It’s Not Just Hormones: The Female Athlete Injury Consensus Statement.

For decades, when female athletes & their injuries have been compared to male athletes, the conversation has revolved around the body.  Wider hips. Larger Q-angles. Menstrual cycle hormones. Joint laxity.

Anatomical differences, joint laxity, neuromuscular characteristics and hormonal influences may indeed matter, however, according to the International Olympic Committee’s Female, woman and/or girl Athlete Injury pRevention—or FAIR—Consensus, they represent only one part of a much broader picture.

Published in the British Journal of Sports Medicine in December 2025, the FAIR Consensus is the first IOC consensus focused specifically on injury prevention for female, woman and girl athletes. It was informed by a series of systematic and scoping reviews, together with a concept-mapping study involving athletes, coaches, clinicians, administrators and researchers.

That concept-mapping study asked 66 participants from six continents to identify, organise and rate gender and sex specific considerations relevant to sports injury.

The findings shift the focus from biology alone to the environments and systems in which female athletes train and compete.

Researchers sorted 101 distinct risk factors into 10 groups, then categorised these under five broader domains. Only one of those five domains focused primarily on sex-related biological factors.

Sex-related factors (hormones, joint laxity, Q-angle, bone density) was ranked fifth for importance – the least modifiable domain. Coaching knowledge, funding equity, and access to strength training, by contrast, were rated the most important & most modifiable.

1. Funding and Resources

• access to suitable facilities
• equipment
• staffing & medical services
• strength and conditioning
• recovery support
• injury-prevention programs.

Where female athletes receive fewer or less appropriate resources, their ability to prepare for and recover from sporting demands may also be affected.

2. Expertise and Knowledge

• Female athletes remain under-represented in sports injury research.
• Across more than 650 studies reviewed for the FAIR Consensus, fewer than 40% included female specific data with many studies not reporting female and male findings separately.

Coaches and clinicians frequently report limited training in female athlete specific care.

3. Sex Related Factors

• anatomy
• hormonal influences
• joint laxity
• body composition
• neuromuscular characteristics.

Although these may contribute to injury risk in some athletes, participants considered them less modifiable than the surrounding environmental & organisational factors.

4. Gendered Sporting Environments

• stigma around female health
• pressure to conform to appearance or body ideals
• harassment and gender bias
• unequal or less developed sporting pathways
• environments that may feel inaccessible or intimidating
• limited representation of women in coaching and leadership roles

These factors can influence whether athletes feel safe, supported and adequately prepared to participate.

5. Gendered Communication

This domain considered how injury, pain and health concerns are discussed with female athletes, including under-recognising or dismissing symptoms.

Communication can influence whether symptoms are disclosed, recognised and acted upon, as well as whether athletes feel comfortable discussing menstrual health, pelvic health, breast health, nutrition or other relevant concerns.

The authors were transparent about the study population. Of the 66 participants:

• 85% identified as female, woman or girl
• 74% identified as white
• 77% lived in high-income countries
• 23% lived in low- or middle-income countries

The authors note the findings may look different with a broader representation from different demographics.

The key findings are that the low-hanging fruit in female athlete injury prevention is organisational & cultural.

Access to strength and conditioning support, coach education in female athlete development & the normalisation of conversations & considerations around the menstrual cycle were all rated as more actionable than any biological changes.

This research shifts the conversation from why the female body makes her more prone to injury, towards shining a light on the environment that has not supported her development, preparation & protection in order to allow her to perform injury free.

This is a landmark step forward for female athlete injury prevention.