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Your body likes status quo and stability; your brain is inherently wired to keep you safe. Yet training for your first marathon, running a 5K PR, or crushing a session in the gym will all challenge that homeostasis (the self-regulating process by which an organism can maintain internal stability while adjusting to changing external conditions). And, of course, working out and pushing your limits isn’t bad—far from it—but consistently pushing your limits beyond what you’re capable of, and without sufficient rest, will ultimately lead to your body (and mind) finding ways to tell you it’s time to take it a little easier. Some of those signals are subtler than others.
As a sports-minded MD, Dr. Kiki Silver knows a thing or two about these signals, having worked with female endurance athletes for 20 years and qualified for the Ironman World Championships on three occasions. Of all the symptoms outlined below, Dr. Silver says that when it comes to female athletes, she will almost always think first of RED-S (relative energy deficiency in sport). Previously referred to as the female athlete triad (amenorrhea; loss of bone density/osteoporosis/stress reactions or fracture; and disordered eating), RED-S occurs when there are not enough calories (either intentionally or accidentally) to fuel the training of an athlete’s life.
She said: “Disordered eating is incredibly common in female athletes. It is critical that coaches understand that many, many women struggle with disordered eating and that they can have a normal BMI even if they have more severe disordered eating (restriction, bulimia, anorexia, orthorexia).”
Of course, not all signs are related to this, but Dr. Silver advises that many can be when it comes to female endurance athletes. With this in mind, here are some common signals your body might be giving you:
1. Irregular or missed periods
Dr. Silver said: “Many women stop menstruating because of low energy availability (LEA) and too low of a lean body mass, although it’s important to note that many women can have ‘normal’ BMI and body fat, but still have too low an energy intake to support a normal menstrual cycle.” If you’ve missed more than three periods or your cycle seems to be drastically different than your typical pattern then seek advice from a healthcare professional. Dr. Silver warned that women on the birth control pill need to pay attention to other signs of adequate energy availability, as having your period while on the birth control pill does not mean that you have adequate energy availability: “The period on the pill does not give reassurance here,” she said.
2. Night sweats
After an intense workout or a hard race, it’s not uncommon to wake up in the middle of the night drenched in sweat, but if this starts to become the norm rather than a one-off, it’s worth paying attention to. Dr. Silver warns it can often be a sign of overtraining and/or high cortisol. It can also be related to thyroid issues or a sign your body is fighting an infection.
3. Trouble sleeping
We’ve all had nights where we toss and turn, struggling to get to sleep. Or we might fall asleep without issue but wake in the night and be unable to get back to sleep. If this persists, it can often be linked to poor fueling and recovery and/or overtraining, Dr. Silver said. Pay attention to the timing of your fueling and refueling post-workout, and make sure you’re consuming adequate carbs, protein, and fats for your activity level. It’s also worth paying attention to your sleep hygiene habits: Is your room too hot or filled with ambient light? Are you spending too much time in front of screens before bed? If your sleep hygiene is on point and you’re still struggling, it’s worth seeking help from a healthcare professional to check for sleep disorders, Dr. Silver said.
4. Lack of appetite
If you lose your appetite while logging your usual (or increased) workout regimen then it can be a sign that something has gone awry. Dr. Silver said her first check is RED-S when a female athlete presents with a lack of appetite, and it can also be an early indicator of overtraining. If you’re fueling well and not overdoing it but still lacking an appetite an MD might check for primary gastro-intestinal disorders or mood disorders, she said.
5. Lack of sex drive
When you’re tired from a big run week or a hard race, it’s totally understandable you might not have any extra energy for—or interest in—any other forms of physical activity, but if these feelings persist then it can be a pointer towards hormonal dysfunction, often related to RED-S, Dr. Silver said. Too much exercise can cause a drop in estrogen and progesterone, two hormones that play a key role in sex drive.
6. Extreme fatigue and low energy
If you’ve done a big training block or pushed yourself harder than normal, it can be expected that you’ll feel physically and mentally tired. This is when it’s important to take rest and recovery days, and you should expect your body and mind to bounce back (even if it takes a few days). When this doesn’t happen and the fatigue persists, it can be a sign that something’s not right. “This could be attributed to a number of things,” Dr. Silver said. “I would first look at hormone imbalances, nutritional deficiencies, training protocols, and even sleep disorders. After that it could be related to any primary organ dysfunction (cardi-pulmonary, renal, auto-immune, etc).”
7. Growth of excessive facial hair
This can be common in women as they age, especially in those approaching menopause, but in younger women it can be a sign of endocrine dysfunction, Dr. Silver said. It can be caused by an excessive amount of male hormones (androgens), and if it’s a concern, it’s worth seeking advice from a healthcare professional to check for primary endocrine dysfunction.