The Menopause is an inevitability for around 50% of the population, yet there’s still very little information or scientific studies on this for women in sport (still today, roughly 6% of clinical studies in sports science are exclusively conducted on women).
If you've noticed your running feeling harder, your recovery taking longer, or your body just not responding the way it used to (and you're in your 40s or 50s), there's a very good chance menopause is playing a bigger role than you realise. This is not anything you can control, it's just your body adjusting to a new normal, and this comes with a variety of effects while it adjusts.
What Menopause Does to an Athlete’s Body
1. Cardiovascular & Thermoregulation
Oestrogen does a lot more than most people realise. One of its jobs is helping your blood vessels work efficiently during exercise. As levels drop, your cardiovascular system must work harder to deliver the same output, which is why efforts that used to feel manageable can suddenly feel tough. Your VO2 max can decline faster during this period than ageing alone would cause, highlighting the fact that the physiological changes driven by the menopause directly impact performance.
Your body's ability to regulate heat changes too. You'll likely find you overheat quicker, feel uncomfortable sooner, and need longer to cool down.
2. Muscles, Bones and Tendons
Post-menopause, your muscles become less efficient at building and repairing from the same sessions that you could do previously. You might find you need more recovery time, or that you're not gaining strength as quickly.
Bone density also decreases at around 1-2% per year and your tendons and ligaments can actually lose some of their stiffness and resilience. This raises your risk of stress fractures and injury, particularly if you're doing high impact sport.
3. Neuromuscular Changes
Declining oestrogen affects how quickly your nervous system fires: reaction time, explosive power, and agility can all decline. If you play a sport that relies on quick movements or sharp decision-making, you might notice this more than an endurance athlete would.
4. Metabolism, Weight and Recovery
Your body can shift how it uses fuel during exercise, becoming more reliant on carbohydrates and less efficient at burning fat as your metabolism changes. For endurance athletes especially, this can affect how you feel on longer efforts and how quickly you recover between sessions. It also means body composition can change even if your diet and training haven't, which is one of the most frustrating parts for many athletes.
5. Sleep & Recovery
Hot flushes and night sweats don't just feel awful; they genuinely disrupt the deep sleep stages where your body does most of its repair work. Growth hormone release, muscle recovery, mental restoration - all of it happens while you sleep. If that's being interrupted night after night, your training suffers. Poor sleep also drives up cortisol, which makes everything harder: recovery, mood, motivation, body composition. Protecting your sleep during this period is genuinely one of the key things you can do for your performance.
6. Cognitive & Psychological Effects
Brain fog is real! Oestrogen influences the brain chemicals that affect focus, memory, and mental sharpness, and research has confirmed these cognitive changes are happening independently of sleep or mood. For athletes, this can show up as difficulty concentrating during training, slower tactical thinking, or just feeling mentally flat. Increased anxiety and lower stress resilience are also common, and they directly affect how you show up to training and competition.
The Compounding Problem
What makes menopause particularly significant for women in sport is that these effects don't operate in isolation. Disrupted sleep impairs recovery, which worsens mood, which reduces training consistency, which accelerates muscle loss, which increases injury risk. It compounds quickly, and that's why so many women feel like they've suddenly lost control of their performance almost overnight. With the right support, the right training adjustments, and a bit of patience with yourself, you absolutely can come out the other side still performing, still competing, and still loving what you do. You just need to change the approach by managing the symptoms.
How to Adapt Your Training During Menopause
1. Strength Training and Load Management
If there's one thing I'd ask every menopausal athlete to do, it’s strength training. Declining oestrogen accelerates muscle loss, reduces bone density, and compromises tendon and ligament resilience and resistance training directly counters all three.
For tendons specifically, plyometric loading (jump landings, hops, and bounding drills) helps restore the stiffness and responsiveness that oestrogen used to support. Introduce this gradually and ideally under coaching guidance, as tendons under stress don't respond well to too much too soon.
Wearing supportive insoles, such as Enertor's, which are clinically shown to reduce impact by 51%, is also a simple and effective way to reduce cumulative stress on your bones and joints every session, particularly important when fracture risk has increased.
Beyond individual sessions, your overall programme structure needs to reflect where your body is. This means longer recovery blocks between hard training weeks, genuinely planned de-load weeks, and being willing to reduce volume before increasing intensity. Aim for at least two dedicated strength sessions per week and track how your body responds.
2. Fuelling: Protein, Fibre, Calcium, and Vitamin D
- Protein – roughly 1.6–2.0g per kg of bodyweight per day for active menopausal women. Spread it across your meals rather than loading it all at once, and prioritise quality sources like eggs, meat, fish, Greek yoghurt, and legumes.
- Fibre - supports your gut microbiome's role in oestrogen metabolism, managing inflammation, stabilising insulin sensitivity, and reducing the visceral fat accumulation that menopause can drive.
- Vitamin D deficiency is extremely common (particularly in the UK) and significantly worsens bone density loss during menopause. Make sure you are getting 1000-2000iu per day naturally or with supplements.
- Calcium - essential for bone health and minimising bone injury risk, consume 1200mg per day to help your bone mineral density.
- Be honest about how much you're eating overall. Menopausal women in sport are at real risk of under-fuelling (sometimes from long-held habits around calorie restriction) and when combined with increased bone and muscle vulnerability, this can be seriously damaging. If you're training hard, you need to eat to match it.
3. Managing Heat, Intensity, and Stress
· Train earlier in the day when temperatures are lower, adjust intensity on hot days, and use simple pre-cooling strategies like cold drinks and cooling the back of the neck before and during sessions. These strategies have solid evidence behind them.
· Monitor perceived exertion rather than just chasing pace or output numbers, because how your body feels on a given day is now a more honest guide than your watch.
· Breathwork, mindfulness, and protecting rest and relaxation time are useful additions; they directly affect your cortisol levels, your recovery capacity, and your long-term resilience.
4. Protecting Your Sleep
Sleep is where your body does the actual work of recovery: growth hormone release, muscle repair and cognitive restoration. Help the process with the normal sleep advice:
· Keep your bedroom cool
· Maintain consistent sleep and wake times
· Avoid alcohol (which worsens both sleep quality and hot flushes)
· Shift intense training sessions away from the evening where possible
If sleep disruption is severe and persistent, don't just accept it. Go see your GP or a menopause specialist, because there are interventions such as HRT with strong evidence for improving sleep quality during this transition.
5. When to Consider HRT
The evidence base for HRT has strengthened considerably in recent years, and for active women it can directly address many of the root causes, not just the symptoms. Bone density, muscle anabolic response, thermoregulation, sleep, mood, and cognitive function can all be meaningfully supported by HRT when it's the right fit. The British Menopause Society and many leading sports medicine specialists now advocate for it as a first-line consideration. If you've been managing symptoms on your own and wondering whether there's more support available, don't hesitate to speak to your GP or doctor.
6. Tracking Symptoms and Staying Consistent
During perimenopause, cycles become erratic and unpredictable, which makes the kind of training periodisation you may have relied on before much harder to plan around.
· Shift from tracking your cycle to tracking your symptoms, energy, mood, and recovery quality day to day. A simple training diary that captures how you felt (rather than what you lifted or how fast you ran) will help you become a better reader of your own signals and identify patterns over time.
· Embrace a mindset shift moving from consistency of output to consistency of effort. Some days your body will be running at 80%. Training to 100% of that 80% is still excellent training.
Stay adaptable and keep showing up. That's the goal, and it's absolutely within reach.