Overtraining & Female Health – An Issue Worth Talking About

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Warning – honest article ahead. I’ve been asked to write about over-training on the blog quite a bit this year. I have written about it in the past (check that out here), and I think as we have recently rolled into a new year that it’s time to chat about it again. What is over-training? Quite simply put, it’s training to excess (either in volume, frequency, or both) without adequate rest or recovery in between.

Have I over-trained in the past? Yep. Multiple times. I’m very open about the fact that I spent a large part of my teenage years and early twenties being a ‘cardio bunny.’ I played a LOT of team sports in my early teens, which I loved – camogie, gaelic football, basketball, volleyball, athletics – but when I got to the last 2 years of my medical degree I found the team training commitments very difficult to balance with college placement and study hours. So, I started using the gym more, and doing more running and home workouts via Youtube. Which, being honest, was a LOT of very frequent cardiovascular type training. This was around the time that the HIIT (High Intensity Interval Training) craze landed, and that formed a large part of my training too. I think I just thought this was all the ‘normal’ way to train – even if I did know deep down that the frequency at which I was engaging with it was to excess.

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There’s this funny thing about ‘getting sweaty’ during your workout – it can become something you think you ‘need’ to be able to feel as though you’ve worked hard. I find it hilarious now that I used to believe that so fiercely. What’s more hilarious to me now (I say hilarious with a touch of sarcasm, because over-training isn’t funny) is that I used to think I ‘should’ ‘train’ (i.e. sweat) 7 days a week. NOT. NORMAL. But hindsight is 20:20 vision, as they say.

Fast forward to me in a better place when I qualified as a doctor, and started my intern year. My friend Aisling got me into weight training (we became fast friends, laughing over many things including her love of weights and dislike of cardio, with me the opposite when we met!), and I was instantly hooked. It made me feel strong, it challenged my body in a very different way to the tired training I was stuck in a cycle of, and I realised very quickly that my cardio-bunny ways hadn’t really given me much muscle mass to speak of. Don’t get me wrong, I wasn’t unwell, nor did I look unwell – but I was definitely, as my dad wisely said more than once, ‘writing cheques my body couldn’t handle.‘ So, over time, as I started lifting weights more, I began to reduce the cardio/HIIT style stuff, and found more of a balance.

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I would honestly say it’s really only in the last 18 months that I have really found a true balance to my training, and I’m still learning. You’ll see I’ve chatted more about how I began prioritising regular weekly rest days after an injury from a 10km event in 2017 in a blog post from that time (read here). So I won’t rehash that now. I’ve also written about the concept of exercise addiction on my blog in the past (read here). In that article I discussed some of the very subtle signs of over-training, which I was largely ignorant of for a very long time – here’s a recap below, which I hope is helpful to some of you:

  • Difficulty with sleeping
  • Poor concentration (at work, school, college, or home)
  • Changes in mood – irritability, restlessness, low mood
  • Fatigue or feeling lethargic
  • Reduced performance physically – are you getting through your workouts the way you used to? Or have you stalled in your progress?
  • Reduced body-weight (whether intentional or not)
  • Frequent minor injuries
  • Frequent minor illnesses e.g. colds/flu-like symptoms
  • Headaches/General aches
  • Delayed recovery from workouts (prolonged DOMs for example!)
  • Lack of motivation

So, particularly since January this year when I found and developed a love for yoga (and became hooked on long walks with Podcasts and audiobooks), I think I’ve finally found a real balance I love to my training. I lift weights 3-4 days per week, depending on the program I am doing . My main ‘cardio’ is my walks, and sometimes short little finishers on the end of my weights sessions (as part of the program). I do yoga either in a class, or at home, multiple times a week, not in a structured way. I come to the mat when my body and/or mind needs it, which might be for 30 minutes, an hour in a class, or just 10 minutes. I set myself some 2019 goals to try new things and shake up my fitness identity, so to speak – I recently tried a Reformer Pilates class, and loved it!

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Let’s get to the real crux of the issue – why is over-training such a big deal? Please note that I’m going to stick to the implications for female health here (purely from an article length perspective!), but of course over-training is not limited to females. And as I always say, though I am a doctor, I am of course not an expert in this area. But, similarly to the post I wrote on gut health recently, I think it’s important to share the basics and raise awareness on those, as well as my own reflections too.

First of all, as you can see above, the signs/symptoms of over-training can potentially have quite a significant impact on your day to day well-being, as well as your physical, mental and social functioning.

Secondly, if you’re prioritising your training above ALL else in your life, that can negatively affect both you and those who love to spend time with you – family, friends, boyfriends – and even affect your college or work commitments.

Thirdly, let’s get to the nitty gritty. Exercise is a stress to your body, one which, in the appropriate dosage, can be and is beneficial for your health. For example, when I lift weights, I apply a stress to my body by lifting heavier over time, which forces my muscle to adapt and ideally allow me to get stronger over time (given appropriate rest and recovery). Any form of stress in excess is however NOT good for our health. That’s not rocket science.

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There is a medical condition observed in physically active females that you may have heard of, called ‘the Female Athlete Triad.’ The American College of Obstetrics and Gynaecology (ACOG) describes the three components of it – ‘1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density’ – and it really is a spectrum of disorders (i.e. it will look a little bit different for each female suffering from it). I’ve given you the full link to the ACOG website page on this condition here. Essentially, it is a condition that results from an energy imbalance – you expend more energy via training than you take in, meaning there isn’t enough energy available for your body to carry out the basic functions it needs to. For females, this low energy availability can lead to disruption of your menstrual cycle (your period) via it’s effect on a part of your brain called the hypothalamus. The hypothalamus is a fascinating part of our brain that plays a key role in lots of different bodily functions – hormone production, temperature, thirst, appetite, emotions, sleep cycles and many more.

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Stick with me here. Because of this effect on the hypothalamus, your menstrual cycle (your period) becomes affected. That’s because there is a hormonal pathway between your hypothalamus, your pituitary gland (in the brain also) and your ovaries. The hormone produced by the hypothalamus (GnRH – gonadotropin-releasing hormone) stimulates your pituitary to release FSH and LH (follicle-stimulating hormone and luteinising hormone), both of which are essential for a normal menstrual cycle as they stimulate the production of oestrogen and progesterone. So, if the hypothalamus doesn’t produce that first signal, GnRH, this can result in a range of possibilities including menstrual cycle irregularities, primary amenorrhoea (i.e. where you have never had a period) or secondary amenorrhoea (i.e. where you started your period with puberty, but then lost it for a period of greater than 90 days). The two main hormones in our menstrual cycle are oestrogen and progesterone. Not having a regular or any menstrual cycle results in a low oestrogen level in the body. We NEED oestrogen to maintain bone health, which is why female athlete triad can cause a negative effect on bone density (conditions known as osteopenia and osteoporosis). Poor bone density puts us at a higher risk of fractures, which I think we can all agree is NOT a good outcome.

There is a whole other realm to this discussion around nutrition, fuelling your training sufficiently, and on that train of thought, having adequate calcium and vitamin D for bone health. As I’ve said before, I’m a doctor, not a nutritionist or dietitian, but the rise in dairy-bashing on social media scares me, because it has led to massive rises in numbers of young women renouncing dairy in favour of plant-based alternatives. I’m not saying it’s wrong to make a dietary choice based on your personal ethical values around animal welfare or climate change, but it is dangerous to give up a food group without really planning out where you’re going source a replacement for the nutrients that food group provided. I eat dairy yoghurt pretty much everyday, and although I do use soy and sometimes oat milk, I recently started consuming dairy milk again (a glass a day, or in my Overnight Oats!) because when I looked at my calcium intake, it was far below what I should be getting, even with attempts to supplement with calcium-fortified milk alternatives. I’m not a huge cheese fan which probably contributed! That scared me, and made me realise that I can help the environment with my dietary choices – but not to the extent that it puts my own health (i.e. bone health) at risk. So my bottom line on the nutrition side of things (until I get a follow-up blog post on this together) is please, get yourself fully educated and informed (ideally from a professional such as a dietitian, qualified nutritionist and/or your doctor) before you starting chopping out food groups, especially if your sole reason for doing so is because your favourite blogger did it.

In 2014, the International Olympic Committee described ‘Relative Energy Deficiency in Sports (RED-S)’ as a broader, more comprehensive term for the Female Athlete Triad syndrome, and to recognise the fact that these issues can also occur in males (with of course the exception of the menstrual aspect!), with the overall emphasis on the impairment of many of our bodily functions due to excess energy expended by activity and not enough replaced. Now, I’m going to stop there, because I don’t pretend to be an expert in this area, but I did think that was worth mentioning, and I think it’s also worth being aware of the female menstrual and bone health implications via the relatively straightforward to understand model of Female Athlete Triad.

Phew. Let’s recap. Over-training and under-fuelling = negative effects on all aspects of our health. In females, it can result in ‘female athlete triad’, negatively affecting our menstrual cycles, oestrogen levels and bone density. All in all, something we would ideally safeguard against.

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How? Rest. Recovery. Refuel. REGULARLY. For me, that now looks like a rest day (i.e. no gym, no heavy cardio or HIIT) 2 days per week minimum, maybe 3 depending on how busy my week has been or how my weight training has been progressing (i.e. sometimes it might be more, I’m still trying to figure it out fully!). I like to structure one day in mid-week, and one day at the weekend, or I’ll use Saturday and Sundays for rest days. People talk about ‘active’ rest days, where you might go for a walk, or do some yoga – some agree with this, others do not. Personally, I use a Fitbit watch, and like to hit my 10,000 steps a day every day (including rest days), and I do believe our bodies are designed to move every day. On my rest days away from the gym, I’ll always go for a Podcast walk, and I might do a short yoga sequence at home, or I’ll book into a class with a friend. I won’t book the classes I know are a bit more intense on those days. I find yoga incredible helpful to complement my gym training and really work on my mobility and flexibility, so I keep it up. It’s important to find a balance that works for you and your body, and to first of all learn to listen to those subtle signals your body is giving you. This takes time, and really until I started yoga I didn’t fully hear them. I do now.

I hope this post was helpful guys. I recommend checking out Dr. Anita Mitra (@gynaegeek on Instagram) if you want to hear more on female hormone health and over-training, as well as female gynaecological health, her content is fantastic, and she has done some awesome Podcast interviews too. I also think the content shared by Renee McGregor, a performance and eating disorder dietitian, is fantastic. She has been interviewed on multiple Podcasts (including the Food Medic, it’s a great listen!) and has her own website which I’ve linked, I definitely recommend checking her out!

Let me know your thoughts as always – I’m @theirishbalance on Instagram/Twitter/Facebook!

Ciara 🙂 x

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