Female athletes face special health risks from pushing too far into the red. Here’s how to stay in the training-recovery sweet spot.

By Selene Yeager

Training is a balancing act. You push, push, push, overreaching just enough to make your body go, “Woah, she’s asking a lot out of us, we’ve gotta get stronger to keep up.” And you recover enough to allow your body to mend your muscles and replenish your energy stores to make you stronger so those hard efforts become easier. And then you push some more.

Most of us are really good at that pushing part. We love to push. That second part can be harder because recovery is more than taking a rest day. It’s proper fueling. It’s managing psychological stress. It’s recognizing that as a female, you’re more susceptible to the hormonal risks of underfueling. Without maintaining balance, we can get into trouble.

What is Overtraining?

The simplest definition of overtraining is when you exceed your capacity to recover. There’s no definitive test for it. It’s diagnosed by a cluster of symptoms of what scientists call “prolonged maladaptation.” In short, you’re in a hole and a number of your biological, neurochemical, and hormonal regulation systems are short circuiting. Signs and symptoms include impaired performance and recovery, increased risk for injury and illness, impaired sex hormones, disrupted sleep, higher resting heart rate/lower heart rate variability, loss of appetite, and low mood. You’re generally considered to have overtraining syndrome if your performance decrements persist longer than two months. 

It’s different from acute fatigue or functional overreaching, where you might hit a point where you’re tired and maybe see a little dip in performance or completely empty yourself out in a big race, event, or training block, but then bounce back stronger after proper rest and recovery. With overtraining, you’re not bouncing back.

It’s also most common in endurance sports where athletes train with high volume and it’s easy to keep training through fatigue. (Some research questions if it’s even a thing in strength sports, but more studies are definitely needed there.)

Though the term “overtraining” is generally used pretty broadly, true overtraining syndrome is pretty rare and profound, says Alex Coates, PhD, who gave a presentation on overtraining at the 2021 Feisty Women’s Performance Summit. Before you hit true overtraining, you have nonfunctional overreaching, where you’re in a performance hole that takes weeks to months to recover from, so by the time you get back to normal, you haven’t enjoyed any performance gain. That’s not good, but it’s not as dire as true overtraining syndrome can be.

“Overtraining syndrome is very rare and when people kind of use the term lightly, it kind of does a disservice to the people who are fully experiencing overtraining syndrome,” says Coates. In severe cases it can take you out of sport for years, and sometimes life, according to research.  

Is it Overtraining or Underfueling?

There’s a longstanding debate in sports science on whether or not overtraining actually exists. That’s not because that cluster of symptoms described earlier is all in your head. It’s because some people think it’s always a product of under-recovering, especially underfueling, rather than “overtraining.”

Without wading into that debate, it’s important to recognize that severe underfueling looks a whole lot like overtraining. When you don’t eat enough as an active woman, you can slip into a state known as low energy availability (LEA), which sets the stage for Relative Energy Deficiency in Sport (RED-S), a condition that, according to research, can result in irreversible health and performance impairments including decreases in metabolism, poor hormone function, bone loss, lower immunity, impaired protein synthesis, fatigue, depression, anxiety, impaired digestion, and increased risk for cardiovascular disease.

You might have heard the term “female athlete triad.” That falls under RED-S and is used to define the relationship between energy availability, hormonal status, and bone health. One of the hallmarks of RED-S for women is menstrual dysfunction or loss of periods altogether. 

So, there’s a lot of overlap, and as a 2021 study published in Sports Medicine explains, they both originate from the same place: your hypothalamic-pituitary axis. As that study concludes: “the symptom similarities between training-overload, with or without an Overtraining Syndrome (OTS) diagnosis, and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic–pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA).”

LEA/RED-S is also insidious because it can come on gradually enough to be easy to ignore, according to Heidi Skolnik, CDN, of Nutrition Conditioning, LLC, author of the Athlete Triad Playbook, and co-author of The Whole Body Reset who explained the issue on episode 103 of Hit Play Not Pause.

“You’re working out. You’re training for your sport. You’re able to go to practice. You may not feel fatigued, especially in the beginning. But we still have our physiology we need to feed. We have to feed our organs, our heart, our lungs, and our kidneys and support our growth, repair, and recovery. When we aren’t taking in enough calories, we have energy available to work out, but low energy availability for the rest of our physiology. That’s low energy availability,” explains Skolnik. 

Left unchecked, you end up with RED-S. Importantly, you don’t have to be a low body weight to have LEA or RED-S. You can be at any weight and still not have enough energy after training for normal hormone production, muscle protein synthesis, bone remodeling, recovery, and general metabolic health.

If you have persistent symptoms of overtraining and/or RED-S, working with a sports medicine professional who can run blood panels and measure hormones and other biomarkers, as well as take a full physical and psychological assessment can help you get to the bottom of it and get back on track.

How to Avoid Overtraining

To avoid overtraining, give your body everything it needs for performance and recovery, so it can adapt to the training you’re doing. Also, track your training, including your menstrual cycle, so you can see performance trends and catch downward trends before they become full-blown problems. Tracking your menstrual cycle along with your training will help you see when you might have issues like fatigue related to PMS that can be addressed separately, and allow you to train and fuel with the rhythm of your cycle. Here are some essentials for avoiding overtraining:

Nail your nutrition

Giving your body the energy it needs is priority number one for performance and recovery. Working with a sports nutritionist, even for a season to get the hang of it, can help. In broad strokes, here’s what Skolnik recommends:

Be wary of intermittent fasting: Intermittent fasting (IF) is a popular weight loss strategy, though it’s questionable if it’s actually superior to other kinds of energy restriction. Research also indicates that IF can be problematic in women and can actually increase stress, worsen glucose tolerance, and may cause hormonal disruption, as our bodies respond to energy restriction differently than men do.

It also can make it hard to maintain muscle, Skolnik says. “You need to hit 25 grams of protein in the morning to press that anabolic, muscle-building button.” What’s more, research has shown that when people lose weight through IF, they lose more than 60 percent of it from muscle rather than the 30 percent people usually lose in the form of muscle when they lose weight. 

“Muscle is hard to come by as we age and we want to maintain what we’ve got and if we can, continue to put it on. So, it [IF] is a terrible strategy,” Skolnik says. “I don’t see the benefits over the drawbacks. If you want to intermittent fast, that’s what sleep is for. Stop eating at 8:00 p.m. and then eat breakfast the next morning at 8 a.m. That’s 12 hours. You’ve just done an intermittent fast.”

Eat adequate carbohydrates. Low energy availability often stems from low carbohydrate availability as so many women (and men) are still afraid that eating carbs will make them gain fat. When it comes to immunity and bone health, some studies suggest that carbohydrate restriction is more detrimental to both than not getting enough calories overall. Most athletes' needs vary from 5 to 8 grams per kilogram of body weight, Skolnik says. “But you may even need upwards of 10 grams per kilogram depending on your sport.”

Get protein throughout the day. You don’t store protein like you store carbohydrates and you can only synthesize so much at one time, so you need to spread it out throughout the day. “The goal is to have 25 to 30 grams of protein three or four times a day coupled with strength training to help you maintain your muscle, which is crucial for health and well-being across the board,” Skolnik says. 

Respect rest days and downtime

Too many women worry that they’ll lose all their fitness if they take a few days off. Or they spend their “recovery” days doing strength training or an intense (rather than relaxing) yoga class. Recovery days are training days. Same with recovery weeks. Two to three weeks of training should always be followed by an easier week.

This extends to the whole season. You can’t—and shouldn’t try to—maintain peak fitness year ‘round. Your body needs to “detrain” a little to fully recover. In fact, a study on female college athletes found that those who came into the season more highly trained showed signs of tipping into overtraining, such as inflammation and muscle breakdown, as early as the first half of the season compared to those who came into the season less close to peak form. This is similar to the “flying in February and fried by July” phenomenon that can happen in endurance athletes who pile on miles and intensity during the off-season.

If you cannot take a day off, examine your relationship with exercise. Research finds that exercise addiction, where people experience physical and psychological withdrawal symptoms when they don’t workout, is a probable cause of overtraining. 

Use your emojis!

Track your moods along with your other training metrics. Your moods are the proverbial canaries in the coal mine for how training is going. Some swings are perfectly normal. The high of a great race is often followed by a low two days later. Efforts that leave you blown out, if elated, send your hormones on a wild ride that will include some downswings. It’s normal to be edgy race day morning. But if you’re consistently agitated or feeling dark, that’s a sign that you need to add more recovery to the balance, which incidentally doesn’t always mean rest. Sometimes it’s a matter of eating more carbohydrates, which are not only essential for recovery, but also happy mood neurotransmitters like serotonin.

Check RPE (rate of perceived exertion)

If all your workouts feel hard, that’s not good. Neither is not being able to hit your training marks. Persistently dead legs and flat performances are a sign of too much overreaching. “A big symptom of overreaching is a decrease in lactic acid production, which some would think is a good thing, but you need to produce lactate to sprint and use our anaerobic metabolism,” says Coates.

Avoid “Punishing” Workouts

Athletes will sometimes have a few bad workouts and convince themselves that they need to train more and push harder to get on track. The opposite is true! If you notice that you’re missing your marks in training, that’s generally a sign that you’re not adequately recovered. Pushing yourself harder will only dig the hole deeper.

“You can be a little tired, but it should only take a day or two to bounce back,” says Coates. “If you're finding that you are training really hard and then it takes you a week to bounce back, you've gone too far. You don't need to dig holes to have performance gains.”

Watch your heart rate

Changes in your heart rate can be indications that you’re heading into overtraining. Signs to watch for include an elevated resting heart rate and a lower-than-usual heart rate for hard efforts. 

“Say you’re biking at 200 watts and that effort usually gives you a heart rate of 150 bpm. Now at 200 watts you have a heart rate of 140. That 10-beat drop would indicate that you are overreached…You shouldn't see your heart rate being suppressed by 10 beats per minute at a given load.”

If you track your heart rate variability, a persistently lower HRV is also a sign of overreaching too far. It means your nervous system is fatigued and not responding to changes in stimuli very quickly.

In the end, avoiding overtraining and/or RED-S comes down to staying in tune with your body and trusting it and the training process, so you can fuel it appropriately, rest it adequately, and get the most out of it in the activity you love.