Perimenopause and Running: A Comprehensive Guide for Female Runners
- Lyns Romano
- May 30
- 5 min read
Perimenopause is not just a reproductive milestone; it’s a whole-body transformation that affects mood, muscle, metabolism, and mindset. For female runners, understanding this transition is essential to adapt training, nutrition, and recovery strategies to stay strong, consistent, and injury-free. You’re not losing it. You’re not doomed. But you do need to understand what’s changing and make smart adjustments so you can keep running strong and chasing big goals.
Here's what we'll cover in this guide:
Introduction and reframing perimenopause as a performance transition
Key hormones affecting female athletes (estrogen, progesterone, testosterone, cortisol)
Recognizing symptoms of perimenopause in active women
Endocrine and nervous system interactions during this life stage
Lifestyle and nutrition strategies to support training and recovery
Actionable next steps including lab testing, lifestyle changes, and medical options
Conclusion focused on adaptation, resilience, and long-term performance
Hormones and Runners: Key Players in Performance during Perimenopause
Estrogen (Estradiol)
Estrogen is central to multiple systems that influence athletic performance. As it begins to fluctuate and eventually decline in perimenopause, it causes changes such as:
Decreased bone mineral density, increasing the risk of stress fractures
Impaired muscle repair and slower recovery
Altered neurotransmitter activity, leading to mood instability and cognitive fog
Less effective thermoregulation and increased hot flashes
Reduced insulin sensitivity and greater fat storage, particularly abdominal
These shifts can result in slower recovery, more frequent injuries, increased perceived exertion, and emotional volatility.
Progesterone
Progesterone supports calmness, deep sleep, and tissue integrity. It also declines erratically in perimenopause, leading to:
Heightened anxiety and irritability
Poor sleep and frequent night wakings
Longer recovery times after workouts
Increased core body temperature, leading to reduced heat tolerance
Weakened joints and tendons due to decreased collagen turnover
Testosterone
Though present at lower levels in women, testosterone plays a crucial role in muscle maintenance, recovery, and competitive drive. Its decline during perimenopause contributes to reduced lean mass and motivation.
Cortisol
Cortisol is a vital stress-response hormone that becomes increasingly reactive during perimenopause. Estrogen and progesterone normally help regulate cortisol levels, but their decline removes this buffering effect. As a result, women may experience:
Faster spikes and slower recovery from stress
Persistent fatigue and central nervous system exhaustion
Muscle catabolism and poor lean mass retention
Visceral fat gain and metabolic inflexibility
Sleep disturbances and poor immune function
Under-recovery combined with underfueling can trap female athletes in a high-cortisol state, leading to diminished performance and increased injury risk.
Recognizing the Signs of Perimenopause in Runners
Perimenopause symptoms can mimic overtraining or chronic stress. Key signs to watch for include:
Performance-Related Symptoms:
Poor recovery from sessions
Decreased endurance or consistency
Increased perceived effort
Loss of competitive drive or enthusiasm
Physical Symptoms:
Irregular or heavy menstrual cycles
Hot flashes and night sweats
Muscle soreness that lingers
Weight gain, especially around the abdomen
Joint stiffness and recurring injuries
Cognitive and Emotional Symptoms:
Brain fog and forgetfulness
Mood swings, irritability, or anxiety
Decreased mental resilience or motivation
Endocrine and Nervous System Interactions
The endocrine system orchestrates these hormonal changes through the hypothalamic-pituitary-ovarian axis. When estrogen and progesterone fluctuate, adrenal glands often compensate, which can exacerbate stress reactivity if not properly supported.
Simultaneously, the nervous system becomes more sensitive. Estrogen and progesterone are neuroprotective and help regulate serotonin, dopamine, and GABA. Their decline can lead to heightened emotional reactivity, anxiety, and poor sleep quality.
Lifestyle and Nutrition Strategies for Runners Managing Perimenopause
Strategy | Mechanism | How to Implement |
ALWAYS Fuel Before Runs | Stabilizes blood sugar and limits cortisol spikes | Eat 15–30g carbs with some protein pre-run |
Post-Workout Nutrition | Aids recovery and reduces catabolism | Carbs + 20–30g protein within 30 minutes post-run |
Daily Protein Considerations | Supports muscle retention and satiety | Higher in perimenopausal athletes @ 1.8–2.2g per kg of body weight |
Avoid Low Energy Availability throughout the day | Prevents hormonal suppression and stress reactivity | Eat balanced meals/snacks every 3–4 hours |
Strength Training | Preserves lean mass and metabolic rate | 2–3 resistance sessions per week |
Prioritize Sleep | Restores hormonal balance and recovery | Consistent schedule, dark room, screen limits |
Mindfulness & Breathwork | Reduces sympathetic nervous system overdrive | Practice after workouts or before bed |
What You Can Do
1. See Your Doctor for Baseline Testing
Start with a comprehensive lab panel. This can help you understand where you are hormonally and rule out other issues like thyroid dysfunction. Suggested tests include:
Estradiol, Progesterone, Testosterone
FSH and LH (to assess ovarian reserve)
Cortisol
Full Thyroid Panel: TSH, Free T3, Free T4, Reverse T3, and Thyroid Antibodies
Vitamin D, Ferritin, and B12
2. Make Lifestyle-Based Changes
Become your own expert. Due to the sparse amount of information available for perimenopausal athletes, you're going to need to do some digging. Like many things in running and athletics, there will be some trial and error. Begin strength training, make nutrition updates, and reach out to experts.
3. Consider Medical Support
Some women benefit significantly from hormone replacement therapy (HRT), which may include estrogen, progesterone, or testosterone. HRT can relieve hot flashes, improve sleep, support mood, and help maintain bone and muscle mass. Discuss risks and benefits with a qualified practitioner.
Conclusion
Perimenopause is a time of great physiological change, but it does not have to be a decline in performance. Doing what has always worked may no longer be effective. This life stage demands a more intentional, responsive approach to training, fueling, and recovery. By understanding the roles of estrogen, progesterone, testosterone, and cortisol, and how they affect your body and mind, you can create strategies that support longevity, resilience, and enjoyment in running. With smart adjustments and proactive care, perimenopausal athletes can not only maintain performance, they can thrive.
Sources
No. | Source | Key Insight |
1 | Emphasizes the need for integrated training, recovery, and nutrition strategies for menopausal runners to maintain performance and wellness. | |
2 | Highlights declines in bone density, muscle mass, and cardiovascular fitness in athletes due to hormonal changes. Advises seeking medical and training adaptations. | |
3 | Demonstrates cortisol’s role in modulating estrogen and testosterone levels, relevant to stress-related hormonal imbalances in athletes. | |
4 | Details the physiological impact of estrogen and progesterone fluctuations on exercise performance, thermoregulation, and mood. | |
5 | Describes how somatic and psychological symptoms of perimenopause affect physical activity and social well-being, reinforcing the article’s holistic approach. | |
6 | Demonstrates that endurance athletes may require up to 1.89 g/kg/day to maximize whole-body protein synthesis, regardless of sex. |
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