Managing Perimenopause as an Athlete
The female body changes dramatically during perimenopausal years. Fluctuating levels of estrogen and progesterone affect how we build muscle and recover from training.
Endurance athletes or individuals who push themselves physically (or emotionally) on a regular basis can be vulnerable to hormonal fluctuations, immune system changes, and nutrient deficiencies that can occur as a result of these stressors.
Several factors should be considered when evaluating the perimenopausal athlete and their symptoms.
First, possible physiologic changes that occur with overexertion, sometimes referred to overtraining, include:
Inflammation through cytokine release (proteins that signal the immune system to activate)
Increased activation or down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis
Increased oxidative stress
Amino acid fluctuations like glutamine and tryptophan
Intestinal permeability (leaky gut) and changes to gut microbiota
Nutrient deficiencies
Symptoms like insomnia, fatigue, brain fog, mood changes, and poor recovery can be traced back to some of these unique causes, depending on the individual.
Layer on the perimenopausal hormone fluctuations that occur in our 30s and 40s and you have yourself a storm!
No study has been able to nail down one specific cause of overtraining symptoms, but in functional medicine, we know why. That’s because each individual will have their own unique contributing factors. One woman may have dysbiosis in the microbiome while another may have down regulation of their HPA axis, and some may have both!
During perimenopause, as our follicular stimulating hormone rises, our ovaries can produce more estrogen. Because our microbiome is critical for estrogen excretion, if there is imbalance there, we feel these effects more strongly.
During the same time, progesterone declines as the number and quality of follicles also diminishes, and thus fewer ovulations. Progesterone helps to keep our cortisol levels under control. Once progesterone levels start to decrease with perimenopause, cortisol is less buffered and we are more vulnerable to the effects of stress (of any form).
What can we do?
Managing stress is critical during this time. You should develop a daily routine that supports:
7-8 hours of sleep per night
Coping mechanisms for managing your emotional stress response
Rest and recovery from training
Adequate nutrition
Due to the increased physiologic vulnerability during perimenopause, I also recommend routine labs to evaluate for nutrient deficiencies and hormone imbalances. If you are having symptoms (think fatigue, low mood or motivation, changes in bowel habits, sleep disturbances, or poor recovery), it’s important to also get those evaluated by a board certified clinician.
You can learn more about my approach here.
If you are located in my service area and would like to know more about how we would approach your case, schedule a Strategy Session today.
References:
PMID: 23016079
PMID: 27660501
PMID: 37842270
PMID: 27924137
