What happens to an athlete through menopause?

As athletes get older, their bodies change internally and externally. Female athletes have more obvious internal changes than men, but even today, there is limited scientific knowledge in this area, and more research must be done. However, for now, what do we know happens to female athletes as they get older, and what does that mean for endurance sports?

As a woman gets older, her body composition changes about four years before she becomes perimenopausal. The menopause itself is defined as 12 months without any menstruation. The perimenopausal state can last up to 10 years before that. Which means athletes who wish to perform must pay attention to the subtle changes when they can in the ~14 years before they become "post-menopausal".

What happens when a woman is Perimenopausal?

Simply, the women's oestrogen levels fluctuate and decline. Their progesterone levels fall (progesterone is produced only on the release of an egg). This hormone balance change triggers a lot of the typical menopausal symptoms prevalent in active and non-active women.

The decline in oestrogen has the most significant impact on the body's performance through the perimenopausal phase. This reduction impacts the muscle breakdown/protein synthesis balance meaning the body wants to use the muscle protein available as a fuel and cannot synthesise enough from their diet to balance this out. Furthermore, women will burn less fat, leading to a greater reliance on carbohydrate stores and increased fat storage. However, the body will also reduce its ability to utilise carbohydrates. Finally, oestrogen also helps regulate cortisol. With less oestrogen, it exacerbates the impacts of high cortisol due to stress and one of the side effects of this is an increase in fat storage.

Additionally, there will be the same sort of ageing effects as those that men see: reduced VO2max and maximal heart rate, sarcopenia (decreased muscle mass due to age) blood volume reduction, aerobic enzymes become less effective and abundant, and heart stroke volume is reduced. Critically though, they may happen almost two decades earlier.

None of these are particularly conducive to what athletes are used to hearing about performance. Many would start to trigger thoughts that a body composition should lead towards a change in the energy balance equation, usually looking at more training, or reduced fuelling to stay lean for performance.

Postmenopause, both progesterone and oestrogen will have dropped, and the body will find a new homeostasis. How the athlete migrates through these changes will impact how successful they are through training both in their mindset around exercise but also avoiding injury (reduction in bone density) and strength. Unfortunately, science is limited for women and options that tend to work for men doesn't seem to work as effectively for women. We have mentioned it before, but more information and research are needed.

Diet and training type has the most significant influence on performance now than any other option, including hormone replacement therapy. Unfortunately, many women look to diets when they become perimenopausal as they begin to store more fat, which is usually the first option. This usually means a restrictive approach which increases the stress in the body and the cortisol, which adds to fat storage, making the situation worse. Alternatively, active women may look towards a ketogenic-style diet that works for men and non-active women. For active women, training style and nutrient timing are essential to avoid unnecessary fat gain and avoid muscle wastage to reduce overall stress on the body. Furthermore fuelling needs to be considered as there is evidence that women's abilities to process fructose is reduced, so some energy drinks should be reviewed as an athlete gets older.

Training style

For ageing men and women, training should tend towards higher intensities and higher loads in strength training. There is evidence that both these styles of training improve bone health and increase the mitochondrial response for using fat, controls the blood glucose level, reduces visceral fat, keeps muscle strength and power high, and improves carbohydrate use by the muscles. The athlete's true age and body age may decouple should the athlete include intensity and heavy strength workouts. This change in intensity, though, should be introduced gradually to avoid sudden increases in training loads.

Diet

We have always highlighted the importance of protein for female athletes, which is still just as true for ageing (female) athletes. Protein uptake and the quality of protein used post-exercise is critical. Due to the reduced oestrogen women should also increase their salt uptake because high oestrogen levels help to reabsorb and store water and a decline in oestrogen may increase bloating or gut distress as the reabsorption doesn't take place.

Female athletes should be conscious that nutritional methods that worked before are unlikely to be as effective during the perimenopausal phase of their lives. They should take more care over their nutrient timing, avoid male-orientated research-driven approaches and work with what is best for them. This is likely to mean a reduction in carbohydrate for fuel due to the body's increased sensitivity to carbohydrate. Employing a nutritionist who understands the hormonal changes of this stage in a female athlete's life can work with them to ensure they can continue with the lifestyle they have always enjoyed.

This article was first published on the Tri Training Harder Blog – click here to read the original or see more articles like this one.