Training through perimenopause

Perimenopause is the transition phase before menopause, often lasting several years. Hormone levels fluctuate rather than decline smoothly, which is why training can suddenly feel harder, recovery slower, or niggles come out of nowhere, even when nothing else has changed.

This article focuses on running (at any distance) and strength training. It separates what is reasonably well supported by science from areas where we are extrapolating from limited evidence and coaching experience (I signal this with “may” or “might”). Unfortunately this isn’t an area where there is a great deal of research!

Declining and fluctuating oestrogen: why it matters

Oestrogen plays a role in muscle protein synthesis, connective tissue health, bone density, glucose regulation, and neuromuscular function. Lower or more erratic oestrogen is associated with reduced anabolic signalling, increased tendon and ligament stiffness, changes in substrate use during endurance exercise, and impaired bone turnover.

Sleep disturbance and thermoregulation issues become more common and directly affect recovery and training quality.

The combination of fluctuating oestrogen and cumulative training stress may narrow the margin for error. Training that was previously tolerable may now push you into non functional fatigue more quickly.

Strength training in perimenopause

Progressive resistance training improves or maintains muscle mass, bone density, tendon stiffness, and neuromuscular coordination in 40+ women. We know that strength training is protective against stress fractures and common running injuries. Unfortunately the message has been reduced to the idea that heavy lifting is the only type of strength training women over 40 should do. Heavy loading is very effective, but it is not the only way to stimulate strength and bone adaptations.

On days of poor sleep or high hormonal stress, heavy lifting may carry a disproportionate recovery cost. Moderate loads lifted with intent, tempo work, isometrics, unilateral exercises, and power-focused work can all contribute meaningfully to strength without the same systemic fatigue.

Aim for 2 sessions per week where possible. One session can be heavier if recovery allows. The second can prioritise quality of movement, unilateral strength, core stability, and power.

Recovery timelines and expectations

We know that age-related changes reduce maximal recovery capacity, even in well-trained athletes. On top of that, hormonal fluctuations appear to make recovery less predictable (but not necessarily uniformly slower).

This means that you may need more easy days between hard sessions, and should avoid back-to -back intensity (and probably B2B long runs too - although two in a week separated by a day or more might be okay).

Accept that sometimes your recovery might take longer. You might feel abnormally tired and maybe a bit sore for a day or two. If this happens consider reducing your training, delaying the next hard session, or cross training. Cross training can be a valuable tool in perimenopause to help maintain fitness, especially if you are troubled by niggles, where a day or two on the bike or elliptical can be all you need to recover.

Running in perimenopause

Lower oestrogen favours greater carbohydrate use at a given intensity and may reduce metabolic flexibility. This can increase perceived effort and raise fuelling requirements during longer runs. This means that more consistent carbohydrate intake during training may be required to maintain quality and reduce excessive fatigue. Now is definitely not the time to start trying fasted training!

Changes in collagen turnover and tendon properties are associated with declining oestrogen. So sudden spikes in intensity or volume may be less well tolerated than before, even when overall fitness is high.

Some training choices can maintain fitness and speed with lower risk. Neuromuscular power and stride efficiency can be maintained with very small doses of high quality work. Replacing a second interval session with 6 x 10 second steep hill sprints (with full recovery between) helps to build and keep explosive strength and running economy. You can also incorporate plyometrics in small, controlled doses to support tendon stiffness and power, for example low volume hops, skips, or bounds once or twice per week.

Plyometrics should be progressed gradually and treated as high intensity work.

Hormone replacement therapy and training

This is a complex and individual medical decision, but HRT can improve bone density, sleep quality, and some aspects of musculoskeletal health in many women. It’s important to note that the direct performance effects of HRT in endurance athletes are not well studied, but being on an even dose of hormones rather than a rollercoaster is likely to make training planning a great deal easier.

Runners often notice physiological changes earlier than less active individuals. This is commonly seen with iron deficiency, where athletes feel performance impacts while blood markers are still within the low normal range. So it is reasonable to hypothesise that athletes may become aware of perimenopausal changes earlier, sometimes in their early to mid 40s, because training acts as a kind of stress test.

It is important to discuss this with a medical practitioner who is up to date with the latest research on HRT. There are side effects and risks with any medication and HRT is no exception, however there has been considerable progress since the Women’s Health Initiative Study in 2002 and some newer types of HRT carry far lower risk.

Summary

Perimenopause is not the end of serious training, but it often requires greater flexibility. Strength training remains essential, but again flexibility in how it is applied is important.

Running performance can be maintained with smarter intensity distribution and lower overall fatigue.

Variability is normal.

The goal is not to train less. It is to train with enough respect for a changing physiology that consistency becomes possible again.

If you want to work through this transition with a compassionate and knowledgable coach, check my availability