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

Welcome to midlife mayhem, a special time in life nobody wants to talk about.

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I felt relatively informed about what puberty would bring. I may not have liked it, but at least I knew. Like most girls in the ’80s, I devoutly read Judy Blume—I walked through first periods and training bras side-by-side with Margaret Simon, who left so few stones unturned for Gen X. But here we are, 35 or so years later, and I need a sequel: Are You There God? It’s Me, Perimenopausal Woman.

You hear that it’s coming, and you vaguely understand the concept of hot flashes. You might even welcome the idea of never worrying about your tampon supply again. But what happens to a woman in midlife doesn’t come with a lot of education or discussion.

One day you wake up and menstruation has turned into a gushing, erratic mess, your pants no longer fit, and you sweat through the sheets during restless nights of tossing and turning. You call a doctor (because obviously you are dying) only to find out that you’re not actually about to expire, only that you’ve entered a phase that lasts somewhere between a few months or 10 years.

During this ill-defined time, hormonal fluctuations may cause anxiety, depression, lower sex drive, weight gain, and general fatigue. You’re required to navigate all of this while continuing your normal routine amid the most dramatic mood swings you’ve ever known: pursuing career goals, taking care of your family, hydrating, and making sure you’re exercising and eating enough vegetables, all as Father Time ravages your insides.

It ain’t fun for anybody, but for female runners in particular, perimenopause and menopause (officially marked by 12 months without a period) can be as jarring as the teen years. The body that’s taken you through thousands of miles of training and across the finish lines of multiple marathons no longer looks or feels like your own. It’s heavier and slower and losing muscle mass. It doesn’t quite recover from hard efforts the way it used to. And you’re just so very tired.

“It is important to acknowledge that the changes women experience in their bodies during peri- and post-menopause can be uncomfortable, especially when it impacts training and competition in ways that it never has before,” says Stasi Kasianchuk, registered dietitian, nutritionist, and exercise physiologist, who is also the director of health coaching at Gennev, a menopause telehealth and education service.

“The stigma around menopause and aging makes this even harder to acknowledge, and it is frustrating for women when they have been able to maintain a certain bodyweight, size, and shape for so long, and then all of a sudden, typically without any changes in their nutrition or exercise routine, they notice changes that impact how they feel and perform,” she says.

For me, weight gain has been the most difficult part, which in a sport like running—fraught with eating disorders and body image challenges—is taboo to talk about out loud. I even contacted one dietitian for this article who refused to offer advice, saying she didn’t want to promote intentional weight loss at any age. I get it, and I agree that focusing on numbers on a scale does nobody any good (I don’t even own a scale!). But nonetheless, when it comes to middle age and genetics, weight gain can also trigger a host of other health concerns like heart disease, diabetes, and high blood pressure.

So I dared to open up the conversation with a couple of experts to find out how we, as female runners who care about our general health and well-being, can navigate the changes in our body composition as we go through perimenopause and menopause. What is really going on that leads to such midlife mayhem? When is it time to worry? When is it time to accept our new selves? And how? Here’s what I learned, noting that the tried-and-true advice remains: check with your healthcare providers to figure out what’s best (and right) for you.

Learn About What’s Happening

We’ve long been told that our metabolism slows down as we age, but research indicates that metabolism alone isn’t to blame for weight gain in perimenopause. It’s the decline of estrogen levels that leads to bone density loss, increased body fat (especially around our midsections), and deteriorating lean muscle mass. It can also interfere with satiety signals—we crave more food without estrogen regulating hunger pangs.

“The body works to mitigate [estrogen loss] by increasing body fat, typically in the abdomen, because our fat tissues secrete estrogen,” Kasianchuk says. “The body is actually working to support our hormone function by increasing fat storage, which is part of the reason losing body fat can be more difficult at this time.”

Photo: Eva Tatcheva

Simply understanding exactly why body composition changes during perimenopause is helpful. You’re not doing anything “wrong,” nature is just taking its course. Somehow that eases the anxiety a little.

We also all face individual circumstances and external factors. For example, I spent most of adulthood training intensely for triathlons and marathons, often running 60 to 70 miles per week for long stretches of each year. I had lost time and interest (and enthusiasm) for that level of training as I charged further into my 40s. And as the pandemic hit, my activity level declined drastically. After long days at my desk, I had more interest in cooking a nice dinner or baking cupcakes during quarantine than I did in logging miles.

Whatever the circumstances (maybe it’s work or caregiving that’s taking time away from athletic pursuits—or just burnout), it’s not unusual for women to meet perimenopause at a time of decreased physical activity, says Sohee Lee, a Los Angeles–based certified sports nutritionist and certified strength and conditioning specialist. And it’s OK to not like the repercussions, either.

“You’re allowed to feel that way,” Lee says. “Runners have an extra variable of thinking about how it’s affecting their performance or how it feels when they exercise or the extra stress it’s putting on joints. Those are valid reasons to want to lose weight, but always with the caveat that you have to keep an eye out for red flags. The biggest mistake you can make is to go into [weight loss] completely unprepared—without a sound plan or a good exit strategy. That leads to a very disordered relationship with food.”

Sort Out Your Feelings

So, it’s fine to crave change, but experts also suggest that women take a deep dive into why exactly they’re feeling displeased in the first place.

“We need to start recognizing when diet culture is influencing our thoughts, feelings, and decisions, and ask ourselves: Does this make sense? Do I need to conform to a certain body, shape, or size, to feel a certain way or reach a certain goal?” Kasianchuk says. “Diet culture preys on women at our most vulnerable times, telling us that we are not enough as we are and that we need to be fixed.”

We don’t have to like everything about our bodies all the time and, in fact, constant body positivity can be “an incredibly huge ask,” for most people, Lee says. She suggests that for every negative thought we have about how we look, it’s also important to acknowledge what we value about ourselves outside of our appearance or performance.

“I like that approach—it allows you to have your emotions,” Lee says. “You have the ability to recognize that you’re having this thought, but you’re going to act in a way that’s better for yourself.”


The midlife years are challenging for myriad reasons. Everything seems to escalate quickly, leaving little time to run long or fit in a speed session, even on days when you really want to. But now is an important time to be a little selfish, Kasianchuk says.

“Many of my clients have dedicated their lives to taking care of others, like partners, kids, parents, and colleagues. While admirable … this often comes at the cost of sacrificing themselves to a point that they don’t even know how to care for themselves when they could benefit most from it,” she says.

Alleviating symptoms of perimenopause and menopause demands carving out the time you need to exercise—not just for the fitness benefits, but for the emotional boost, too.

“Are you feeling anxiety and rage due to hormonal fluctuations and need your workout to support you in processing these emotions? Go for it,” Kasianchuk says. “Get curious about what you are feeling and what you need to support yourself in that moment.”

Photo: Eva Tatcheva

You might not always choose running, either. If you’re looking for the best way to stave off that decline in lean muscle mass, you have to do more resistance training. Lift weights at least twice a week, even if it means replacing a run with a strength workout, Lee says. Running will continue to keep the heart and lungs strong and healthy, but weights help preserve muscle mass.

“If somebody is running six days a week and not doing any resistance training, they will probably see better performance improvements running three days and lifting two or three days a week,” Lee says. “There’s so many benefits to lifting weights. Over time you’ll see and feel the difference in your body. If you want to change your body, it’s the most effective tool.”

No matter what, it’s just critical to keep moving. As we age, we may find other activities we enjoy more than running, too (gasp!). Supplement the miles with something you look forward to, whether it’s hiking, swimming, cycling, walking, or hopping on the elliptical. Not only does a session a day help give you a psychological boost, but it can also improve your sleep.

“With hormones changing daily, I find that some people do best when they are willing to be flexible with their training plans,” Kasianchuk says. “Some days if you’re feeling extra fatigued, a yoga session—or even a nap—may be better than a trail run or track workout. It’s important to give yourself grace and know that there will be other opportunities for those workouts you want to crush.”

Embrace the Changes

After we understand what exactly is going on with our bodies and what variables we can control to stay healthy and fit (exercise, sleep, and nourishment), it becomes easier to accept that we also can’t go backward. Our physiology is simply not the same as it once was—but we need to learn to support the physiology we now have.

“We have a tendency to want to go back to a time when we felt better,” Kasianchuk says. “But I encourage my clients to use this as a time to explore new ways to do things they may not have done in the past.”

I’ve heeded Lee’s advice, taking up lifting sessions twice a week and adding in a long swim when I don’t feel like a long run. While I haven’t noticed big changes in my body composition yet, my general demeanor and attitude have improved during the weeks I make adequate time for running, strength training, and cooking up some healthy meals.

My old jeans may never fit again, and I’ll probably never set another marathon PR, but I’ve (mostly) made peace with that. My new body takes up a little more space, but I feel stronger than I ever have—an unexpected benefit in the midst of all the change. And that’s the advantage of growing older, of course—we also become wiser, even if Judy Blume and Margaret Simon left us hanging in middle age.

“None of us know what the future holds,” Kasianchuk says. “The reality is, it has every opportunity to be better than the past, if we let it.”