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Let’s Talk About Menopause and Running

Women don’t stop training after age 40, so why aren’t we openly discussing how to adjust and adapt as our bodies go through seismic shifts?

Photo: Getty Images

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Sasha Gollish, a 41-year-old Canadian elite runner, can reflect on a precise moment, five years ago, when she knew her body was going through some things. She was in the call room for the 1500 meters at the Payton Jordan invitational track meet, an annual event at Stanford University, when she unexpectedly got her period.

She didn’t just start menstruating, though. It was more of a gush.

“It was just like a fire hose that opened up,” Gollish says.

Typically, athletes aren’t supposed to leave the call room before they line up for a race. But an elderly male race volunteer could see it was an emergency. He uttered, “I can’t help you,” as Gollish responded, “No sir, you cannot help me. I need to go and change my clothes.”

“He just said, ‘You do what you need to do,’” she says.

Surprisingly, Gollish ended up having a decent race, until she had about 200 meters to go. Then her legs started flailing as her hips splayed, her lower half just unable to respond in her normal stride. She slowed as she made her way around the final bend, into the finish line, bleeding through her shorts again.

“I was like, ‘What is going on with my body?’” she says.

Most of us don’t recognize the onset of perimenopause (the two to 10 years when ovaries gradually stop working), followed by the shift into menopause (which officially begins after 12 months without a period), until we have some distance from it. The irregular, heavier-than-normal periods start, then we gradually add in some hot flushes. Soon our sleep patterns are disrupted. Sometimes we have dizzy spells and heart palpitations or the onset of anxiety and depression. Our hair falls out and skin becomes dry and itchy. The hormone fluctuations cause rage, grumpiness, and often an increase in body fat, especially around the belly, no matter what we eat or how high our weekly mileage climbs. The body aches and joint pain come out of nowhere. We find ourselves navigating midlife with confusion, frustration, and often in isolation.

RELATED: What Is Happening to My Body? A Runner’s Guide to Perimenopause

“What makes me sad is that a lot of people suffer alone. I suffered alone for the first bit of this because I was afraid to talk about it,” says Gollish, who now uses Instagram to discuss what she’s going through as a perimenopausal athlete (one who’s competing in the 2023 World Championships marathon). “I need to make light of it to get through it, for my own mental health. But the number of people who have reached out to say, ‘Oh my god, I’m not alone?’ tells me that 40- and 50-year-old runners feel invisible.”

Seeing the Unseen

Menopause doesn’t come with the kind of indicators that other phases of female reproductive health do, like a first period, pregnancy test, or giving birth. We don’t educate anybody on what to expect or when it might start. In fact, as a society we do everything in our power to avoid showing signs of aging—the global anti-aging market with all its face masks, wrinkle creams, injections, and supplements was valued at $66.7 billion in 2022, according to Zion Market Research. Instead of greeting this new chapter of life with acceptance, a lot of us feel shame and grief. And when we’ve spent many years—practically our whole lives—assuming the title of “runner” as part of our identities, the changes can feel like the ultimate body betrayal we never saw coming.

As Christine Yu, author of Up to Speed: The Groundbreaking Science of Women Athletes, writes, menopause is “a disorienting experience, especially for active and performance-driven people with ovaries in their forties, fifties, and sixties.” And although we know that women are training and competing at high levels at these ages, we still don’t have a lot of research and information on how the physiological changes impact our active lives, Yu writes.

“Scientists aren’t sure whether peri- and postmenopausal people need to approach exercise, training, nutrition, recovery, and injury prevention differently than those who are premenopausal because there hasn’t been an incentive to investigate. Previous generations weren’t necessarily invested in physical activity or interested in remaining active in sports through midlife and beyond to the same degree as people today,” according to Yu.

But an estimated 1 million people in the U.S. enter menopause each year and we can safely assume that many of them want to continue their athletic pursuits, whether they run or participate in another sport. As the researchers and scientists continue to delve into the ways in which we need to adapt in order to perform and feel our best, Gollish, who also works in the Mental Health and Physical Research Centre in the Faculty of Kinesiology at the University of Toronto, and other athletes are pushing to amplify the conversations that women are having about their experiences, in order to dispel myths, bust through the taboos, and empower women with the information to make the best decisions about their health.

“There’s so much shame around it and our stories don’t get out there because nobody wants to share their misery,” Gollish says. “And I think the biggest voices in running have been dominated by an age demographic that isn’t going through this.”

So we asked a few runners and experts what they wish they would have known when the symptoms of perimenopause began, where they’ve found helpful information or support, and what advice they would give with others who are approaching this phase of life. Although we all go through different experiences, sharing stories is often helpful in alleviating fears and stigmas.

Here’s what they had to say:

You’ll Probably Blame Everything Else.

Olympian Carrie Tollefson, 46, wasn’t quite ready to name what was happening when she started experiencing some signs of perimenopause in 2020. After all, the pandemic had just hit, she had three kids at home, a husband still going into the office, and her broadcasting career on hold as live events were getting canceled. She had also just raced a marathon and may have lost a bit of weight in training, so she tried to eat more to see if that might help regulate her menstrual cycle.

Nonetheless, Tollefson, who is also host of the podcast “C Tolle Run,” continued noticing that her period was coming more sporadically and sometimes it was heavier. She had dizzy spells and felt lightheaded, as well as unusually fatigued. Then came hot flushes, which was the telltale sign for her. She talked with her older sisters and finally came to the conclusion she was perimenopausal.

“It’s funny because I think every woman I’ve talked to has come up with some other reason, you know, besides menopause—like, it just couldn’t have been menopause,” Tollefson says. “It had to have been an autoimmune disease or heart disease or, for me, I was a fit runner and blaming the pandemic stress.”

A year later, Tollefson stopped getting her period. It was then that she started noticing changes in her body composition. Her legs didn’t feel as strong anymore, either, especially her quads. While she knows that women are highly encouraged to lift weights—the drop in estrogen levels in menopause leads to a decline in muscle mass and bone density—she hasn’t quite gotten into a routine yet.

“I just need like 30 more minutes in a day and I cannot seem to find it,” Tollefson says. “My run fills my soul and I need that. It is the one thing I do for myself in life, even if it’s just a 20-minute run. If I don’t go and get a good sweat, I feel like my hot flashes are a little more prevalent throughout the day.”

Abbie Smith-Ryan, PhD, co-director of the Human Performance Center at the University of North Carolina, who studies women’s health, exercise, and nutrition, says that while women should continue running if they want to, especially if it provides mental health benefits, the science also shows that sacrificing some of the time spent logging miles for resistance training is important.

“Lifting weights as you age is good for preventing osteoporosis, it’s good for your joints, it’s great for injury prevention—it goes back to building muscle and supporting the skeleton in a way that is really needed as women age,” Smith-Ryan says, adding that lowering mileage and increasing intensity like speed work (think: fast track intervals, fartleks, and hill sprints) is another strategy that aids insulin sensitivity during the menopause transition, as well as cardiovascular and metabolic health.

Tollefson’s experiences, Smith-Ryan says, are not unusual. In her research she sees that the majority of women enter perimenopause at a time when they’re at the peak of their careers while taking care of their kids and, sometimes, their aging parents, too. It’s difficult to decipher if symptoms are a result of the frantic pace of life or because they are entering menopause.

“This is why they’re not talking about it—they think, ‘Oh, it’s just me,’” Smith-Ryan says. “But it’s actually physiology and no one was ever taught about this.”

RELATED: 7 Natural Ways to Mitigate Menopause Symptoms

You’re Not “Crazy.”

Laura Scholz, a freelance writer who lives in Atlanta, didn’t finish the 2016 Boston Marathon. It was hot that year and she ended up in the hospital, diagnosed with a virus.

“After that, running just never felt right again,” she says.

Now 47, Scholz looks back on the months that followed that DNF and can piece together the evidence that it may have been more than a virus. But back then? She had no idea what was going on. Even after she recovered, her pace was a minute per mile slower than usual and her tolerance for heat was nonexistent, something she had convinced herself was all in her head. In addition to running six days per week, she was teaching early morning fitness classes, trying to keep up with her writing career, and getting only five or six hours of sleep per night.

“My first symptom was this sort of heat exhaustion, but then I had this general exhaustion, too,” Scholz says. “I wasn’t able to complete daily tasks, I couldn’t do an easy run, and I definitely couldn’t race. That was definitely a rough patch.”

Scholz got some blood work done specifically to measure female hormone levels. While it indicated perimenopause, the results also revealed hypothyroidism (when the thyroid doesn’t release enough thyroid hormone, which leads to fatigue and weight gain). Her cortisol (stress hormone) levels were high as well. “Being a healthy, active person and suddenly gaining 10 or 15 pounds and not being able to do anything about it no matter what is stressful,” she says. “Especially because I have a background of eating disorders.”

Menopause and Eating Disorder Risk

A 2023 study published in the journal Menopause found that perimenopausal and early postmenopausal women were more likely than other age groups to report fear of gaining weight or losing control of their eating, indicating that women in midlife are at risk of developing eating disorders, which isn’t commonly discussed. Participating in a sport like running, where so many people of all ages struggle with disordered eating and eating disorders, can exacerbate these symptoms as women become dissatisfied with their bodies in midlife.

“Just because you’ve had a good handle on nutrition doesn’t mean that you can’t have an eating disorder now,” Smith-Ryan says. “So many women are experiencing this and it’s really normal. They’re exercising more, eating less, yet their body fat is going up. It’s really hard to figure it out on your own, so it’s best to get expert help if you need it, from a therapist and a dietitian.”

Scholz has gotten her thyroid regulated and figured out how to adjust her running in the heat. She’s sought out a running coach who encourages Scholz to give herself grace when her body isn’t up for doing what’s on the training schedule—a strategy that she recommends to others in her position. It’s taken a lot of work to be OK with the new realities of training for shorter distances and slowing the pace down, but that’s what will lead to longevity, too, which is her ultimate goal. Scholz has also found camaraderie with other masters-aged runners in her community. They confide in each other as they all go through this chapter together.

“Our moms weren’t out there trying to run marathons during perimenopause or menopause, so not knowing what was happening was the scary part,” she says. “Now I know I wasn’t crazy. My body just was not going to do what I wanted no matter what I threw at it and I was probably making things worse for a few years. That would’ve been helpful to know.”

Be Mindful.

When Kirsten Miller, a 56-year-old triathlete in Denver, was pregnant with her son at age 40, she knew she was also in perimenopause—she had symptoms before the pregnancy, including weight gain and hot flushes.

Three years after she gave birth, Miller also went back to school to become a certified holistic nutritionist while working a part-time corporate job. Then she added Ironman training to the mix. It was then that she realized how stressed her body had become—not only because of everything she was juggling, but because her hormones were in a state of flux.

“I added in meditating and things to put me into a calmer state and that made a huge difference,” Miller says. “It was really basic—just sitting and breathing, trying to clear my mind.”

Aside from stress management, though, Miller immediately noticed an increase in injuries as she progressed through perimenopause and menopause. She had some soft tissue problems, as well as one stress fracture. At the time, her coach was putting five to six days of running on her schedule, “which I would not recommend for an aging female in the perimenopause or menopause state, because we need that recovery for our bones and feet,” Miller says. “That’s the beauty of being a triathlete—we swim and bike, too.”

The niggles and tweaks really start to show up when athletes refuse to change their ways and make time for strength training, recovery, and nutrition—as well as become open to the idea of fewer miles. At this stage, Miller encourages her clients to focus more on fiber-rich carbohydrate sources like fruits and vegetables, as opposed to faster-burning carbs like sugar, as well as healthy fats and increased protein to support muscle repair. It’s critical that active women going through menopause eat enough—instead of counting calories, they need to make sure they’re getting all the nutrients that support their lifestyle and overall health.

Following her own advice, Miller is still competing the Ironman distance, most recently finishing Lake Placid. Part of her motivation, she says, is leading by example—proving that athletes in her age group can still train and thrive in endurance sports.

“That was part of my goal of doing this race. I want to show people that I’m racing as a 56-year-old,” she says. “It’s to show that we can still do this, we just need to be really mindful. There are definitely more women doing endurance sports through menopause and that’s a fantastic thing—we need to get more information out there, because people really want it.”

RELATED: InsideTracker Aims to Demystify the Hormonal Changes Around Menopause

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