Initially Published On TrainingPeaks Coach Blog linked here
It is not surprising that women in perimenopausal and menopausal life stages comprise a considerable part of the female triathlete population. At this point, the children are grown, careers are established and women finally have the time and the ability to invest in themselves and their lifelong goals and aspirations.
I see more and more female athletes in their 50s signing up for their first triathlon. It is great news to bring more women into the sport.
With so many athletes in this life stage, one would think that there would be resources addressing the specific needs of these athletes. Unfortunately, there is not enough information, research, or conversations about perimenopause and menopause and what it means for active women undergoing these physiological changes while trying to stay healthy and competitive.
Perimenopause and Menopause Life Stages
So what are the characteristics of these female life stages? Perimenopause is the time during which a woman’s body makes the natural transition to menopause, going from a monthly cycle of 25-40 days to a very irregular cycle, missing periods completely or having prolonged periods that can last for several weeks. The average age for perimenopause is 45 years old, but some women may experience it in their 30s.
If you check the race age group start lists, you will quickly realize that often these are the largest groups by the number of athletes. These are also the women who are most likely going through some pretty serious changes happening in their bodies. As with everything in our world, knowledge is power. Coaches and athletes need to be educated on perimenopause and menopause to support our female clients better.
Menopause is defined as when a woman has not had her period for 12 months. Oddly, menopause begins and ends the same day. She will be in this hormonal state for the rest of her life, called postmenopause. If a woman is not keeping track of her cycles, she may not even realize when she has reached the common notion of “menopause.”
That’s why consistent tracking of the menstrual cycle is one of the most powerful tools a woman has for understanding and monitoring changes in her body. The average age of menopause is 51, but some women can reach this stage in their 40s.
Characteristics and Symptoms
Most people have heard of the symptoms associated with perimenopause (although often referred to as menopause symptoms) — hot flashes, fatigue, brain fog, headaches, mood swings, bloating, incontinence, sleeplessness and heavy periods, just to name a few. Why is this happening, and how can we, as coaches, help women going through this life stage continue being active, setting goals and chasing their dreams? The first step is understanding what is happening inside the female body that causes all these symptoms.
Women are born with a set number of eggs stored in their ovaries. Ovaries are responsible for producing the primary female sex hormones — estrogen and progesterone. As women reach perimenopause, the body may start skipping releasing an egg every month, which causes a hormonal imbalance. Occasionally an egg could be released again, causing hormones to shift once again. This on-and-off cycle may continue for half of a decade, and this hormonal imbalance is what triggers the myriad symptoms we listed above.
During this time, women may also notice that they are gaining weight even though their training and nutrition regimen did not change. Women may have difficulty keeping the same body composition as they had just a few years ago. Interestingly, most weight gain happens during the years leading to menopause. In women who have reached menopause, meaning their hormones will remain in the same state, the weight gain curve seems to flatten.
When coaches work with perimenopausal athletes, it is super important to not focus on an athlete’s weight but instead work on maintaining the desired body composition and keeping athletes strong. Even if some weight is gained, it may not be bad, especially if it’s lean muscle.
As I mentioned, the main sex hormone levels decline during perimenopause. Estrogen is a big one, and it’s an anabolic hormone that helps muscle growth. As these hormone levels flatten, it becomes increasingly difficult for women to build and maintain lean muscle mass.
If, before, athletes could get away with doing swim/bike/run workouts and getting desired results, that same training program often might not work for an older athlete. To make up for this hormone deficit, women need to stimulate muscle growth in their bodies with specific strength training sessions — it is the best way to maintain and possibly increase lean muscle mass.
Sometimes coaches overlook this critical aspect of training and focus only on swim/bike/run sessions. Many of the training plans found on the internet also don’t include strength sessions. And while younger athletes may be able to manage without, it would not be an ideal plan for a woman in her 50s unless she already has been doing a routine strength program. If a coach is unfamiliar with building a strength program, it may be a good idea to start building relationships with local strength coaches and gyms or online services that offer custom programs for their athletes.
HIIT (high-intensity interval training) and SIT (sprint interval training) sessions are invaluable for perimenopausal and menopausal women and are highly effective in improving body composition and reducing fat mass. These sessions are characterized by short (10-30 seconds) max effort intervals followed by short recovery periods.
Women are already built for endurance, having primarily slow-twitch (type I) muscle fibers. By adding HIIT/SIT training, we won’t compromise any endurance training but actually support that fitness. The remarkable thing about this type of training is that you do not even have to schedule specific HIIT/SIT workouts as separate sessions in a training plan. These intervals can be built into a woman’s swim/bike/run workouts. Time is a precious commodity for most people and if a female athlete’s schedule does not allow for a specific HIIT/SIT session, include it in her swim/bike/run workouts.
An example is a 30-30 workout on a bike. After a good warmup, 30 seconds of all-out effort followed by 30-seconds of recovery. The same idea for the run workouts, hill repeats are another great HIIT-type exercise that kills two birds with one stone — we get the run done and the benefit of HIIT. Believe it or not, even swim workouts could be HIIT sessions.
As with anything, too much of a good thing can be harmful, and coaches need to monitor and ensure athletes are physically ready for this type of training while managing the load. For an experienced athlete during the offseason, shooting for 2-3 sessions is ideal. During base and build, 1-2 sessions, whereas during race preparation, one session a week would keep an athlete in the best possible shape.
Bone density loss is another huge factor that affects older female athletes. Women can lose up to one-fifth of their bone density during their perimenopausal years. The result is brittle bones that can affect athletes’ training and keep them from being able to train and compete for several months. When a fall on a trail would have caused nothing but a bruise just a few years ago, it is more likely to cause a broken bone for an older athlete, especially a woman.
Just like we can stress our muscles to build lean muscle, we can stress our bones to build strong bones. This is where using variety in the stress to our bodies is valuable. We do not have much lateral movement in our daily lives and swim/bike/run activities are mostly repetitive static positions. Adding plyometric exercises is an excellent addition to training to stress bones and make them stronger.
The sessions do not have to be long. Start with only 30-60 seconds and build from there. Depending on the athlete’s level, it could be as simple as side-to-side jumps, which can progress to an advanced level in terms of difficulty and duration. And as with HIIT, these sessions can be included in standard workouts as part of the warmup or cool-down. When coaches educate their female athletes about the benefits of these exercises, they are more likely to follow through with them.
Breathing, Core and Pelvic Floor
Breathing, core and pelvic floor are often overlooked aspects of training that are super important for older female athletes. Incontinence is one of the many symptoms women experience during perimenopause and menopause. Nobody talks about it, and women are often left to suffer in silence.
When I started working in the area of women-specific training, I had no idea that there were pelvic floor PT specialists out there. Women are lower-body dominant and generally have weaker trunk muscles. I like using the word trunk, as many think of the core as just a six-pack in front. Trunk implies everything around the abs, including the back, shoulders and glutes. Without a strong trunk, pelvic floor muscles get overworked doing a job they were not designed to do, causing some incontinence issues. The trunk also keeps our bodies stable, which is critical to stabilizing the whole body while we swim, bike and run.
Engaging the diaphragm to develop breathing control is another hugely overlooked area. We all can breathe, right? I was shocked to find out how many of us can’t do it right, including myself. Pelvic floor exercises are impossible to do without proper breathing, so before women can master control of their pelvic floor, they may need to learn proper breathing techniques. Men have pelvic floors, too, so don’t hesitate to tell your male athletes about this! Again, if a coach is unfamiliar with this area, refer your athlete to a PT who can help.
Joint pain and muscle tension are other symptoms that perimenopausal and menopausal women experience that can affect the body’s movement patterns. These women may need longer warmups with muscle activation exercises and specific soft tissue work like massages and foam rolling to break up the adhesions and improve the range of motion. Yoga and Pilates are also great for improving mobility and flexibility.
I like to put these short sessions on the athlete’s TrainingPeaks calendar. Including 5-10 minutes of foam rolling and 20-30 minutes of yoga is all we need to reap the benefits. If it is on the calendar, athletes are more likely to do it. Everyone likes to see the green box on their calendar. Many apps offer free yoga sessions that women can do and filter by type or duration. Encourage your athletes to check those out if you are not an expert in this area.
Sleeplessness is yet another huge issue that women experience as they age. The female sex hormone progesterone is responsible for relaxing our bodies and helping us fall asleep. Again, with the levels of this hormone declining, it is not surprising women have trouble falling asleep and staying asleep during their perimenopausal years.
Sleep is the best tool for recovery. It is absolutely essential as this is when the majority of the tissue repair is happening so our bodies can adapt and get stronger. Without enough sleep, cortisol levels (stress hormone) will stay elevated, which causes fatigue, mood swings and many other symptoms. Post-menopause, women seem to be relieved from these symptoms and their sleep improves. During perimenopause, often check-ins with an athlete are essential.
Women need to understand that getting higher sleep scores generally gives them more benefits than dragging their sleepless tired bodies to the gym for a workout. For perimenopausal athletes, a consistent day off, or even two to three rest days a week, may be necessary. Encouraging women to be kind to themselves and listen to their bodies will make training much more enjoyable than sticking to a strict training plan. Women need to know this often, as they already tend to put too much pressure on themselves.
Finally, nutrition plays a key role in keeping our bodies healthy and helping balance hormones. Coaches should also consider nutritional strategies if a woman struggles with her symptoms and energy levels. If a coach is inexperienced in this area, refer the athlete to a specialist. No one person can be an expert in every field. That’s why having a working relationship with a team of coaches, nutritionists, physical therapists, strength coaches, chiropractors, etc., working together can provide the best possible outcome for an athlete.
Inspiring Older Women
I ran the Boston Marathon in 2017. One of the most memorable moments of that race was meeting Kathrine Switzer — the first woman to officially run the Boston Marathon. I remember sitting in a room full of people listening to a group of amazing and inspiring women speaking onstage. I started thinking, “How can Kathrine, at 70 years old, look so good and strong to run the Boston Marathon tomorrow?”
For years, society has been telling women to slow down and be more careful. That declining performance is just a part of getting old. But this woman turned that belief around and showed that it is possible to be strong and beautiful at 70 and beyond. I really wish that every female athlete out there could emulate her.
I hope this article brings more spotlight to the amazing older female athletes who have so much potential with proper training, recovery and nutrition – they could be stronger and faster than they ever were and we, as coaches, having a better understanding of female physiology can guide them to their victories.