Micronutrient Strategies for Female Athletes

Micronutrients—vitamins and minerals—are vital for health and performance, supporting immune function, energy metabolism, hematological adaptation, and tissue repair. Female athletes often face unique risks of nutrient deficiencies due to smaller body size, heavier training loads, menstrual losses, restrictive diets, or low energy intake. This guide breaks down how to meet requirements for four key micronutrients and offers actionable strategies to stay strong and perform your best.

1) Iron

Iron is indispensable for oxygen delivery and energy metabolism. Athletes lose a small amount of iron through sweat, red blood cell breakdown, and occasionally gastrointestinal bleeding. Women face additional losses of iron from menstruation—about 5–40 mg per cycle. Heavy menstrual bleeding further elevates risk. Iron deficiency in female athletes affects performance and health, with prevalence at 15–35% compared to 3–11% in males.

The negative impact of iron deficiency can be seen before an individual is diagnosed with clinical iron-deficiency anemia. Low serum ferritin (the protein that stores iron) has been linked to poor performance outcomes and declines before other measurements of iron deficiency.

Key Actions for Maintaining Healthy Iron Levels:

• Get screened every 6 months (3–4 months if risky factors like low energy or menstrual changes are present).

• During periods of heavy training, consider taking approximately 1–2 mg additional iron daily to offset training losses.

• Eat iron-rich foods (lean red meat, beans, leafy greens) and combine with vitamin C for better absorption.

• If necessary due to dietary restrictions, consider timing supplementation when estrogen is high in the cycle to enhance absorption—but only under medical guidance.

2) Calcium

Calcium is essential for bone strength and repair. The International Olympic Committee (IOC) recommends 1,500 mg/day for athletes—higher than the 1,000 mg RDI for adults—to account for the increased metabolic demands exercise places on bone health.

Tips for Getting Enough Calcium from Food and Supplements:

• Consume calcium in ≤500 mg doses, three times daily, from dairy or fortified plant-based sources.

• Ensure adequate intake during adolescence to support peak bone mass.

• If dietary intake is insufficient, use supplements (1,000–1,500 mg/day) under medical supervision.

• Don’t take calcium and iron together—separate them by at least 2 hours to avoid absorption interference.

3) Vitamin D

Vitamin D supports muscle function, immunity, bone health, and hormone balance in athletes. Up to 42% of female athletes may be insufficient in vitamin D. Athletes who are deficient in vitamin D may be at an increased risk for stress fractures. Low levels of vitamin D (<50 nmol/L) impair calcium absorption, reducing it to 10–15%, whereas levels ≥75 nmol/L boost calcium absorption to 30% .

How to Improve Vitamin D Levels:

• Check 25(OH)D levels regularly; aim for ≥75 nmol/L.

• Get safe sun exposure when the environmental conditions and geographical latitude allow and include vitamin D foods like fatty fish, egg yolks, and fortified milk.

• If levels are low, supplement with vitamin D3 (2,000–4,000 IU/day) under professional guidance.

4) Folate

Folate (vitamin B9) is crucial for red blood cell production and preventing megaloblastic (folate-deficiency related) anemia. Female athletes have increased need for folate—especially during pregnancy or when using oral contraceptives, which can lower folate levels .

Key Actions For Folate Intake:

• Eat folate-rich foods: leafy greens, legumes, citrus, eggs, and fortified grains.

• Pregnant athletes should aim for ~800–1,000 µg DFE/day (common in prenatal supplements).

• Consult with a health professional to discuss supplementing with additional folate if using hormonal contraception.