Nov. 13, 2024 – “You are definitely menopausal.”
My doctor delivered the news just as I had begun to train for the Chicago Marathon this year.
I wasn’t surprised. I’d had night sweats and mood swings for years, struggled with crushing fatigue, and hadn’t had a regular period in months. Blood tests confirmed that, indeed, I was approaching the finish line of my reproductive years. I felt a twinge of melancholy.
But as a longtime athlete training for my 16th 26.2-miler, I also had to wonder: Are my fittest and fastest days behind me?
Not necessarily, say women’s health experts.
“In most cases, performance absolutely does not have to change, and if you are willing to do things a little bit differently, you may actually be able to increase your performance,” said exercise physiologist Abbie Smith-Ryan, PhD, co-director of the Human Performance Center at the University of North Carolina at Chapel Hill.
Many menopausal women find they are capable of even more than they were in their younger years because they have learned to fuel and train properly and have more time now to focus on themselves, said Boston-based reproductive endocrinologist Carla DiGirolamo, MD.
A bonus: Smart training can help ease menopause symptoms for women of any fitness level, research shows.
“I like to think of this stage of life as a detour, not a decline,” said DiGirolamo, who specializes in helping active women meet their performance goals. “It’s about relearning your body and making strategic adjustments.”
I took such advice to heart, dug into the research, and switched things up for this race.
Here’s what I learned.
Menopause Is a Moment
Technically, menopause means it has been 365 days since your last period. That moment happens at age 52, on average, in the U.S. Next comes post-menopause, a stage of relative calm following the hormonal chaos that preceded it.
That “perimenopause” or “menopause transition” typically begins four to eight years earlier, as the ovaries begin to produce less estrogen, affecting a host of other hormones that collectively influence virtually all the tissue in your body. Instead of declining steadily, hormones can fluctuate daily, or even hourly.
“It is a time of hormonal chaos,” said DiGirolamo. “I’ve had elite triathletes tell me they suddenly have all this fat around their middle. Cyclists who are at the top of a hill they’ve gone down hundreds of times and are now petrified. Runners who say the things they used to do just don’t work anymore. It’s like they went to bed and woke up in someone else’s body.”
There is no definitive test to determine where you are in the transition – or if it’s even begun. (Believe me, after a few quite heavy “surprises” during long runs, I asked my doctor: “When will this end?”) Some doctors will test levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which tend to soar and stay high as we approach post-menopause. (My blood tests showed mine at “post-menopausal levels.”)
The last few years before periods cease can be particularly tough, as they have been for me.
But it doesn’t have to be that way, said Toronto-based personal trainer Amanda Thebe, author of Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too.
“At the moment, the message is ‘You’re doomed,’ ” she said. “We need to change that narrative.”
Nurturing Muscle
Looking in the mirror, I saw the changes clearly the last year or so. My once-beefy skier’s legs were looking a bit bird-like, and overall, I felt more soft than strong. Why?
“The loss of the sex hormone estrogen causes a decline in our skeletal muscle mass,” explained Alyssa Olenick, PhD, an exercise physiologist and ultrarunner who studies female metabolism.
One study of 144 healthy women ages 30 to 70 found that muscle mass declines about 10% during perimenopause, with decline speeding up during the later stages as FSH levels rise. Fat often takes its place.
This results from a menopausal double whammy, research suggests: During this transition, the body both breaks down protein faster and is more resistant to the muscle-building power of dietary protein. For endurance athletes like me, whose long, slow slogs on foot tend to benefit type 1 (“slow twitch”) muscle fibers while neglecting larger type 2 (“fast twitch”) muscles, this loss can be even more evident.
To preserve what you’ve got, and even grow more muscle, eat more protein and lift more weights, experts say.
Olenick recommends about 1 gram of protein per pound of ideal body weight throughout the day, along with heavy (7-9 effort) resistance training with dumbbells, kettlebells, or bands two to three days per week hitting all the major muscle groups. Plyometrics (explosive jumps) can help too (while preventing menopause-related bone loss).
High-intensity interval training (HIIT) – think repeats at the track – can also engage those fast-twitch muscles and offset muscle loss, and has been shown in some studies to ease menopausal symptoms.
Smith-Ryan suggests that this might also be the time to (if you can stomach it) try taking protein before working out, like a cup of yogurt or an essential amino acid drink.
“This pre-fueling can help prevent some of the protein breakdown and accelerate recovery,” she said.
What about my joints, which had begun to creak and groan when I stepped out of bed?
When we’re younger, our joints and tendons are rich with estrogen receptors, which keep them supple and flexible, like an elastic band fresh out of the package, said DiGirolamo. When estrogen declines, these can become brittle, more like a rubber band that’s been left out in the sun. This makes us more prone to injury.
You can restore some of that flexibility with mobility work, such as yoga and stretching, which can stimulate collagen production in the joints.
Omega-3 fatty acid supplements can also dampen inflammation around joints, and some research suggests collagen protein supplements can restore some of that suppleness.
Also, said DiGirolamo: Stop skipping the warm-up and cool-down. You need them more now than ever.
Fighting Fatigue
Midway through a long training run this summer, I bonked so hard, I wasn’t sure I’d make it back to the car. I’d eaten my usual pre-run oatmeal and mid-run sugary gels, yet my brain felt foggy. All I could think about was how nice it would feel to stop running and take a nap.
Once I finally made it home, I did just that. But I felt wiped out for days.
“Usually, when I hear someone complain about fatigue, it’s a combination of energy imbalance, sleep disturbance, and not paying enough attention to recovery,” said DiGirolamo.
As it turns out, I – like as many as 80% of competitive athletes – was probably never getting enough carbs. But I had youth on my side.
“When you get older, you are more sensitive to under-fueling,” she told me. “You can’t get away with it anymore.”
With menopause also comes a host of metabolic changes: The body becomes less “metabolically flexible,” meaning less able to switch from burning carbohydrates to burning fats for fuel (a critical task when you are running or cycling for hours). Insulin resistance increases during the menopause transition too, making it harder for mitochondria (the cell’s powerhouses) to turn sugar into energy efficiently.
Meanwhile, our thirst sensation gets blunted with age. This, after a fierce battle with night sweats, can leave menopausal women feeling parched.
The solutions are multifaceted but simple, said Thebe.
“Check in with yourself more often. If you are thirsty or your urine is yellow, drink. If you are hungry, eat. If you are feeling low energy, take the day off or adjust your workout.”
Thebe recommends starting with a total daily energy calculator to see how many calories you should be taking in per day in general. Olenick recommends 60-90 grams of carbohydrates per hour while running. (I was nowhere near this, which is probably why I bonked, she said.)
To nudge the body to become even more metabolically efficient, mix up your workouts.
“If you have been an athlete your whole life, your mitochondria are so efficient from years of endurance training,” it can be hard to see improvements, said Smith-Ryan. “If you never swam, go swim. If you are a runner, get on the rowing machine. It stimulates the mitochondria in a new way.”
Crossing the Finish Line
Realistically, no matter what we do, most women will have some not-fun symptoms as they navigate the menopause transition. But a few studies and a lot of anecdotal evidence suggest that in post-menopause, hormones stabilize, symptoms tend to lift, and performance becomes more predictable.
In the meantime, being in the right headspace is also key, said DiGirolamo.
“Don’t make your body your enemy,” she advised. “It is still your friend. It just needs different things from you right now.”
I tried to give my body some of those things this time. I replaced a few long, slow slogs with quick HIIT workouts at the track. I dusted off the dumbbells under my bed. I ate protein shakes and tried to give myself time to rest after hard workouts or long runs. I gave myself some grace. And I saw results.
On October 13, with my husband and adult children cheering me on at the finish line of the Chicago Marathon, I looked down at my watch, and burst into tears.
At age 54, I’d just run the second-fastest marathon of my life.
I’ve already signed up for my next one.
