“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 improve their performance as part of their athlete career. Unfortunately, it probably wasn’t on the bookshelf of American elite runner, Mary Cain nor her coach. In an interview featured 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. There is a huge trade-off between thinness for athletic performance and immune and hormonal health. 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. 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 many coaches of female athletes, nor of female exercisers who are chasing weight loss through doing lots of exercise. But for women, whether they are athletes or not, understanding the detrimental effects of their exercise on their menstrual cycle and how this can affect their performance, especially as they transition from peri-menopause into menopause, matters. This knowledge may well be the difference between winning and losing, managing weight in menopause, or preventing bone injuries and fractures or not.
The role of exercise and how it fits into our menstrual cycle as we arrive in peri-menopause is just as important for non-athletes as it is for athletes.
I’m always mentioning to women attending my live seminar, (now available ONLINE for you), that we are the first generation of women to go into peri-menopause and menopause in the context of advice from the modern fitness and sporting industries. Too often however, this is based on male research and/or young athletes. That’s why hormonal-health research specific to females in their menopause transition is important. With numerous hormones (not just oestrogen and progesterone) changing as we move into our post-menopause years, this affects many other structures and organs around our body, especially our muscles, heart, joints and bones – all structures which are affected by exercise.
Dr Sim’s 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, a New Zealander living 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, states Janet, Type I females (bigger framed) function better during weeks 2 and 3 of their cycle around ovulation time (with week 1 being the start of the period) . Type II females (leaner and taller), function better during weeks 1 and 4 of their cycles. As Janet reiterates, 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. Interestingly, it’s the same for women in peri-menopause and with oestrogen levels declining, this is a vulnerable time when women experience more injuries, especially in their joints, tendons and ligaments. I’ve written about this in previous posts (READ MORE HERE).
Studies that link our menstrual cycle with sport and exercise science research is important to us if we enjoy exercise. 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 reproductive ageing.
I had two questions when I began to understand that in peri-menopause and menopause, we have to be careful about exercise:
- How can we use emerging hormonal-health and exercise research to improve our exercise performance and recovery in peri-menopause?
- What type of exercise is better suited to our menstrual cycles during peri-menopause when for many women their periods come and go irregularly as oestrogen and progesterone decline?
As I’ve taken my Masterclass on Menopause seminar throughout New Zealand, Australia and the United Kingdom over the past couple of years, I always have my ‘socio-cultural’ hat on. This ‘hat’ is important to wear. Taking notice of the factors that influence our exercise over the years is important. This is because we are the first generation of women to go into menopause in the context of all the sports and exercise that we’ve done throughout the past few decades. The fitness industry brings us a range of exercise options that many of us have enjoyed for years, but do these types of workouts suit us as we go into a changing hormonal environment in peri-menopause? That’s the question I had to ask myself and as time went on and the exhaustion arrived along with sleepless nights, weight gain and sore joints, this was a confronting question.
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 the type of exercise that best matches our menstrual cycle as we arrive in peri-menopause is important. And whilst 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 higher-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, we have oestrogen receptors in our joints, so a low oestrogen hormonal environment makes women more susceptible to injuries, especially knee and foot injuries such as plantar fasciitis.”
Throughout a woman’s menopause transition, one of the most challenging symptoms is insomnia and night sweats. For women who are regular exercisers, this makes overnight recovery from exercise a thing of the past. Eventually, many discover 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.
What exercise is best to fit in with our changing menstrual cycle?
Your menstrual cycle is typically divided into 3 phases:
Phase 1: This is the time when you get your period and this occurs from Days 1-5 of your cycle.
With both oestrogen and progesterone low in this phase, increasing the intensity of the workout as tolerated on at least 2 days per week and doing functional strength training is recommended. You could do circuit-training, a higher-intensity class, or some faster-paced walking or jogging.
If you are used to weights or other forms of resistance training, then you can go a bit heavier than normal if you are experienced. What you should also do is to include muscular core (lower abdominals and lower back exercises) and pelvic floor strengthening. These are the ‘forgotten’ factors of an exercise programme for women in peri-menopause. 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, so seek specialist advice if you need this or explore what’s in my home-based Rebuild My Fitness programme.
Because women are menstruating in this phase for the first 5 days of the cycle, the other caveat against doing too much intense exercise is to do with whether or not you are experiencing a heavy period. If the period is heavier than normal (which can happen as your hormones change), then Vitamin B12 and iron levels should be checked by your Dr. With low iron, any higher intensity workouts place strain on the heart muscle and cardio-vascular system, increasing the workload of these systems.
If iron or B12 is low, the heart has to work even harder to bring oxygen-rich blood to working muscles. Red blood cells carry oxygen, which needs iron to bind the oxygen to the blood cell. Looking after our heart muscle is important, because it is affected by lowering oestrogen levels in peri-menopause and menopause too. Our heart muscle is full of oestrogen receptors which are not receiving the amount of oestrogen that they used to, so allowing for adequate recovery time 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. If you missed my article about your ageing heart, then you can click through to it HERE.
Phase 2: The Follicular Phase
The follicular phase towards ovulation is when oestrogen dominates the hormonal environment , as does Luteinizing Hormone (LH) – one of your master reproductive 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, through extending the duration of cardio and up to 45-60 minutes is ideal. If you can manage 3 days of this cardio-type exercise, this is great for you. Swimming, cycling, walking, slow-jogging, rowing or dance-based exercise. It’s the type of exercise which is known as ‘aerobic’ exercise and the goal is to move in ways that allow your breathing to be deeper than at rest, but not to get out-of-breath.
In Phase 2, increased insulin sensitivity also 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!
Phase 3: The Luteal Phase
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.
If women are still menstruating however, 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 when their periods have ceased, greater strain on cardiac muscle occurs in this phase.
This is when I tend not to encourage women to do heavy weight training (unless they have adequate experience in this type of training) because heavy weight training requires some breath-holding. This is 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 regular, relaxed breathing are important, as is doing moderate cardio and focusing on fat-burning exercise. I often promote swimming or slow jogging in this phase and stretch-based strengthening exercise such as yoga or pilates. These are all great forms of exercise for lowering our blood pressure and helping to move excess fluid from tissues into our lymphatic system, helping to reduce feelings of bloat.
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. So too is looking at exercise to keep us healthy. It doesn’t have to be performance-based. If we find exercise or activities that are pleasurable to maintain, then this enables 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 as I arrived into menopause. But the issue was that I wasn’t dealing with the underlying symptoms in menopause, especially not sleeping. Many of the women who join me have felt the same.
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 (or get back into some regular exercise for those of you who are more sedentary), not only for our changing cardiac health, but to boost our moods also.
For women who are used to more vigorous activity, this may also mean cutting back a bit on the intensity of workouts until they are sleeping but adding in some longer, endurance sessions at a lower intensity. Slow jogging helps to boost aerobic fitness as well as cardiovascular efficiency as we move through menopause. So too does walking and I love how women from around the world who join me on my programmes motivate each other to become more active.
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.
Dr Wendy Sweet, PhD/ Women’s Healthy Ageing Researcher & MyMT Founder/ Member: Australasian Society of Lifestyle Medicine
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.
Tanaka, H. (2019). Anti-ageing effects of aerobic exercise on systemic arteries. Hypertension, 74, 237-243.