Menopause and Performance – The Oestrogen Connection
As women, we all understand that in our forties and fifties, we begin to approach menopause, which is officially reached when a woman goes for 12 months without menstruating. In the years leading up to menopause, the time known as peri menopause, most women start noticing that their bodies are changing. Menstrual cycles may become irregular, or be characterised by heavy bleeding. Many women report aching joints, forgetfulness, loss of libido, insomnia and vasomotor (hot flushes/difficulty regulating body temperature) symptoms. It’s important to note that not every woman will suffer from every symptom, however these changes can impact upon how well a woman can perform, both in their daily life and their athletic training.
Our forties and fifties are also a time when many women, free from the constraints of raising children, start to return to competitive sport. Both strength and endurance sports enjoy an increased participation rate by female Masters athletes, with many women happily competing into their senior years.
However, if you’re an athlete or particularly active woman approaching menopause, it can be difficult to find answers to your pressing questions about what happens to athletic performance during this time and how you can maintain or improve your performances. With increases seen in overall longevity, menopause could be considered the midpoint of life. Age related declines in exercise performance occur across both sexes, however, for women, there are particularly strong declines post menopause.
The onset of menopause signals a sharp decline in the female sex hormone estrogen. However, estrogen levels are also slowly declining in peri menopause. The absence of circulating estrogen increases a woman’s risk for heart disease, diabetes and osteoporosis.
Undoubtedly, declining estrogen levels have the biggest impact on training and performance. For this reason, it’s worth examining the role of estrogen in exercise induced muscle damage, repair and function and how this affects female athletes.
The presence of estrogen has positive effects on skeletal muscle. When we exercise, we load our bodies in a way that forces our bodies to adapt. For example, when you lift a weight in the gym, the usual advice is to ensure that the last repetitions of an exercise are challenging. As a result, we “damage” our muscles on a cellular level. After performing exercise, our body spends time repairing, rebuilding and adapting to the load or stress it has been placed under.
For women, the presence of estrogen has been shown to not only protect our bodies against too much exercise induced damage, it also promotes the enhancement of recovery from intense exercise sessions.
Special cells known as muscle satellite cells reside within skeletal muscle. Adult muscle cells rely on these satellite cells to repair muscle and induce hypertrophy. Animal studies have shown that the presence of circulating estrogen encourages the activation and proliferation of such cells, thereby encouraging a faster recovery from bouts of exercise. Additional evidence suggests that this also occurs in women with circulating estrogen.
Additionally, research has also shown that the presence of estrogen improves a woman’s ability to gain muscle mass. Typically, as we age, we begin to lose muscle and our metabolism slows as a result. This phenomenon is known as age related sarcopenia. Active individuals, who have exercised across their lifespan tend to have reduced rates of muscle loss.
However, in menopause, a rapid decline in estrogen within the body starts an acute and rapid reduction in strength and muscle mass. It also takes longer to recover from injuries, and to regain muscle that may have wasted away as a result of being inactive. These falls in strength and muscle mass have big implications for ageing women, regardless of whether they are training or not.
What does this mean for performance in sport as we age? The benefits of estrogen on muscle mass, strength and repair suggest that estrogen in the form of menopausal hormone therapy (MHT) could have significant benefits for muscle function and strength. MHT, therefore, not only helps ageing women with function and mobility, but also is worth considering to help maintain sporting performance.
It is worthwhile considering that a balanced training regime that includes resistance training supports muscle retention, strength and function without additional supplementation. With the addition of MHT, studies show the effects of such a training regime are amplified.
If you are considering using MHT, a risk benefit analysis should be undertaken. Generally, MHT is safe for most women to use and recent studies support this. For example, a ten year trial study of 1000 post menopausal women has recently shown the beneficial health effects of estrogen – women who used MHT had reduced mortality and cardiovascular events, without any increased risk of cancer. The study suggests that the most benefit is gained when MHT is started as a woman approaches menopause. Additionally, the use of MHT has been shown to improve peri menopausal symptoms as well as reduce fat deposition around the abdominal area, which is part of the menopause process. However, there are some contraindications for use of MHT, including a history of breast and other hormonally driven cancers.
My overarching advice for women approaching menopause is to consider the use of MHT to reduce menopause symptoms and improve quality of life. It’s worth your attention because our increased longevity means that we will be living without the benefits of our female sex hormones for almost as long as we have lived with them!
MHT has the potential to positively impact sporting performance directly and indirectly.
The use of MHT has a “knock on” effect if you’re currently training to improve fitness or to compete in sport. MHT can successfully address issues such as insomnia, vasomotor symptoms and aching joints that can crop up for women approaching menopause and beyond. This allows an improved quality of training and recovery, which can improve sporting performance.
The direct effect of MHT on skeletal muscle, especially when paired with resistance training, amplifies its effect resulting in improved muscular and bone strength, which can potentially enhance performance.
Regardless of whether you decide to supplement with MHT, all women approaching menopause and beyond benefit from both resistance and cardiovascular exercise. Resistance training positively impacts muscle strength, function and mobility, while cardiovascular exercise has a positive effect on heart and circulatory health. Both forms of exercise improve mood, which is worthwhile considering, as rates of depression during menopause usually increase.
To conclude:
every woman’s experience of menopause is different
all women should consider MHT for reduction of bothersome symptoms and protective health benefits
athletic women in particular, should consider MHT to maximise muscle and bone strength, as well as function
MHT alone does not improve athletic performance – instead it amplifies the effects of a balanced training regime for your chosen sport
all women who are approaching menopause and beyond, regardless of whether or not they use MHT should consider a regular resistance training regime
to get the best out of your training, consulting with a degree qualified exercise professional who has expertise with Masters athletes is recommended
MHT does not negate the need for good nutrition practices which may or may not improve symptoms, but have a direct influence on sporting performance
Women who are wanting reliable information about menopause should consult with their doctor. It is worthwhile checking out various Menopause Societies in your geographical location. They often provide a list of doctors who have a special interest and up to date knowledge in the area.
References:
Schierbeck LL, Reinmark L, et al. (2012) “Effect of Hormone Replacement Therapy on cardiovascular events in recently post menopausal women: randomized trial. British Medical Journal,
Tiidus PM, Lowe DA, Brown M (2013) Estrogen replacement and skeletal muscle: mechanisms and population health. J Appl Physiol. 2013;115:569–78.
Tiidus PM (2017): Estrogen and Menopause: Muscle Damage, Repair and Function in Females. In: Hackney A, “Sex Hormones, Exercise and Women”, Springer.