sleep duration (e.g., earlymorning sessions).
• Not taking rest days or adding in otherphysical activity on rest days.

Look at young people’s
weekly schedules andensure there is time
to adapt (to exercise),
repair muscle andrecover. Encourage atleast one day of rest
from hard physicalactivity per week.

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Maintaining energy in sport

Supporting young people to maintain energy
Plan and prepare

Monitor load and wellbeing

Encourage and assist young people toprepare the fuel they require around theirschedule. They may need additional food forschool, for travel to and from activities, andpre / post exercise.

Monitor the workload of young people (volume
and intensity) as well as the demands of a busy
schedule (school, work etc.). Watch for signsof low energy (fatigue, demotivation, recurrent
injury or illness, mood changes).

Advocate and take action

Have courageous conversations

Ensure young people have balanced lives withinsport and other physical activities. Acknowledge
when you don’t understand something andpractice being a supportive ally. It is importantthat young people see adults talking about andresponding to female health issues in supportiveand inclusive ways.

Have conversations with young people’s parents,
coaches, leaders and teachers if they show signs of
low energy, female health related issues, injury or poor
health. It can be difficult to understand someone’s
experience when you have not been through it yourself.
But it is better to have a conversation and accept that
there will be moments where you feel uncomfortable
than to avoid it.

Consider thisSupport overall balancein young people’s lives.
This includes sleep,
recovery, a mix of activities
and social and emotional
connections.
Focus on listening to young
people and understanding
their unique needs.

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Supportingbalanced health
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Supporting balanced health

What does imbalanced health look like?
A young person with imbalanced health:has prolonged tiredness
and fatigue

has an irregular or absent
menstrual cycle

often gets inadequate sleep(less than 8 hours)

has recurring injuries
or illness

may have irritability ormood changes

doesn’t make time for physical activity,
hobbies or social connection

Considerthis

If you notice any of these signs and symptoms of imbalanced health,talking to young people about it is the most important thing you cando. When approaching these conversations, be mindful of what else ishappening in their lives and make listening and learning your focus.

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Supporting balanced health

When there is a lack of balance in sport
If the right balance isn’t achieved in sport, there are potential risks to the overall health and wellbeing of young people.

Risks to physicalwellbeing••••

injury and illness
menstrual cycle related issues
overtraining or under-recovery
unhealthy nutritional practices

Risks to mental wellbeing• long term injury• under-performance pressureand expectation• burnout• development of concerning behavioure.g., withdrawal, avoidance, anger

Risks to social
wellbeing••••

unsupportive environments
controlling practices or environments
bullying, harassment, and discrimination
hazing, abuse, conflict, and isolation

Did you know?

Consider thisDid you know?

Stress fractures canoccur in the feet, shins, back andribs. It may be a sign that there areunderlying issues affecting bonehealth which need assessment.

Adults need to proactively monitor andmanage the workload (intensity and volume)of motivated young people to mitigate risks ofover-training and overloading.

Ongoing fatigue should not
be an accepted consequence of playing
sport or being physically active. It may
be a sign of over-training, under-fuelling,under-recovery or a combination.

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Supporting balanced health

Who is at risk of imbalanced health?
Young people at risk of imbalanced health are often
individuals who:• are involved in early specialisation - usually in one sport.
There is greater risk in activities with an aesthetic or weight
restricted focus e.g., gymnastics, ballet.
• participate in multiple sports and activities, with overscheduling of commitments.
• have multiple life stressors e.g., physical activity demands,family stress, academic pressure, relationship conflict.
• exhibit perfectionist tendencies. They tend to be highachievers in multiple areas of life.
• move to higher level programs or training groups.
The number of hours and intensity often increase.
• have previous injuries (especially bone stress injury) andrecurrent illnesses e.g., coughs and colds.
• have engaged in disordered eating practices such as
restricted eating, avoiding food groups, reward eating.
• demonstrate disordered training practices e.g., over-training,skipping rest days or signs of exercise addiction.

Consider thisSupport young people toparticipate ina variety of sports andactivities to build a wide
set of skills and avoid therisks associated with earlyspecialisation, such as
overuse injury. Injury andillness may mean lost timeto sport and other physicalactivities, which can in turnimpact mental wellbeing.

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Supporting balanced health

How to assess balanced healthAs coaches, instructors, or parents you can ask these questions to assess overall balance and better understand a young person’s health and wellbeing.

Training

Nutrition

Menstrual Cycle

Sleep• Are they enjoying
participating in their sportor physical activity?

• How are they eating tosupport their physical activity?

• Are they experiencing
regular menstrual cycles?

• Are they getting 8+hours of sleep per night?

• Do they avoid meals or specificfood groups?

• Are they taking a hormonal
contraception which may mask
issues of the menstrual cycle?

• Do they feel fatigued or
not recovered?

• Are they motivated to attend
and / or compete?
• Is their activity balanced andare all elements covered? i.e.,
strength, core, fitness, fun.

Support• Do they have a good
support network?
• Do they have a trusted adult
who they can talk to if needed?

• Do they have energy throughout
training and games?

• Do they have at least one rest
day per week?

• Can they recover between activities?

Injury / Illness
Social Connection• Have they been regularly
injured or unwell?

• Are they connectingwith friends and social groups?

• Is there a history of bone injury
e.g., shin splints, stress reaction
or stress fracture?

• Are they feeling any pressuresaround participating in sportor other physical activities
e.g., body image, playing
with friends, loss of fun?

• Do they have a prolonged injury
affecting participation and / orwellbeing?

Other Interests• Are they engaging insocial activities and downtime away from sport orphysical activity?
• Do they come back motivatedand engaged?

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Supporting balanced health

If you identify signs of imbalanced healthStarting a conversation with a young person about their health and wellbeing can sometimes feel difficult, but one
courageous conversation may resolve ongoing issues or prevent health and wellbeing challenges in the future.
Following a conversation with a young person and/or others in their support network, there are other external
support networks you can reach out to if you identify signs of imbalanced health.
Timely assessment and interventions from appropriate health professionals can prevent long term healthconsequences, reduce lost time to sport or physical activity through injury and illness and improve physicalperformance and maintain engagement in exercise.

Low Energy Availability,
Gastro-intestinal issues,
Disordered eating
GP, Nutritionist, Dietician

Menstrual
Dysfunction

Mental Health,
Mood disorders

Recurrent Injury, Illness,
Performance

GP, Endocrinologist,
Sports Physician

Psychologist, Counsellor,
Nutritionist, Dietician

GP, Physiotherapist,
Sports Physician

Consider thisEncourage Physiotherapy
and /or GP support for
injury and illness.
Be involved in young
people’s plan for ahealthy return to sport.

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Supporting balanced healthTop 5 takeaways

Acknowledge
that puberty is atransition period
Be supportive of thephysiological,
emotional and socialchanges that occur
during this time.
Acknowledge, support,
and help them develop
their strengths.
Help to instil positive
attitudes and self
confidence in young
people through sportand physical activity.

Advocate for balance
Encourage young people
to maintain balance intheir lives.
Facilitate open andhonest conversations
with other support networks(eg coaches, instructors,
parents) about a balanced
life within sport.
Support balanced healthand wellbeing to reduce
the risk of illness and injury.
Stay informed about femalespecific health issues orwellbeing concerns.

Look beyond results
to measure success
Focus on young people’s
enjoyment of sport andphysical activity rather
than results as a measureof success.
Remember – a very small
proportion of young
people will become elite
athletes, so encouragethem to try a variety ofsports and activities
to see which ones they
like best.

Focus oncreating positive
relationships andsafe environments
Develop and facilitate
positive relationships
with young people.
Be proactive aboutbuilding trust withyoung people.
Create environments
which are safe,
inclusive and supportive.

Know that you havea key role to play
Have courageousconversations whichenable young people tolearn and thrive.
Put young people and theirhealth and wellbeing first.
If you are concerned
about the health or
wellbeing, make decisions
and take action to reduceload or stress.

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BALANCED FEMALE HEALTH

Resources

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BALANCED FEMALE HEALTH

Resources

Learn more
Going with the flow: Menstruation and rainbow inclusive
practices in the outdoors
This resource by Education Outdoors New Zealand aims to increase
gender equity and menstruation inclusiveness in the outdoors.
Learn more about:Sport NZ philosophies, research and initiatives• Balance is Better – The Home of Youth Sport in New Zealand• Young Women Profile, 2021, Sport New Zealand• #ItsMyMove Campaign – Supporting young women to be
active their way• cultural perceptions and practices of menstruation,• rainbow communities experiences in the outdoors,• practical tips and information on how people can manage theirperiods in the outdoors, and• how to create safe and inclusive environments to have conversations

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Acknowledgments

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BALANCED FEMALE HEALTH

Acknowledgements
Balanced Female Health is a resource produced in collaboration with NetballSmart
SmartHealth authors Sharon Kearney – Netball New Zealand Lead Physiotherapist andNetballSmart Consultant (MPHTY, PG Dipl. Sports Med., Dip Phty) and Kylie Cox – The
Healthy Athlete Project (MSS, PGDipl. Sports Med., BPhty) with contributions from SportNew Zealand and High Performance Sport New Zealand (HPSNZ).
Sport NZ acknowledges the work of Netball New Zealand and NetballSmart and theirleadership in the development of the SmartHealth resources. Sport NZ wishes to thank bothparties for collaborating and sharing their knowledge with the broader sport sector.
Sport NZ also acknowledges ACC who provided funding for the SmartHealth resource
produced by NetballSmart.

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For more information, refer to:sportnz.org.nz/balanced-female-health