LEAF-Q Test: RED-S & low energy availability
What this LEAF-Q test screens for
This test is based on the LEAF-Q (Low Energy Availability in Females Questionnaire), a validated tool designed to flag female athletes and active women who may be at risk of low energy availability and RED-S (Relative Energy Deficiency in Sport). In a few questions, it looks at the warning signs most strongly linked to an energy deficit: injuries, gastrointestinal symptoms and menstrual function.
It is a screening and awareness tool, not a diagnosis. Its purpose is to help you recognize early signals and decide whether to seek a proper assessment with a healthcare professional.
What are low energy availability and RED-S?
Energy availability is the energy left for your body's basic functions once the cost of your training is subtracted from what you eat. When it stays too low — often below about 30 kcal per kg of fat-free mass per day — the body prioritizes survival over functions it treats as “optional”, starting with reproduction.
This is the core mechanism of RED-S: a relative energy deficit that can disrupt the menstrual cycle, bone health, metabolism, immunity and performance. The absence of periods (amenorrhea) is one of its most visible signs, but RED-S can be present even when periods seem normal.
Why your menstrual cycle is a key signal
Reproductive hormones are among the first functions the body shuts down when energy is scarce. That is why irregular or absent periods — outside of hormonal contraception — are considered a red flag for energy deficiency. The American College of Obstetricians and Gynecologists describes the menstrual cycle as a “fifth vital sign” of overall health.
Hormonal contraception can mask this signal: the monthly bleed it produces is a withdrawal bleed, not a true period, and it does not protect bone if you are in an energy deficit. This is why the questionnaire asks about contraception.
How to read your LEAF-Q score
The questionnaire produces a score and a risk profile. A higher score, or specific red-flag symptoms, suggests a greater likelihood of low energy availability and warrants attention. A score at or above the critical threshold is commonly used to identify athletes who should be assessed further.
Whatever your result, it does not replace medical advice. If your score indicates a high risk — or if you have not had a period for more than three months — talk to a doctor, gynecologist or sports physician.
Scientific basis and official references
This test is based on the validated LEAF-Q and on the international consensus on RED-S:
- Melin A, Tornberg ÅB, Skouby S, et al. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. British Journal of Sports Medicine, 2014;48(7):540–545.
- Mountjoy M, Sundgot-Borgen J, Burke L, et al. IOC consensus statement on Relative Energy Deficiency in Sport (RED-S): 2018 update. British Journal of Sports Medicine, 2018;52(11):687–697.
- Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 IOC consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 2023;57(17):1073–1097.
- American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 651: Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. 2015.
Frequently asked questions
What is a RED-S test?
A RED-S test is a screening questionnaire that estimates your risk of Relative Energy Deficiency in Sport — a condition caused by not eating enough to cover the demands of your training. This test uses the validated LEAF-Q to flag the most relevant warning signs.
Is the LEAF-Q a medical diagnosis?
No. The LEAF-Q is a screening and educational tool. It can identify a risk and prompt you to seek help, but only a healthcare professional can diagnose RED-S or its causes.
Who should take this test?
Any girl or woman who trains regularly, especially in endurance, weight-category or aesthetic sports. It is also relevant if you have irregular or absent periods, repeated injuries or stress fractures.
What LEAF-Q score indicates a risk?
The higher the score, the greater the likelihood of low energy availability. A score at or above the critical threshold, or specific red-flag symptoms, suggests you should be assessed by a professional. The test gives you your score and a personalized profile instantly.
Can I have RED-S if I still get my period or take the pill?
Yes. RED-S can be present even with seemingly normal cycles, and hormonal contraception produces a withdrawal bleed that can mask a suppressed natural cycle. The pill does not protect your bones if you are in an energy deficit.
What should I do if my result shows a high risk?
Don't panic, but take it seriously. The priority is usually to increase your energy availability and reduce your training load, then to consult a doctor, gynecologist or sports physician — including a bone density (DEXA) scan if your periods have been absent for a while.