“The rise and fall of hormones during a woman’s menstrual cycle have a profound impact on performance.”
[Exercise Physiologist, Dr Stacy Sims, New Zealand].
Stacy’s work with female athletes is pioneering and her book called ROAR, should be on the book-shelf of any young female athlete wanting to break through their performance as part of their athlete career.
Unfortunately, it wasn’t on the bookshelf of American elite runner, Mary Cain nor her coach. In an interview featured this month in the New York Times, Ms Cain, accused her coaches of encouraging her to become thinner and thinner, which only made her slower and slower. Yes, there is a huge trade-off between thinness for athletic performance and immune and hormonal health and unfortunately for Mary Cain, this was a journey she should never have been on.
I’ve been teaching sport and exercise science students about the effect of over-training on female hormones for decades. Unfortunately, knowledge about the Female Athlete Triad [the term used to describe the interrelationship between menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density] is not well understood by coaches of female athletes. But for young female athletes, it’s understanding the detrimental effects of their hormonal cycle on performance, is the difference between winning and losing, making PB’s or not. Unfortunately, this gets overlooked in women’s sports and fitness by Coaches, Trainers and the Athletes themselves.
The role of exercise and how it fits into our hormonal cycle is just as important for non-athletes as it is for athletes.
I’m always mentioning to women attending my live events, that we are the first generation of women to go into menopause in the context of all the information that comes out of the modern fitness and sporting industries, but too often, this is based on male research and/or young athletes. That’s why Stacey’s research is so important.
Her research takes females on a journey through their menstrual cycle and how to adapt aerobic and anaerobic conditioning to each phase of the menstrual cycle. It’s ground-breaking stuff, as is the work of Personal Trainer and Titleist Women’s Golf Master Trainer and Educator, Janet Alexander, in America. I’ve known Janet for decades and her work acknowledges the different body-types of female athletes and the need to take this into consideration too. As she says,
“There are two types of females – type I and type II. Type I females have high oestrogen levels and are typically, shorter in stature, bigger breasted, and early developers.” Alexander goes on to describe Type II as having “lower oestrogen levels and are the opposite of type I in terms of appearance: long, skinny, small breasted, late developers.”
Training-wise, reports Janet, type I females function better during weeks 2 and 3 of their cycle (with week 1 being the start of the period) around ovulation time. Type II females function better during weeks 1 and 4 of their cycles. The other thing that she mentions, is that during a female’s period, their ligaments become more lax and they are often relatively more mobile in their joints, so any exercise selection needs to promote stability and control during this time too. Interestingly, it’s the same for women in peri-menopause too.
This research is incredibly important to know but unfortunately, mid-life women have missed out, because much of the research on exercise and hormonal health has been conducted on younger female athletes and not on women as they transition through menopause. That’s why I decided to pull it together for you and put it into the context of peri-menopause.
Peri-menopause is the time, usually in your mid-to-late 40’s that your oestrogen and progesterone levels are declining and your body is shifting physiologically into menopause and your ageing. And yes, it can go on for years.
I had two questions when I began to understand that in peri-menopause and menopause, we have to be careful about the type of exercise to do.
- How can we use this research to improve our exercise performance and recovery in menopause?
- How should we exercise to suit our changing cycles during peri-menopause when for many women their periods come and go irregularly as oestrogen and progesterone decline?
There’s another thing that I’m acutely aware of too – and that is that most mid-life women are not athletes. From the thousands of women I meet in my travels at my live-events and from those who come onto my two different 12 week programmes, they on the ‘treadmill of life’ and not the ‘treadmill in the gym’!
Feeling busy, stressed, over-whelmed and for many, not sleeping, keeps blood pressure elevated. Then, as we arrive in peri-menopause and oestrogen begins to decline and if we aren’t sleeping, our joints become sore, our knees ache and injuries become more frequent. Yes, this happened to me as well and nobody I went to for advice, mentioned menopause. It’s a similar story for many women on the MyMT programmes as well. It’s also part of the reason why so many women in peri-menopause give up on the exercise they used to love to do.
When I take my seminars I always have my ‘socio-cultural’ hat on. As we age, this ‘hat’ is important to wear. Taking notice of the factors that influence our exercise over the years is important. Women in their mid-late 50’s today are the first generation of women to go into menopause in the context of all the sports and exercise messages and when we reach this stage of life, many of us continue to carry these beliefs and exercise practices into our 50’s. As time goes on, many are confused as to why they feel so exhausted, experience sore joints and muscles as well as poor sleep and the weight doesn’t shift.
It’s little wonder that physical activity participation research from Professor Wendy Brown and her team in Australia, shows that mid-life women are the highest demographic to stop exercise participation. Some of this is attributed to ‘lack of time’ which has followed many of us for decades and some of it relates to the messages that prevail in fitness environments with workouts that are too hard on our heart, joints and muscles as we navigate the symptom chaos that can accumulate during the change of life.
That’s why understanding how to exercise in menopause is important. And although Dr Sims advocates higher intensity activity [Boot Camps, Cross Fit and HIIT classes], for women who are in the low oestrogen phase of their cycle [Phases 1 and 3], I don’t advocate this high intensity training UNTIL women are sleeping all night and have reduced any joint pain as they transition through peri-menopause. As I always say to women on the MyMT™ programmes –
“If you aren’t sleeping, then our stress hormone called cortisol remains high, and therefore, you cannot recover overnight from all the higher intensity activity. As well, oestrogen receptors are in joints, so a low oestrogen hormonal environment makes women more susceptible to injuries. You can easily end up exhausted and injured.”
Not sleeping is a problem for many women who used to be regular exercisers. Eventually, they find that they can no longer tolerate the exercise they used to do. Just like young female athletes, when we don’t sleep, this sends our adrenal glands into more chaos which in turn, prevents our muscles, including cardiac muscle, from recovering from day to day.
The result? We feel more exhausted and drop in and out of our exercise, just as the physical activity participation research reports.
But if you ARE sleeping and you do have your energy levels, then, because November is ‘Exercise Month’ with MyMT, here is my suggestion for how to plan your exercise during peri-menopause. The term peri-menopause is the time leading up to menopause, when you are still getting your periods, but they might be fluctuating. Menopause itself is when your periods cease, and you go into post-menopause when you haven’t had a period for a year or more. Globally, this occurs between 51-53 years of age.
Your menstrual cycle is typically divided into 3 phases:
This is the time when you get your period and this occurs from Days 1-5 of your cycle. Both oestrogen and progesterone are low in this phase. This phase is good for increasing the intensity of the workout as tolerated and doing functional strength training which I have as programmes in my ‘Rebuild My Fitness’ 12 week online programme. This includes pelvic floor strengthening too. This is the ‘forgotten’ factor of an exercise programme, but because we lose oestrogen receptors in our cervix and pelvic floor muscles during menopause, many women who are used to doing high-impact activity, such as running and jumping activities, may find that they experience some pelvic floor prolapse as well. If this is the case, then I recommend seeing a Physio or Specialist Trainer who understands pelvic floor anatomy.
Because women are menstruating in this phase for the first 5 days of the cycle, the other caveat against too much exercise is to do with a heavy period. If the period is heavier than normal (which can happen as hormones change), then Vitamin B12 and iron levels should be checked by a Dr. With low iron, these higher intensity workouts place strain on the heart muscle and cardio-vascular system, both of which are affected by lowering oestrogen levels as we transition through menopause/. The heart muscle is the ‘forgotten’ factor in menopause and I have a lot of emphasis on cardiac health in the MyMT programmes, particularly the ‘Rebuild My Fitness’ programme. This is because our heart muscle is full of oestrogen receptors which are not receiving the amount of oestrogen that it used to, so recovery following higher-intensity activity is important. Your heart is working hard in this type of activity and it needs rest afterwards to restore vital energy not only to the heart wall, but also to other organs as well.
The follicular phase towards ovulation is when oestrogen dominates the hormonal environment , as does Luteinizing Hormone (LH) – one of your master hormones from your Pituitary Gland. Your moods may be improved in this phase and therefore, your motivation to exercise. With oestrogen levels higher in this phase larger women need to be fat-burning, either through extending the duration of their cardio, or going a little bit harder. In this phase, increased insulin sensitivity occurs, along with an increase in pain tolerance, so women may find that they can work harder. However, I add caution here. We have oestrogen receptors throughout our tendons and ligaments and as part of our natural ageing, these can become stiff and sore, so women must add in more stretching and a longer warm-up and cool-down if they are doing higher intensity activity. The American Journal of Sports Medicine found that due to joint laxity and oestrogen-induced changes in collagen structure, ACL tears are four to eight times more likely to happen during this phase. Be warned – you need to stretch more as you age!
The last phase of the monthly cycle before our period starts again is the luteal or progestational phase. Normally, the corpus luteum is readying itself to support a foetus and the endometrium is thickening but in peri-menopause, this changes because both oestrogen and progesterone are declining in production as our ovaries naturally age. But if women are still menstruating, then in a normal cycle, this phase is dominated by progesterone. Women often feel bloated, hot and have less tolerance to exercise, especially higher intensity exercise or long-distance endurance exercise. More importantly for women entering menopause, greater strain on cardiac muscle occurs in this phase. Our heart muscle is also losing the effect of oestrogen so in my Rebuild My Fitness programmes, I don’t encourage women to do heavy weight training because this causes many women to hold their breath – a phenomenon known as the ‘Valsalva Manoevre’. Breath-holding during resistance training makes blood pressure soar. With these changes in mind, any resistance training should be lighter and exercises which promote deeper breathing are important, as is doing moderate cardio and focusing on fat-burning exercise. I often promote swimming or slow jogging in this phase, which is great for lowering our blood pressure and helping to move excess fluid from tissues into our lymphatic system, helping to reduce feelings of bloat.
Feeling Moody and Un-Motivated? Then boost your mood with exercise.
One of the main hallmarks of peri-menopause for millions of women is not only lack of sleep, but lowering mood and loss of motivation.
This is because there is a powerful link between low oestrogen and low serotonin, which is one of our mood hormones. I find that the role of exercise in boosting mood is often forgotten in all the scientific prescriptions for exercise, but the mid-life women I interviewed for my doctoral research, all reported that they simply used exercise as a way to help them ‘feel good’. They also wanted to feel strong and functional as they moved into their ‘older age’ – the old adage of ‘use-it, or lose-it’ prevailed. Bur perhaps the most important aspect of exercise for women when they exercise in a group, is simply the power of social connection and as this is one of the hallmarks of women’s health as they age, then this must not be forgotten – sometimes it’s not just about the exercises themselves, it’s the fact that you’re working out with your friends. 😊
Our female physiology is complex … and it’s riddled with fluctuations in sex hormones from one month to the next as we move on from our menstrual cycles and into the next phase of our lives – post-menopause.
Maintaining cardiac health, bone health and a healthy weight are important goals for women to achieve but so too is using exercise to enable improved function and confidence for the recreational activities that we want to enjoy as we age. I was stunned when I couldn’t enjoy skiing which I had enjoyed for decades, but the issue was that I wasn’t dealing with the underlying symptoms in menopause. Lydia was the same and I was so thankful that she joined me on the Transform Me programme, followed by the exercise programme.
When it comes to exercise choices in mid-life, we must sort out our sleep and joint health first as well as learn how to exercise for our changing cardiac health too. For many women who are used to more vigorous activity, this means also adding in some longer, endurance sessions at a lower intensity. Slow jogging helps to boost aerobic fitness as well as cardiovascular efficiency as we age. The older we get, the more we need our mitochondrial cells to function better, because these are the cells that store our precious oxygen.
Remember Kaye from the image earlier? Well, here she is now. Starting with the weight loss ‘Transform Me’ programme to restore her sleep, sore joints and weight, she went on to do the 12 week Rebuild My Fitness programme. Doesn’t she look great?!
Our menopause transition can be a really challenging time of life. But don’t forget that when we aren’t sleeping and still have so much going on in our lives, sometimes it’s not about ‘what’ exercise we do, but simply that ‘we do it’.
If you are struggling in your menopause transition, then I hope that you can join me on one of the three different programmes I offer. Please VISIT HERE to read more.
Alexander, J. (2018). What to know about workouts for women. Podcast/ https://18strong.com/janet-alexander/
de Jonge, X.A.K.J. (2003). Effects of the Menstrual Cycle on Exercise Performance. Sports Med, 33: 833. https://doi.org/10.2165/00007256-200333110-00004
Sims, S. (2017). Roar: How to Match Your Food and Fitness to Your Unique Female Physiology. Amazon Publ.