Burnout in Female Athletes. What strategies can you use to prevent and treat burnout?
Have you ever asked an athlete why they do what they do?
Pushing themselves through gruelling training sessions, to compete against like-minded people, to see who trained harder to achieve gold. When you dumb it down like that, you wonder what all the fuss is really about.
Most athletes will admit they will come back every time for “that feeling when it’s all over”. It’s the euphoric feeling of endorphins rushing and blood pumping through your body that makes you feel most alive.
So now you can only imagine why they come back every time, and sometimes that feeling can even be addictive.
It’s easy to get caught up on performance and working your hardest in training sessions, and forget to pace yourself, fuel yourself and, recover. Over-exercising and under-eating can lead to burnout, which occurs in both male and female athletes.
However, female athletes who suffer from burnout, can also experience from menstrual dysfunction and poor bone health. Regardless of training status, it is not normal to be amenorrhoeic (absence of menstruation).
These factors concerning burnout, as this blog will explain, can seriously affect your performance.
This blog will reward you with:
- A better understanding of why your own menstrual cycle is so important for health and performance.
- Information on Relative Energy Deficiency Syndrome (REDS) and how it affects the menstrual cycle and performance
- Strategies on how to prevent and treat REDS.
Why is it important to have a regular menstrual cycle?
You may feel like skipping this section if you don’t have plans for children in the future, or you’re happy with missing a period every so often, so you can avoid all the pain that comes with it.
However, having a regular menstrual cycle is actually so important that, in the foreseeable future, it may be used as a method for doctors and other health professionals to assess women’s overall health (along with blood pressure and temperature etc.).
So why is that may you ask? Research confirms that having a normal cycle can affect your performance levels, immunity, bone density, and other factors such as mental health.
The menstrual cycle is a necessary inflammatory process. A well-known example of another necessary inflammatory process would be your body increasing its temperature, to kill any bacteria/virus causing infection in your body.
Various types of white blood cells are released/ have different functions in response to certain stages of your menstrual cycle. White blood cells help protect your body and fight off infection.
Therefore, in the same way that the above process is absolutely necessary to keep your body safe and healthy, having a regular menstrual cycle can contribute towards a normal functioning immune system.
Bone density is something that may seem irrelevant to you now. You may be young, have good posture, no aches, or pains… However, declining bone density is an inevitable process in which no human can dodge, and can lead to many bone-related diseases such as osteoporosis. That said, having a high bone density throughout your life can reduce the decline and significantly reduce your chances of any bone-related diseases.
How is all this related to your menstrual cycle? Well, bone density is controlled with the help of the hormone oestrogen, which one of the main hormones involved in the menstrual cycle. Oestrogen is seen to have periods of high and low levels during a regular cycle.
Therefore, as you can see, having a regular cycle could represent adequate levels of oestrogen, which is important to avoid huge declines in bone density.
Relative Energy Deficiency Syndrome (REDS)
In the past, the Female Athlete Triad was used to describe the relationship between low energy availability, menstrual dysfunction, and low bone mineral density in female athletes.
However, now that term is outdated as, we now know that the link between low energy availability, and poor health can affect both genders. As a result, this term is now renamed Relative Energy Deficiency Syndrome (REDS), and applies to both genders.
REDS occurs when the body does not take in enough energy (in the form of food/fluids) to support demands of energy expenditure (physical activity and exercise). This creates an energy deficit in the body.
This causes what is called low energy availability. Energy availability can be determined by subtracting energy expenditure from energy intake.
This energy deficit is often seen in athletes, due to the high levels of energy expenditure they have during training and competition, and it is particularly seen in female athletes due to lower energy intakes.
However, any negative effects of REDS, are only seen after the energy deficit has been maintained for a long period time. Here are some of the signs you may experience if you have suffered/are currently suffering from REDS:
How does REDS affect your menstrual cycle?
Like all mammals, humans require energy for reproductive processes, such as menstruation.
Yet, when too little calories are consumed, or too much energy has been expended, metabolic fuel is redistributed from the reproductive system in order to preserve fuel for survival purposes.
The hypothalamus is a section in your brain that helps regulate all the glands in your body. Ovaries are also a gland (an organ that releases hormones). As explained above, energy deficits can disturb the signalling between the hypothalamus and your ovaries.
In short, no communication, no regulation of hormones involved in the menstrual cycle.
Therefore, when female athletes are in a calorie deficit, or are over-exercising, they can become amenorrhoeic (loss of a menstrual cycle for more than 90 days).
65% of female endurance athletes are affected by amenorrhoea, and Hypothalamic Amenorrhoea affects 20-35% of those suffering from secondary amenorrhoea (lack of 3 consecutive periods).
As mentioned above, having no regular menstruation is not only a poor indicator of health, but it also puts you at a performance disadvantage as athletes who experience regular menstruation can plan their training and nutrition around hormonal fluctuations that occur in the cycle. This can optimize performance.
Here are some signs of hypothalamic amenorrhoea:
What can you do treat and prevent REDS, and exercise induced amenorrhoea?
Firstly, go to your GP. Discuss your symptoms and get some tests done to see if there is anything else going on.
Increasing your energy intake and/or reducing your energy expenditure, until normal menstrual function returns and your symptoms of REDS disappear, is a good place to start, as well as ensuring you are consuming adequate amount of carbohydrates and protein.
Research suggests that weight gain can decrease the damage done to bone mineral density, and mechanical loading can also have a positive effect on bone density.
Weight gain is also closely linked to the return of regular menstrual functioning.
If you are unsure about how your next training session/competition could affect your health, you can use this table to assess your risk level:
Conclusion
As addictive as exercise and sport may be, you must remember that looking after your body and health is more important. The prevention of these syndromes are easy when dumbed down, eat enough to fuel the work you plan to do, and listen to your body to notice if you are over-exercising.
Ensuring regular menstrual function, high energy availability, and good bone mineral density, are your responsibilities as an athlete to optimize your performance. (J, et al., 2018)The benefits of exercise hugely outweigh the risks, so start with prevention before negative symptoms start to appear.
Want to discover the key changes you could make to your diet, that are specific to your unique female physiology ?
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References
- J, E.-S.K. et al., 2018. Endocrine Effects of Relative Energy Deficiency in Sport. International Journal of Sport Nutrition and Exercise Metabolism, 28(4), pp. 335-349.
- Mountjoy, M. et al., 2018. International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. International Journal of Sport Nutrition and Exercise Metabolism, 28(4), p. 316–331.
- Mountjoy, M. et al., 2014. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Sports Medicine, 491–497.
- Nattiv, A. et al., 2007. The Female Athlete Triad. Medicine & Science in Sports & Exercise, 1867 - 1882.
