Athletes are finely tuned individuals. Females are multifaceted beings. Combine the two together and you have yourself one very complex “situation”. With female sport becoming increasingly prominent as a part of Australian culture, the lack of knowledge and research on how to manage this athlete group has really come to a head. During my time as a competitive runner and as a practicing physiotherapist, I’ve experienced and witnessed time and time again coaches, allied health professionals as well as the individual themselves perplexed as to how to address the many challenges that come with training at a high level as a female.

It has been encouraging to see the increasing awareness made surrounding the female athletes triad or what is now known as RED-S (Relative Energy Deficiency Syndrome). However, in addition to this there is an array of factors that need to be considered even for those experiencing regular periods and at a healthy weight. Some of these factors include the effect of different phases of our menstrual cycle on training, differing nutrition needs, as well as the alterations we will or have had to make when menopause occurs. Unlike males, females bodies are changing; day to day, month to month and year to year. As a result, we must respond accordingly and be adaptable through training and competition, whether an elite or recreational athlete. I have done a lot of reading into the work of Senior Research Scientist Dr Stacey Sims and she coins it perfectly when she states “women are not small men!”

Listed below (as although I’m a complicated female I still like things simple and easy), I will present just some of the vital factors that all female athletes should consider and prioritise going forward:


  • Upsurge of estrogen causes sparing of glycogen in the muscle and liver increasing reliance on fat as fuel. This is why females feel flat around ovulation and we feel stronger training more steady endurance efforts over high intensity intervals.
  • Female athletes have 5x increased incidence of diarrhoea, intestinal cramping and side aches compared to men. This is attributed to fluctuations in estrogen and progesterone with a greater increase in gastro-intestinal issues during the first 5-7 days following menstruation.
  • It is recommended that females avoid fructose and Maltodextrin (a white starchy powder added to many packaged foods such as pastries, candies and soft drinks) during exercise as this substance can work against you and your gut health.
  • If you don’t have your period you are not a healthy female athlete! To be able to adapt to your training and adapt to high stress loads… your endocrine system needs to be working, and your period is one of the indicators of your endocrine system status.
  • 45% of recreational athletes are in the sub clinical low energy state. Sub clinical means it’s enough to disturb menstrual irregularity, result in thyroid dysfunction, create undue fatigue and compromise your recovery – but not be necessarily in amounts that will show positive in clinical tests.
  • Post exercise women need protein and we need it fast! You’ll recover faster with 25-30g protein within 30mins of a hard workout (menopausal woman need 40)
  • When we are exercising we are breaking down our body, using fuel, incorporating all these hormones and enzymes to match the stress we put it under. You don’t want to stay in this catabolic (break down) state of high stress or else we don’t recover, repair, and adapt. For women, although estrogen is anabolic (building up), progesterone outweighs that when breaking down muscle tissue, making it more difficult to repair and build lean muscle mass. Getting good protein post exercise will help rebuild muscles and reduce the signalling to store body fat – protein helps restore the balance.
  • During the high hormone, pre menstrual phase blood sugar levels, breathing rate and thermoregulation are negatively impacted which accounts for a decrease in aerobic capacity and strength. To compensate for the shift in core temp and body water it is important to do some pre menstrual phase pre faking and start drinking before you begin your workout. The night before preloading on sodium may help, but don’t experiment with this – seek help from SSPC Dietitian Chris Rauch if you are having issues.
  • While training aim to eat 3.5 calories per kg of body weight per hour. This will prevent the release of cortisol and reduce the signalling to store body fat when you finish training. Your body will be primed to build lean mass and restore carbs stored in your liver and muscle.
  • Again… CARBS CARBS CARBS. They fuel your brain and central nervous system, help your body burn fat and help preserve muscle tissue. Low carb diets increase fatty acid oxidation during exercise and encourages intramuscular fat storage.
  • Aim for 40-45% of your daily intake to come from wholefood carbs to improve both body composition and performance.


  • As a female peak bone mass is already lower than males. Your bones are in a constant state of remodelling as the body absorbs old bone and re-lays new bone in its place. This remodelling continues to decline as we age and even more significantly with a reduction in estrogen. Strength training 2-3 x week helps keep our bones strong and is something we should all incorporate into our training.
  • I repeat!!! Lift heavy weight! Women who don’t can expect to lose at least 3% of their muscle mass per decade after the age of 30.
  • Women mobilise more fat during exercise but the opposite is said during recovery. Therefore it is harder for women to recover post sessions. Our metabolism is elevated three hours post waking compared to 21+ hours for males
  • Your hormones are favourable for performance once your period starts. The body goes into a more relaxed mode and all these energy systems used on the high hormone phase are at your disposal for exertion. One study on performance found swimmers recorded their fastest time during menstruation and slowest during the pre menstruation period. So don’t panic if you have your period race day, it could lead to your next PB!
  • Women who train with consideration to their menstrual cycle and completed strength and lifting during their low hormone week and rested more when hormones were highest saw a 32% increase in strength.
  • The more active you are and the more consistent and regular you are with your activity, the better your periods will end up being. Less cramping and less heavy flow.
  • Taking Oral contraceptives to manipulate your cycle can result in decreased anaerobic capacity and increased catabolism resulting in reduced lean mass availability. This can result in severe losses in how you could potentially be performing.


  • During menopause women need to adjust their exercise and alter the kind of stress put on the body. Start to incorporate more high intensity training (helps with blood sugar and insulin control), Plyometrics, heavy lifting (stimulate neuromuscular development and maintain muscle integrity)… less of the long, slow stuff!
  • The speed and strength of muscle contractions decreases after menopause. This is why we need to shift our thinking on training to more power based sessions.
  • During these high intensity power based sessions an increase in recovery time will be required.
  • You become more sensitive to carbs as you enter menopause. You become more susceptible to blood sugar swings and you need less intake overall. Eat more mixed macro nutrient foods when fueling during exercise, aiming to eat about 30g carbs per hour.
  • Focus on protein and bring leucine up, focus on complex carbs and where they are coming from.
  • Track your moods, recovery and how you’re responding to training over 6-8 weeks so you can see some patterning.
  • If you are considering HRT during Peri-menopause seek good advice regarding its use, and a plan on how and when you can come off the therapy. Research has shown that its use can increase risk of ovarian cancer.

Woah! Take a deep breath as you try and process all that. But as I stated in the beginning, there’s a lot to take in and there is a lot to consider far beyond just having a normal BMI. Being an athlete is a commitment in itself and being a female athlete adds a whole new demand. However, if you work as a team; with your coach, your physio, your doctor and your body… you CAN become the athlete you were always meant to be, reach your absolute potential and record performances that you never thought possible!

Anna Kelly

SSPC Physiotherapist

Anna runs regular Strength & Conditioning Classes at SSPC (when allowed) and enjoys treating female athletes. Anna herself is a high level distance runner, and you can find out more about what she does on the following instagram handles: