Welcome back to “Mature Adult Content,” a monthly column discussing menopause, and the training and nutrition to help you stay strong and competitive. Last month, I introduced a race you won’t find on UltraSignup, The Menopause 200 (MP 200).
Since puberty, I’d been running with a friend, estrogen. She’s quite a badass and responsible for everything from muscle mass to tendon contracture, pregnancy and parturition. Sometime in my 40s, she began taking a few days off. In my 50s, she informed me that she was done—finished—and not lacing up her shoes again.
Estrogen had been my constant companion, on and off the trails. If she was done, I needed to do some serious rethinking. How had my body been working, and what had changed? I approached these questions the same way I would any race, using a format I call, “Head-Heart-Heat.” Head is the research phase, when I look at course maps, read blogs and learn everything I can about the event. Below is a quick summary of my research for the MP200:
Unfortunately, finding reliable information about menopause is more difficult than locating a MP200 course map. I started with Guyton and Hall’s Medical Physiology, 14th edition.1 This 1,133-page tome is thick enough to stand on for one-legged toe touches and doubles as a kettle bell. It’s the primary physiology textbook at many medical schools, so I expected a chapter on menopause. I found four paragraphs, beginning with, “The cause of menopause is ‘burning out’ of the ovaries.” Dismissive and misogynistic language is deeply embedded in the medical literature. Fortunately, a number of excellent clinicians and scientists are working to correct this with peer-reviewed studies and accessible, well-referenced books.2–5
This is the literature I will reference to describe the physiologic changes called menopause, the symptoms and clinical conditions associated with menopause, discuss hormones and therapies, and present evidence-based nutrition and fitness practices to help you run long and strong. It’s also important to acknowledge that menopause and aging are influenced by many factors, and most studies focus on the general population or risk groups within a population. Endurance athletes are typically fitter and leaner than study populations, and there are still very few studies addressing aging and ultrarunning.
Puberty to 40ish
Every 28–40 days, in response to your brain’s hormonal signals, estrogen levels in your ovaries increase, then stimulate 8–12 immature ovarian eggs, or follicles, to grow. Seven to 10 days later, the largest of these follicles matures and the remainder degenerated. Around day 14, your ovary releases a mature egg, which transits the fallopian tube to the uterus. At this point, your ovarian hormones shift. Estrogen declines and progesterone increases. Your uterine wall thickens in preparation for pregnancy. Around day 28, if the egg is unfertilized, progesterone declines, estrogen increases, the uterine lining sheds and menstruation begins. Over and over, every 28–40 days for almost 40 years, these cycles continue.
Menopausal transition or Perimenopause4
You were born with about one million follicles and begin puberty with 300,000–400,000. That sounds like a lot, until you realize how many follicles are released each month. Sometime in your 40s (earlier for some people) the ovarian follicle supply runs low. Some months, none of the follicles develop into an egg and progesterone levels remain low. Without progesterone, there is no stimulus for the uterine wall to thicken, no shedding of the uterine lining and no period. Estrogen becomes, for a time, the dominant hormone. At first glance, this seems advantageous for athletes. Ovarian estrogen, or estradiol (E2), is the major contributor to muscle growth and strength, bone density, body metabolism (including glucose regulation and appetite), skin (including blood flow and vaginal lubrication), and electrolytes. However, the high estrogen contributes to many uncomfortable symptoms like hot flashes, joint pain, irritability, sleep disruption and mood swings.
Early in perimenopause, the hormone fluctuations and symptoms are typically mild. You may only notice a skipped period, or shorter or longer bleeding at the end of the month. The closer you are to menopause, the worse the clinical signs. Athletes typically experience fewer side effects than non-athletes, but hormonal shifts impact training and recovery. Strides and easy runs feel doable one day, exhausting the next. Fluid shifts can leave your legs feeling heavy. Your sleep may be disrupted by hot flashes, anxiety attacks or both. Moods can swing, and changing metabolism slows your thinking.
Menopause and Postmenopause
Sometime in your early 50s, there is a final period or Final Menstrual Period (FMP). This is the formal transition from perimenopause into menopause. Unfortunately, the transition doesn’t come with an announcement. You may go six or eight months without a period, and then experience a particularly heavy and long flow. Formally, menopause is diagnosed 12 months after the last period. If this sounds like a magical doorway through which you pass, leaving behind hot flashes, anxiety and training challenges, it is not. Hot flashes in particular may last 6–12 months, and could last 10 or more years. And, as estradiol (E2) decreases, your risk of cardiovascular disease and osteoporosis increases.
The information above is a brief overview of the menopausal transition and postmenopause. You spend a third to half of your life postmenopausal, and 10 or more years perimenopausal. Symptoms are common and expected, but can impact your racing and training, and your heart and bone health.5 The good news is, like any race, the more you know about the course, the better you can adapt your training to meet the demands of the MP200.
This is where Heart comes in. Heart is sacred space. It is mental toughness built through training, knowing your why and connecting with others. It is a vulnerable and courageous space, where you reach out to running partners and dare to talk about menopause, slowing down and aging. It is a safe space to share fear and shame, support each other and celebrate victories.
Finally, action items, or what I call: Heat. Add a section in your training log to record periods and symptoms. These daily notes will help you adapt training and nutrition to your changing body. And, before your next run, check out Selene Yeager’s Hit Play Not Pause podcast.
Join me next month for a conversation with Pam Smith and Meghan Canfield, where we’ll talk about perimenopause, menopause, and the power of sharing our stories and running together.
References, further reading and resources:
1. Hall, J. E. and Hall, M. E. Female physiology before pregnancy and female hormones (2021). In Hall, J. E. (Ed.), Guyton and hall textbook of medical physiology (14th ed, 1027–1044.). W.B. Saunders.
2. Gunter, J (2021). The Menopause Manifesto: own your health with facts and feminism. Toronto: Random House.
3. Sims, ST and Yeager S (2022). Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond. New York: Random House.
4. Santoro, N., & Sutton-Tyrrell, K. (2011). The SWAN song: Study of Women’s Health Across the Nation’s recurring themes. Obstetrics and gynecology clinics of North America, 38(3), 417–423. https://doi.org/10.1016/j.ogc.2011.05.001
5. Harlow, S. D., Gass, M., et al, & STRAW 10 Collaborative Group (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause (New York, N.Y.), 19(4), 387–395. https://doi.org/10.1097/gme.0b013e31824d8f40