Running Through Perimenopause into Menopause: How Perimenopause and Menopause Affect Athletic Performance

For many women – myself included - running is more than just a form of exercise, it’s a source of empowerment, mental clarity, and physical strength. Running for me is my “me time”, my “I can do this” time, my “I might be getting older but I’m not going to let that stop me” time.  I have never been a natural runner, and I have never been fast, but my distances were getting steadily longer, and I was feeling great……until I was about 52.  Then, I started getting slower, less energetic, I couldn’t complete my interval workouts, and I felt like I was running through mud.
​At the time my periods were still regular and I had no perimenopause symptoms like hot flashes or moodiness, so I didn’t immediately put it down to hormonal changes.  But my sleep was starting to really suffer and after talking to friends also going through these issues I realised that it might be perimenopause.  In fact, with the average age of full menopause (no periods for one year) being 51, and the perimenopause period lasting up to 10 years before menopause, I was definitely in the perimenopause period of my life. 
So, I delved into understanding how these hormonal changes impact athletic performance and looked to find evidence-based strategies - including nutrition, supplementation, and hormone replacement therapy (HRT) - to navigate this transition effectively.

​Understanding Perimenopause and Menopause

Perimenopause is the transitional period leading up to menopause, characterized by fluctuating levels of estrogen and progesterone. This phase can begin several years before menopause and is marked by irregular menstrual cycles and various physical and emotional symptoms. These hormonal shifts can lead to symptoms such as hot flashes, mood swings, sleep disturbances, and decreased muscle mass and bone density. For runners these changes can manifest as reduced endurance, slower recovery times, and increased susceptibility to injuries. Research indicates that both early and late perimenopausal women experience declines in muscle strength and power during the transition to postmenopause (NIH).
Menopause is reached after 12 consecutive months with no period, then postmenopause follows, during which hormone levels stabilize at low levels.

Hormonal Changes and Their Impact on Running Performance

Estrogen plays a pivotal role in various physiological processes, including the metabolism of many connective tissues, including bone, muscle, tendons and ligaments, and cartilage.  As estrogen levels decline during perimenopause and menopause, women may experience decreased muscle mass, increased fat accumulation, and reduced maximal running capacity. These changes can significantly impact running performance, leading to slower times and increased fatigue.
Moreover, the decline in estrogen affects the body’s ability to repair and build muscle tissue, making recovery from workouts more challenging. Joint pain and stiffness, common complaints during menopause, can further hinder training and increase the risk of injuries. Additionally, fluctuations in cortisol, the stress hormone, can exacerbate fatigue and impede recovery.

Nutritional Strategies to Support Performance

Adapting nutritional strategies is essential for mitigating the effects of hormonal changes on athletic performance. Increasing protein intake is particularly important, as it supports muscle maintenance and repair. Experts recommend that menopausal women consume between 1.2 to 1.6 grams of protein per kilogram of body weight daily, distributed evenly across meals. 

Carbohydrates are also important to fuel endurance activities, especially around your run.  Running can raise your cortisol level, and carbs can help blunt the effect of elevated cortisol. 

Fueling Strategies for Runners

During perimenopause and menopause, changes in metabolism and energy demands may necessitate adjustments in fueling strategies for optimal performance and recovery.

• Pre-Run Fuel: Consuming a meal rich in easily digestible carbohydrates and moderate protein 2-3 hours before a run can provide sustained energy. Examples include oatmeal with berries or a banana with peanut butter. Avoid high-fat or high-fiber meals that may cause digestive discomfort.  For anyone – like me – that runs first thing in the morning, finding something that is quick and carb-heavy is key, perhaps half a bagel, or my favourite, an RX Bar that has a great mix of carbs and protein.
• During the Run: For runs longer than 60 minutes, additional fueling becomes crucial. Women in this phase may benefit from consuming 30-60 grams of carbohydrates per hour through sports gels, chews, or drinks. Maintaining blood sugar levels is essential to prevent fatigue and maintain performance.  While I used to be able to go much longer without fuel, I find I need more carbs than I used to in order to keep me feeling like I have enough energy to complete my run. 
• Post-Run Recovery: After a run, aim to replenish glycogen stores and support muscle repair within 30 minutes. If you’re planning on eating a meal right away, then a balanced meal containing carbohydrates and protein in a 3:1 ratio is ideal, or if – like me – you are not hungry right after a run, make sure to grab a snack containing protein and carbs.   I personally love whey protein or Greek yogurt with a handful of berries. 

Due to fluctuating and declining levels of estrogen, perimenopausal women often have greater challenges maintaining stable blood sugar levels, which can lead to increased risk of insulin resistance, prediabetes and even diabetes.  To keep blood sugar levels as stable as possible, avoid fast-acting carbohydrates any time other than pre and peri (during) your run.  The rest of the time, make sure to get your carbs from high-fibre, whole grain sources, such as vegetables, berries, brown rice, quinoa and sprouted-grain bread.

Supplements to Support Athletic Performance

Supplements can play a crucial role in supporting performance and recovery during perimenopause and menopause.  (Make sure to talk to your doctor before adding new supplements, particularly if you are taking any medication.)

• Vitamin D is crucial, given its role in calcium absorption and bone health. Estrogen enhances the activation of vitamin D; thus, declining estrogen levels can lead to deficiencies, increasing the risk of stress fractures. 
• Omega-3 fatty acids, found in fish oil and flaxseeds, have anti-inflammatory properties and support cardiovascular health, which is beneficial during menopause.
• Magnesium supplementation can aid in regulating hormones and improving metabolism. Plus, in associated with less oxygen needs and better cardiorespiratory indices.

• Collagen: Essential for maintaining joint health and connective tissue, collagen supplementation may reduce joint pain and improve recovery from high-impact activities like running.
• Creatine: Known for enhancing muscle strength and power, creatine can also support cognitive function and mitigate age-related muscle loss, making it beneficial for menopausal athletes.  Creatine can also help contribute to gut-health, potentially alleviating some of the “runners-tummy” issues that plague many of us. 
• Taurine: An amino acid that helps regulate muscle contractions and reduce oxidative stress, taurine may improve endurance and delay muscle fatigue during long runs.
• Beta-Alanine: A non-essential amino acid, beta-alanine has been shown to elevate carnosine levels in muscles, which has the effect of reducing muscle fatigue and aiding with faster muscle recovery. It does have a slight tingling effect, but this is normal, not harmful, and I have grown to enjoy it!    

 
The Role of Hormone Replacement Therapy (HRT)

HRT involves the administration a combination of estrogen and progesterone to alleviate menopausal symptoms. For athletes, HRT can help maintain muscle mass, bone density, and better sleep which could lead to overall better performance levels. Studies have shown that HRT can have beneficial effects on metabolism and body composition, potentially aiding in the preservation of athletic performance during menopause.

Recovery During Menopause

During menopause, recovery should become a central focus for athletes to prevent overtraining and support long-term performance. Key strategies include:

• Sleep Optimization: Prioritizing quality sleep is essential for muscle repair and overall recovery. Using sleep aids, such as magnesium or melatonin, may be beneficial.
• Active Recovery: Incorporating low-intensity activities like yoga, stretching, or walking can improve circulation and reduce muscle stiffness.
• Hydration: Hormonal changes can affect hydration levels, so maintaining adequate fluid intake before, during, and after exercise is crucial.
• Massage and Foam Rolling: These techniques can help alleviate muscle soreness and improve flexibility.
• Periodization of Training: Adjusting workout intensity and volume to align with energy levels and recovery capacity can prevent burnout and injuries. 

Adjusting training, zone 2, MAF etc.

Embrace the slow!  80% of our runs are supposed to be done at an easy pace, and many of us don’t adhere to this.  This can be a great time to incorporate Zone 2 running or delve into MAF training.  Both are methods of keeping your heat rate low with the goal of gradually increasing your speed while keeping to the same low heart rate.  This low intensity running also has the benefit of not increasing cortisol as much as higher intensity runs. 
 
Conclusion

Perimenopause and menopause are natural phases in a woman’s life that bring about significant hormonal changes, impacting various aspects of health and athletic performance. For runners, these changes can present challenges, including decreased endurance, slower recovery, and increased injury risk.
However, by understanding the physiological shifts and implementing targeted strategies—such as adjusting nutrition, incorporating supplements, emphasizing recovery, and exploring HRT options—women can continue to perform at high levels and maintain their passion for running.
As I progress into this period of my life I am constantly analysing and adjusting these strategies to try to navigate perimenopause the best I can.  And while each run might not be great, I am out there doing my best and still loving running.