Fit and active? How the menopause can affect you

If you’re used to regularly exercising, it can be disconcerting when perimenopausal or menopausal symptoms disrupt your workouts

Menopausal symptoms can affect your exercise routine
You can still compete and achieve your goals
Learn to listen to your body and make adjustments to optimise your performance

Head to your local swimming pool or parkrun and we bet you’re surrounded by women of a similar age. Many of us are used to leading active lives and in fact more women in their 40s and beyond are competing in sports than ever before. Plenty are performing at a high level or are achieving incredible goals – the recent Netflix film Nyad tells the true story of Diana Nyad, who at 63 become the first person to swim from Cuba to America without the aid of a shark cage on her sixth attempt (she failed during her first attempt, when she was aged 28).

But while it’s possible to continue to perform your chosen sport, symptoms of perimenopause or menopause can have an impact on your mindset, enjoyment and performance. In a study of 183 female master swimmers who were questioned about the influence of the menopause on their performance, a quarter said their symptoms, particularly weight gain and sleeplessness, negatively affected their swimming [1]. A quarter said the intensity of their swimming had reduced due to the menopause and a third said that their confidence for competing had reduced. Despite this, a third of the women said that it was very important to them to be highly competitive at swimming – their desire to perform well remained.

How does the menopause affect the physically fit?

If you’re already physically fit and conditioned when you enter the perimenopause, you may find it frustrating to read well-meaning but limited advice on “getting fit” to help with symptoms. And as Ironman athlete and personal trainer Selene Yeager writes, much of the research on menopausal women has been done on sedentary women who are suddenly at higher risk for heart attacks and diseases rather than active women, and so the advice isn’t tailored to differing fitness levels [2].

But as Dr Hussain Al-Zubaidi, the Royal College of GPs Lifestyle and Physical Activity Lead, fitness coach and Ironman triathlete, explains, the menopause and perimenopause bring an array of physiological changes that impact strength and aerobic fitness, particularly in those who were previously active.

‘Oestrogen plays a pivotal role in maintaining muscle mass and strength. As oestrogen levels wane, women may experience increased fat deposition and a change in distribution. Women often experience an increase in tummy fat, sometimes referred to as visceral fat, which is associated with a higher risk of cardiovascular disease. Declining oestrogen also contributes to a decrease in lean muscle mass due to reduced protein synthesis, leading to muscle atrophy, making it more challenging to maintain a healthy weight and metabolic rate. These changes can lead to a decrease in overall strength,’ says Dr Hussain.

‘Hormonal fluctuations can also affect aerobic fitness by influencing cardiovascular health, including changes in blood vessel function and lipid metabolism, potentially affecting the efficiency of oxygen transport and utilisation during aerobic activities. Associated symptoms of menopause, such as hot flashes and sleep disturbances, can disrupt exercise patterns, motivation, and the ability to maintain other healthy lifestyle habits,’ he adds.

However, Dr Hussain says strategic interventions, including targeted strength training and aerobic exercises, can help mitigate these effects and you can have an active transition through menopause. ‘I have worked with incredible athletes who have shown through dedication, hard work and support they can not only maintain performance during this time but thrive.’

What can I do?

Be reassured that you don’t have to put your competitive goals behind you. But you may need to make adjustments – for instance, rather than chasing times you used to achieve in your 20s, consider focusing on good for age gradings. The time you run a parkrun now might be slower, but your age rating may be higher. Adjustments to your training, nutrition, recovery methods and mindset can also make a difference. Here’s what to consider.

Mindset

Most people who compete in sport are competitive – if not with others, then with themselves. But while you’re experiencing menopausal symptoms, be gentler with yourself up. The menopause isn’t something to fight or conquer but think of it as something to work through.

Accept that any exercise you do will be benefitting your future health – even if today’s workout didn’t go as planned. Dr Hussain says: ‘Staying strong and fit now is allowing you to be potentially independent and mobile in 20, 30, 40 years’ time.’

Think of this as a transition time – you might not be up to doing your usual triathlon, but a sprint triathlon could pose a new challenge. Or consider a new sport. Dr Hussain says many of his clients who have taken up different sports enjoy the sensation of starting afresh and having new pbs to chase.

Make your training or competing more social – organise a bike ride with a friend or if you usually run alone, join a club. This can help lift your mood, as can supplementing your workouts by coaching others – it will also help you to realise the value of your experience and achievements.

Kit

As your body changes, you may want to consider making some adjustments with your kit. For example, if you’re a cyclist and experiencing vaginal dryness or sensitivity, sitting on a saddle can put pressure on your vulva. A vulval moisturiser or vaginal oestrogen can help and opt for seam-free, well-padded shorts. Gel saddles and those specifically designed for women may be more comfortable to ride on.

For high-impact exercises such as running, you may need to get an extra supportive bra, particularly if your breasts are now sensitive. And if you’re experiencing irregular or heaving bleeding during the perimenopause, period pants can be helpful, as can period swimwear.

Exercise tweaks

As your body changes with age, it can benefit from adjusting the way you work out.

Put speed over endurance

Whether you’re used to running marathons, cycling long and steady rides or swimming for hours, consider reducing these sessions and swapping for faster, shorter workouts. These will be more intense and benefit your muscles by building power. Don’t be fooled, these workouts aren’t easier because they’re shorter – you need to work hard to be faster!

Get strong

Dr Hussain says strength and resistance training helps maintain or increase muscle mass, promoting a healthy body composition, reducing injury risk, and aiding recovery. A recent study revealed that regular resistance training not only diminishes hot flushes but also enhances the quality of life for menopausal women [3].

It’s recommended we do at least two sessions of strength, resistance or balance training per week, working on all muscle groups.

Think quality not quantity

Focus on quality of training rather than quantity – it’s better to have a few intense sessions where you work hard then spend time properly recovering rather than doing a series of average sessions.

Start jumping!

Plyometrics, an aerobic type of exercise that’s based on jumping, can help to increase your speed, build and strengthen your bones, and retain muscle. Dr Hussain suggests incorporating these explosive plyometric exercises into your workout.

Jump Lunge:

Start in a standing position with feet hip-width apart and hands on your hips.
Step forward with your right foot, lowering into a lunge position with the front knee directly over the ankle.
Propel yourself upward, executing a mid-air switch of your feet, landing in a lunge position with your left foot forward.
Continue this dynamic movement, alternating legs with each jump.
Aim for 10-15 repetitions.

Squat Jump:

Stand with your feet hip-width apart and toes pointing forward.
Bend your knees, lowering your hips into a squat position, ensuring your knees align with your toes.
Explosively jump upward, reaching for the sky with your extended arms.
Softly land back into the squat position.
Repeat for 10-15 repetitions.

Nail your nutrition

With age, you may find you are less tolerant of overprocessed food. And if you’re experiencing perimenopausal or menopausal symptoms, adopting the Mediterranean diet can help. A study found the Mediterranean diet to be associated with higher muscle mass and bone density [4], while it’s also linked to lower incidence of hot flushes.

Protein becomes increasingly important too, and is particularly helpful to active menopausal women in helping to fuel recovery and maintain muscle mass. Although official guidelines for protein intake are 0.7g of protein per kg of bodyweight per day (so 49g for someone weighing 70kg), many experts believe older adults need more than this.

For example, the American College of Sports Medicine recommends that from the age of 50, you should increase your intake to 1g per day per kg of body weight to maintain muscle mass, and if you are exercising regularly and want to increase muscle mass you should aim for 1.2-1.7 grams of protein per kilogram of body weight per day.

Rest and recover

You may have discovered that your body needs more time to recover from intense workouts, so plan recovery time in your exercise schedule. Dr Hussain warns that when high-frequency, high-intensity workouts are coupled with a deficit in recovery time and insufficient caloric intake, this can contribute to a decline in key female hormones. He advises that cold water and contrast immersion therapy, and yoga, can aid recovery.

Adapt to your energy levels

Dr Hussain encourages flexibility with training so you can respond to your energy levels and symptoms each day. Assess how you are feeling out of 10 – if it’s 1-3, consider low intensity work such as a walk or a gentle swim or 10 minutes in nature to improve mood; whereas a 5-6 could be moderate intensity exercise for under an hour; and 9-10 could be vigorous intensity.

When to get help

You know your body best. If you’ve adjusted your exercise routine, adopted best practice for nutrition and rest but still feel fatigued or menopausal symptoms are preventing you from exercising, consult your doctor. While symptoms such as recurrent UTIs, tiredness, joint aches, etc can be common in perimenopause and menopause, you don’t have to put up with them.

Finally, remember that any exercise you do will have a positive effect on your body. Not every session will feel good or how it used to, but by tuning into how you are feeling, and making any adjustments, you can work with your body, rather than against it.

Resources

Follow Dr Hussain @irondoctorhaz

References

Ussher M, Mount C, Greenberg S, Goodair C, and Perz J. (2009) ‘Perceived Effects of Menopause Among Women Master Swimmers,’ International Journal of Aquatic Research and Education, Vol. 3: No. 4, Article 5. doi: 10.25035/ijare.03.04.05
Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond by Stacy Sims and Selene Yeager (£18.99, Rodale Books)
E. Berin, M. Hammar, H. Lindblom, L. Lindh-Åstrand & A.-C. Spetz Holm. (2022), ‘Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms’, Climacteric, 25:3, 264-270, doi: 10.1080/13697137.2021.1941849
Silva TRD, Martins CC, Ferreira LL, Spritzer PM. (2019), ‘Mediterranean diet is associated with bone mineral density and muscle mass in postmenopausal women’, Climacteric. Apr; 22(2): pp162-168. doi: 10.1080/13697137.2018.1529747