High-performance (HP) coaching is a demanding profession. The proportion of woman HP coaches is reported to be in the range of 8.4–20%. Mental health concerns in elite sports have recently gained attention, but mainly focusing on athletes. Beyond coach burnout, limited attention has been given to coaches' mental health. A recent coach burnout review included only one paper that focused exclusively on women. It has been argued that women HP coaches face greater challenges in a male-dominated coaching culture. The purpose of this study was to explore challenges experienced by women HP coaches and their perceived associations with sustainability and mental health. Thirty-seven female HP coaches participated by answering a semistructured, open-ended questionnaire. All responses were analyzed using inductive thematic analysis, which resulted in two general dimensions: challenges of working as women HP coaches and sustainability and well-being as women HP coaches. Overall, results indicate that challenges reported might be common not only for all HP coaches, but also highlight gender-specific elements. Consequently, coach retention and sustainability would benefit from more attention on well-being and mental health among HP coaches.