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Menopause and Fitness: Sex Differences, Part 3

“Menopause and Fitness” was a collaborative effort between: Jonathon Mummert (Head Coach of Lose Weight Smiling) and Adam Ali (Mastermind of Physiqonomics). Jonathon has spent countless hours studying the differences that trainers should consider when working with females vs. males. His work on training around the menstrual cycle was featured on Girls Gone Strong and he has taught on the subject for groups like Lift The Bar and Elite Fitness Mentoring

Before getting into the article, we want to give an honorable mention and thanks to The Docs Who Lift,  who were gracious enough to let Jon interview them as part of research for this article. We will be including pieces of those interviews throughout.

If you haven’t read the first two parts of this series, we’d suggest you do so before diving in.

Gender Differences in Training and Metabolism

The Menstrual Cycle and Contraceptives:  A Complete Guide for Athletes


The topic of menopause tends to be quite a taboo subject, and we can say without much reserve that there is as much a lack of understanding about menopause among women as there is among men, perhaps due to the reluctance of the majority of women to discuss this topic openly.

Our goal with this article is to create a reference guide that both women and trainers can refer to time and time again. We also hope to make women aware of the importance of starting a healthy fitness routine as early as possible to insure that their chances of getting osteoporosis and/or heart disease will remain much lower. Leading an active lifestyle, lifting weights, and eating to maintain an optimal level of body fat and muscle can help to alleviate and possibly even eliminate some of the negative experiences often associated with menopause.

Below, you will find some background information on perimenopause and menopause. Here, we discuss some of the symptoms and the importance of recognizing the signs of perimenopause and menopause. For the purpose of this article (and in order to properly understand the nutrition, supplementation, and training advice given), we will emphasize menopause’s effect on bone mineral density, since it’s the major effect of menopause most positively affected by training.

What is menopause?

Menopause marks the the time in a woman’s life where her ovaries stop producing eggs and the menstrual cycle comes to an end, bringing with it hormonal changes.

On average, menopause begins in women around the age of 50-51 and is marked by more than 12 months without menses.

While for some women, menopause can be something to look forward to because of no longer having to worry about “That Time of The Month” (TTOM), there are some things you need to take into consideration and be aware of to help prevent – or at the very least, reduce – some of the negative experiences that can arise during perimenopause and menopause.

What is perimenopause

Perimenopause means “to be near or around menopause.”

This happens when the body begins dropping the final supply of eggs. This sporadic drop will lead to irregular menses and uneven rises and falls in estrogen levels.

Women will commonly reach perimenopause between the ages of 40-45, but perimenopause can start earlier. Women in their late 30s should not ignore any symptoms (should they arise).

It is also during this time that women might experience up to a 3% loss of bone mineral density per year if they are leading a sedentary lifestyle and not on hormone replacement therapy. This high loss of BMD can carry on even after menopause. For this reason, it’s important for women to take preventative measures against osteoporosis BEFORE they begin experiencing symptoms of perimenopause.

Furthermore, it’s commonly accepted that a woman loses her ability to gain more BMD around age 25.

As a qualifier, I do want to point out that I have seen a study or two suggesting that there might be a way to add to a woman’s BMD through heavier lifting at lower reps. While I have not personally seen enough research on this to be convinced, I do not want to throw out the possibility altogether. Whether this is the case or not, we can all come to the conclusion that lifting weights and living a healthier lifestyle will help prepare a woman for peri/postmenopause.

Women can also experience an earlier onset of perimenopause due to things like surgery or radiation. Chemotherapy and radiotherapy have both been linked to causing a decrease in egg count and leading to earlier-than-expected menopause. Additionally, smoking, hysterectomies, and living in higher altitudes can all lead to an earlier onset of menopause.

While there are some symptoms that may indicate perimenopause, it is not something that should be self-diagnosed and/or ignored. Tell your healthcare provider ASAP if think you may be experiencing the beginnings of perimenopause.

While your healthcare provider may not be able to tell you how long you will be in perimenopause (average is 4 years), the sooner you let them know, the more help they will be able to provide.

Dr. Spencer Nadolsky explains the importance of doing so:

People do not like to talk about menopause and sometimes will even hide it from their doctor. It is very important to be upfront with your doctor as soon as you think you are experiencing these symptoms. Doctors like to use the lowest amounts of hormones possible as early as possible. There are some doctors who will give testosterone to boost libido as well as increase estrogen, but (that) does not have as many studies behind it. For your doctor, it is better to know sooner than later in order to provide help.”

 


 

Bone Mineral Density Loss

A woman will achieve maximum bone mineral density (BMD) around the age of 25-30.

Until this point, bone loss and bone growth will happen at a positive turnover ratio (this is just a fancy way of saying that though some BMD is lost, it repairs and grows at a faster rate than it is lost). After a woman reaches her peak, she will begin to experience a loss in BMD each year starting around her late 30s-40s.

There have been a few studies looking into whether or not it is possible for women to stop the loss of BMD and even possibly reverse it through training techniques. While I personally hope they find this to be true, it currently seems that this is not the case. Again, either way, loss of BMD can be better controlled through hormone replacement therapy (HRT) and performing weight bearing exercises.

While changing one’s genetic disposition might be a little difficult, there are still a few things that can be done to slow the rate of decline. Excessive alcohol consumption and smoking have been linked to a decrease in BMD. Additionally, smokers have been shown to enter menopause on average 2 years earlier than non-smokers. Now, I am a big fan of enjoying a great beer and/or cigar, and I’m not saying to completely do away with these things. However, moderation is definitely key here.

In terms of BMD, Dr. Kasey Nadolsky recommends focusing on maintenance.

“Generally, we begin to lose about 0.5-1% a year starting from our 30s-40s, but during post menopause you can expect up to a 2-3% loss yearly, without HRT,” he said.

A healthy diet and exercise can both help with the slowing of BMD loss. Diets that promote lower weight and increased muscle mass are best. Weight bearing exercises are going to be the best bet as far as exercise is concerned, and weight lifting might be the better choice (more on this in training recommendations).

Dr. Kasey Nadolsky sums this up brilliantly:  “It’s really pretty simple: eat well, lift weights, don’t smoke.”

One thing we wish to point out here: Postmenopausal women not on HRT can experience an even greater loss. This yearly loss of BMD can lead to osteopenia and eventually osteoporosis.

Osteopenia is when the numbers on a BMD test are lower than they should be, but not yet in the range of osteoporosis.

Osteoporosis  is a medical condition in which the bones become brittle and fragile. It is the most common bone disorder and can lead to a poorer quality of life due to inactivity, as well as an increased risk of death.

Regardless of a woman’s age, please do not read this as a death sentence; it simply signals that lifestyle changes should be considered.

Preparation will always trump blind optimism. BMD loss can be slowed with weight bearing exercises, so why wait until the numbers start dropping before deciding to make a change?

Other Symptoms

Menstrual Irregularity

Menstrual irregularity is when a women does not experience her period on a regularly occurring cycle. For example, a regular menstrual cycle might start and finish every 28 days (the length most commonly referred to in the literature), but someone with an irregular cycle might start and finish in 25 days one month and in 30 the next month.

This is one of the most common markers for the onset of perimenopause, and often one that is ignored or overlooked for some time. This could be due to a lack of understanding of one’s menstrual cycle and missing small changes from month to month. This is one of the reasons that we strongly encourage women to install an app or keep a journal of their menstrual cycle. As mentioned before, it is also very important that a woman sets an appointment with her doctor as soon as she believes she might be perimenopausal.

Some women will experience a shortening of the cycle and others might experience more time passing between each cycle. It is also important to pay attention and make note of whether the flow is lighter or heavier than normal. These two markers can alert one to the possibility that perimenopause has begun.

Some women might experience heavy bleeding to the point of risking bleeding through, even in as short of a time as an hour training session. It is for this reason that trainers should be aware of what is going on and have an open dialogue with their clients. Women, if you are experiencing this, make sure you let your trainer know so that they can better work with you.

If a woman is experiencing a heavy flow, but is still wanting to come in and train, it might be a good idea to avoid lower body exercises like squats and hip thrusts. Another thing to consider would be to purposefully plan a longer break every (x) minutes in order for the client to have time to rest.  Heavier flow and more blood loss means a larger drop in hematocrit and endurance, so people will be more likely to fatigue with shorter rest intervals.

Menstrual irregularity might also be a little harder to notice at first if one is on contraceptives. Contraceptives are commonly used to help women who are irregular or experience painful periods and or ovulation, as well as the obvious. This is another reason why it is so important to have a better understanding of your cycle, as well as look out for other symptoms like vaginal dryness, hot flashes, and severe mood changes.

Vaginal Dryness / Painful Intercourse:

This is one of the more common symptoms that women feel most uncomfortable mentioning to their doctor.

A decrease in estrogen levels around menopause might also lead to a decrease in collagen levels. Collagen can make your skin look younger and helps keep your bones, tendons, and ligaments strong. As collagen begins to break down, connective tissue can become less sturdy in the absence of estrogen (testosterone helps with collagen levels as well), and this can lead to joint pain and increased likelihood to injury if one is not careful in her training. The bright side here is that this can be controlled through HRT.

This drop in estrogen and collagen can lead to what is known as vaginal prolapse, a process in which one’s organs are not kept in place and begin to fall down. This weakening of the vaginal wall and surrounding areas can also lead to incontinence issues.

This is also something that is important to consider when programming. If you know that you or your client might be at an increased risk for injury or an embarrassing situation, make sure that you develop the program with that in mind.

Vaginal dryness can also lead to an increased risk of infection, which is another reason to alert your doctor. While painful intercourse might be something alleviated by lubricants, a topical hormone treatment can also help alleviate this problem and help avoid itching and infections that might accompany vaginal dryness.

Some women think vaginal dryness is a normal part of aging and that there is nothing else to really consider.  You don’t know what you don’t know, and this lack of understanding can commonly lead one to just ignore this symptom altogether.

Hot Flashes, Night Sweats, and Sleep Problems:
      
Hot flashes are probably the thing most will quickly associate with perimenopause. Hot flashes are characterized as a feeling of feverish warmth that can also cause the skin to turn red and blotchy. These can range from mildly irritating to a full-blown desire to jump in an iced river. They can also lead to sweating, which can be highly uncomfortable when at work or out with friends.

It is normally around the time that a woman starts to experience severe hot flashes that she finally breaks down and heads to the doctor. While the menstrual irregularity can be hard to spot or simply controlled because of contraceptives, a hot flash is not something that can so easily be controlled or ignored. Also, hot flashes can come out of nowhere, without any warning signs at all.

Sleep problems are lumped in with hot flashes because they tend to be a main culprit in sleepless nights. Sometimes it might be the hot flash itself that wakes a woman up; other times, it is the tossing and turning in discomfort. Add in soaked pillows and comforters from sweating, and it is easy to see why one’s sleep would be disturbed due to hot flashes.

While it is common for sleep to be disturbed due to hot flashes, there are some women who will experience a disturbance in sleep separate from hot flashes. The fluctuations in hormones combined with the body’s constant need for homeostasis MIGHT also be at play here.

Depression, Irritability, and Severe Mood Changes:

Before jumping much more into these symptoms, I need to point out that each in and of itself can be separated from the others and are indeed different. While there are many complicated reasons for why all or one might happen, they are all boiled down to psychological symptoms of perimenopause.

Depression, irritability, and severe mood changes are all common side-effects of not getting adequate sleep. Add in the stress of the day to night sweats and sleeplessness and a woman might become depressed, irritable, and moody. Sleep may not be the only culprit, though.

Depression is common among women during perimenopause and can last into menopause. While lack of sleep can be a part of the problem or exacerbate the problem, menopausal onset of depression could also be linked to a drop in estrogen levels, which can lead to a drop in serotonin (the happy drug). It’s for this reason that many women will turn to St. John’s Wort for help (more about this in supplement section).

Irritability and mood changes can also be linked to a lack of sleep, as well as the fluctuating changes in hormones during this time. With estrogen rising and dropping in a way that is not normal, it can easily cause one to become irritable. Some of the irritability and mood changes might be lessened or controlled by eating some fruit, as there has been evidence showing that hormonal shifts can lead to blood sugar levels plummeting and leaving one feeling angry, sad, or anxious.

Many of the psychological challenges associated with perimenopause can be attributed to estrogen receptors in the brain and how they react to lower levels of estrogen during peri/postmenopause. Estrogen has even been considered a master regulator in the brain’s ability to process time and energy metabolism. While many symptoms of peri/postmenopause can be associated with lack of sleep and stress, there might also be more to the understanding that estrogen loss itself is to blame.

 


Training: The Benefits and Recommendations

Before I get into specific recommendations on programming for this population, let’s run through some of the different training goals a coach and trainee should consider: training for body composition, training for coordination and balance, training around hot flashes, training for heart health, and training around lack of sleep.

Disclaimer: These are suggestions that will need to be tweaked in order to best fit you and/or your client’s needs. There is no “one size fits all” when it comes to training people, so please use this as a guide, not a to-do list.

 

Training For Body Composition:

The need for lower body weight, but not lower muscle mass is a recurring recommendation. Ultimately, it would appear (as well as be advised by The Docs Who Lift) that it’s better to go through perimenopause “lean and mean,” as Spencer Nadolsky would say.

Women need to be prepared, rather than waiting to make changes when symptoms begin to occur. Additionally, having proper training in place can help women reap rewards before the “hard times” hit.

The bottom line is this: Don’t wait until the shit hits the fan to grab a rag; keep that shit away from the fan!

If we know that the average age that perimenopause will start is going to be late 30s (not as common, but remember those who smoke can begin earlier) to early 40s, start concentrating on keeping a lower body fat percentage beforehand. Focusing on exercises that build muscle (we will touch more on dual benefit with benefits to BMD) will not only help decrease losses in BMD, but will also help in maintaining higher levels of lean body mass while dropping weight, as well as help with pain tolerance and sleep quality.

The Midsection Spread

It’s common for women in menopause to put on weight, and many will notice an increase in the fat they carry around their abdomens. This has been referred to as the midsection spread.

While there are many factors that can contribute to weight gain and holding on to fat stores, this happens more for women once their estrogen levels have begun to drop during perimenopause. With this drop, women experience symptoms that can lead to sleepless nights and elevated stress levels. It could be a combination of all of the above that lead to the excess abdominal fat. There is also evidence that points toward estrogen levels and their rise and fall having a direct effect on metabolism and fat storage.

That being said, there is evidence that suggests that drops in estrogen levels are the cause of excess weight gain – with that weight tending to stick more around the waist. Estrogen has been shown to potentially aid in fat burning and storage. Estrogen can regulate energy homeostasis, and a drop in estrogen count can lead to a state of slightly decreased metabolism and increased appetite. It is this decline that is believed to be the reason for excess weight gain around menopause in regards to lower levels of estrogen. It is also for this reason that HRT can help keep women from gaining excess weight around the midsection during peri/postmenopause.

It is important to talk with your doctor about this, because this increase in abdominal obesity has been shown to drop when HRT is administered. Whether it is directly from estrogen levels being once again elevated in the body or from the benefits this might have on other symptoms, we see that this symptom can be alleviated with the help of a knowledgeable doctor and the right course of action in regards to HRT.

For those who are still hesitant about HRT, it might be beneficial to consider upping your intake of phytoestrogens in hopes of raising your estrogen levels more naturally. I must still point out here, this has not been shown to be anywhere near as potent as HRT treatments.

The combination of increased estrogen levels and a proper training program and diet should improve excess storage of fat around the abdomen. The goal here should be to work with a qualified doctor and follow the advice he or she has given in order to figure out the best plan of action for the symptoms you are dealing with. Sometimes, the first try is not always the final one. This might take a few different techniques to figure out what works for you.

 

Training for Coordination and Balance:

Coordination and balance are, like many things, very likely to go downhill in our 40s and 50s. Part of this could simply be from a steady decline in how much we move, combined with vision and hearing issues.

How we perceive the world around us as we are moving plays a big role when it comes to responding to outside forces or obstacles. Being able to see and/or hear something that might cause you to stumble will send a signal to the brain. The brain will then tell the body how to react based on the information it receives.

One of the best definitions and explanations I’ve read about this came from Strength and Conditioning: Biological Principles and Practical Applications. It refers to the system that controls our body’s regulation of postural control – how the body balances and coordinates itself in space – as the sensorimotor system. The sensorimotor system consists of the neural pathways between the brain, the eyes, the ears, as well as the brain, the spine, and the proprioceptive system (skin, muscles/tendons, joints).

Sensorimotor training can be very simple and made more complex as you progress in your training. It can be as simple as standing and lifting one leg while balancing on the other, to as complicated as doing math problems while standing on one leg with your eyes closed on a wobble board (please don’t try this without someone spotting you).

One of my favorite warm-up exercises is called the lunge twist. All you do is lunge forward and then reach both arms to the side, twisting your torso slightly. Almost every one of my clients falls the first time they try this. To add a harder dimension, you could try performing a lunge twist with your eyes closed. If you are really brave (and have someone spotting you), then you could try a walking lunge twist with your eyes closed while completing a math problem out loud.

Sensorimotor training should be a large component of a peri/postmenopausal woman’s training.  This type of training counters the increased risk of falls due to balance issues as we age, combined with the slow degeneration of BMD. While we lift weights and perform weight-bearing exercises to improve and/or maintain BMD so that we don’t break bones if/when we fall, we perform sensorimotor training to make it less likely that we will fall in the first place.

Two guys I really look up to in the realm of programming for balance and coordination are Will Levy and Ben Cormack. While I could go on with single leg workouts and drills for improving balance and coordination, I’ll simply leave a link for you to check out all the work these two have done and let you go from there.

Ben Cormack – Cor Kinetic (http://www.cor-kinetic.com/)

Will Levy – WillLevy.com (http://willlevy.com/)

 

Training Around Hot Flashes:

A hot flash can last around 4 minutes, and some women have complained about high tempo exercises (like boot camps, intense circuit training, HIIT) leading to more hot flashes in the gym. It is important for trainers (especially those who’ve never had a hot flash before) to remember that it’s something that can pass, but pushing through can sometimes cause heightened levels of anxiety.

While some women will simply want to sit down or maybe just stand in front of a fan, others will be OK with taking a cool rag to their head or chest and simply walking a few laps around the gym to keep heart rate elevated, but not to a point to exasperate the situation. As with every good routine, this part must be completely left up to the one training and how she feels.

 

Training for Heart Health:

Postmenopausal women are at an increased risk for cardiovascular diseases. This is believed to be due to the loss of estradiol during perimenopause and at the onset of menopause. Estradiol may have antioxidant properties, and the loss of this can be why oxidative stress levels rise in postmenopausal women and can ultimately lead to cardiovascular disease.

Women who are more active experience a decrease in oxidative stress due to increase in enzymatic antioxidant levels. While this might be true, it is still important to remember that problems with heart health could also be tied to the stress that many women experience around menopause due to lack of sleep, lack of understanding, and a lack of a solid support system. Regardless, training for a healthy heart is so important.

The CDC recommends a minimum of 150 minutes of moderate-intensity aerobic exercises per week (brisk walking) or 75 minutes of vigorous-intensity aerobic exercises (jogging, running, etc.). This would look something like going on a 30 minute walk 5 times per week, or doing a vigorous swim or run for 15 minutes 5 times per week.

 

Training Around Lack of Sleep:

When we sleep, our bodies repair. If someone is not getting enough sleep, but training stimulus is kept at the same intensity and volume, then they will have trouble recovering.

Now we come to a bit of a crossroads. If we know someone is not getting enough sleep and time to recover, but we also know that workouts can lead to better and longer periods of sleep, what do we do? My recommendation is to pay attention to the symptoms and what your body (or your client’s explanation of what’s going on with her body) is telling you.  Continue to work out to reap the benefit of improved sleep, but take it a bit easier since recovery will be a bit slower.

Suggested Reading About the Importance of Sleep: Body Composition, Muscular Strength/Growth/Recovery

 

Example Beginners Training Program:

(Please remember that these are example programs written with a client in mind who is healthy enough to participate and has been cleared to do so by their doctor.)

EXAMPLE PROGRAM 1:

This workout is designed for a beginner who is looking to get in a full-body workout twice each week and cardio in 3 times per week without doing the same thing each cardio day. The intensity in this routine is a little higher than some might like and should be used by those who’ve been cleared to workout with a continually raised heart rate. This is perfect for those who want to achieve a lot in a smaller amount of time.

Monday:

30 – 45 minute brisk walk followed by light stretching

Tuesday:

3-5 minutes on elliptical/bike/treadmill

3-5 minutes: Warm-up/proprioceptive techniques

Exercise Sets Reps Tempo Rest Interval
Bench or DB Bench Squats 2-4 8-12 1:2 60 seconds
Dumbbell Bench Press 2-4 8-12 1:2 60 seconds
Circuit: 3 1:2 45 seconds
1a)Hip Thrusts 12 1:2
1b)Triceps Cable Press Down 12 1:2
1c)Cable Curls 12 1:2

10 minute brisk walk followed by light stretching.

 

Wednesday:
2-3 minutes of warmup at light pace on elliptical.

10 minutes of brisk pace on elliptical

10 minutes of brisk pace on bike

10 minutes of brisk pace on treadmill

2-3 minutes of cooldown at light pace and light stretching.

 

Thursday:

3-5 minutes on elliptical/treadmill/bike

3-5 minutes of warm-ups/proprioceptive techniques

Exercise Sets Reps/Time Tempo Rest Interval
Dumbbell Lunges 2-4 8-12 1:2 60 seconds
Dumbbell Press (Seated or Standing 2-4 8-12 1:2 60 seconds
Circuit: 3 1:2 45 seconds
1a) Goblet Squats 12 1:2
1b) Dead Bug 20-45 seconds
1c) Plank 20-45 seconds

10 minute brisk walk followed by light stretching.

 

Friday:

3 minutes of light pace walking

5 minutes of vigorous pace on elliptical

5 minutes of vigorous pace on bike

5 minutes of vigorous pace on treadmill

3 minutes of light pace walking followed by light stretching

 

Saturday and Sunday:
Rest

 

EXAMPLE PROGRAM 2:

This program is designed for those who are beginners and have limited access to a gym but still have a few dumbbells they can use at the house. This is also designed to be at longer rest intervals for those needing to keep heart rate down or those who experience greater occurrences of hot flashes around more intense training sessions.**

**Please note that we cannot guarantee that your heart rate will be below the number your doctor or trainer recommends with this workout. If you need to keep heart rate under a certain number, we recommend keeping a heart rate monitor of some sort on you during your workout

Monday:

5 minutes of warm-ups/sensorimotor training

20 minutes of light to brisk walking

5 minutes of cool-down/sensorimotor training

 

Tuesday:

5 minutes of warm-ups/sensorimotor training

Exercise Sets Reps Tempo Rest
Goblet Squats 2-4 8-15 1:2 90 seconds
Assisted or Modified Pushups 2-4 8-15 1:2 90 seconds
Forward Dumbbell Raises 3 12 1:2 90 seconds
Lateral Dumbbell Raises 3 12 1:2 90 seconds
Upright Dumbbell Rows 3 12 1:2 90 seconds

5 minutes of cool-down/sensorimotor training followed by light stretching

 

Wednesday:

5 minutes of warm-ups/sensorimotor training

20 minutes of light to brisk walking

5 minutes of cool-down/sensorimotor training

 

Thursday:

5 minutes of warm-ups/sensorimotor training

Exercise Sets Reps Tempo Rest
Goblet Squats 2-4 8-15 1:2 90 seconds
Assisted or Modified Pushups 2-4 8-15 1:2 90 seconds
Hip Thrusts 3 12 1:2 90 seconds
Dumbbell Curls 3 12 1:2 90 seconds
Overhead Triceps Press 3 12 1:2 90 seconds

5 minutes of cool-down/sensorimotor training followed by light stretching

 

Friday:

5 minutes of warm-ups/sensorimotor training

20 minutes of light to brisk walking

5 minutes of cool-down/sensorimotor training

 

Saturday:
10-15 minutes of sensorimotor training

Optional 20 minute brisk walk

 

Sunday: 

Rest day

 

Note for More Serious Lifters

The very first thing to remember is that menopause is different for every woman, and you need to make changes based on YOU, not anyone else. I’d suggest starting out by making a list of your symptoms and how they make you feel when you are training. You are probably already recording your lifts and your food, so just add a little note to these explaining how any symptoms you are experiencing have changed your workouts or appetite

Some of you might have read my article series, Menstrual Matters for Girls Gone Strong. I discuss the importance of recording the menstrual cycle and how this can help with your programming if you know what to expect, but what if perimenopause is causing your periods to be all over the place and this is messing up your lifts?

The first thing I would suggest here is to talk with your doctor about contraceptives to see if this might be an option that works for you. As mentioned earlier, contraceptives can help to better regulate the cycle and keep it more predictable.

More Information About the Menstrual Cycle and Contraceptives for Athletes.

Another option for those who either can’t or don’t want to take contraceptives is to plan with what I call a buffer zone. If you know that lifting heavy and hitting a PR is just never going to happen during days 1-3 of your cycle, then plan a routine that can be changed by 3 to 5 days if need be.

An example would be if you planned to test your new PRs after a 6 week program, but due to the sporadic nature of menses during perimenopause, your cycle starts on the day you are testing. Rather than push through, knowing you are going to get a sub-optimal PR, it might just be better to have a “option 2” workout where you now add a week of lighter lifting and cardio – maybe even treat it as an unexpected deload week.

Unfortunately, if you are an athlete who is lifting in competition at this time, there is really not much that can be done outside of HRT and/or contraceptives. On the plus side, most women who are competitive athletes who’ve been lifting for some time have probably benefited from the increased levels of pain tolerance and the psychological ability to push through. It is important here that diet and supplementation be taken very seriously in order to provide the body what it needs at time of competition.


 

Common Supplements and Drugs

Most of the supplements and vitamins, with HRT and contraceptives being the exception, in this section can be read about in further detail on examine.com. We have included a quick synopsis of each to give a basic understanding, but all credit is given to examine.com and we encourage you to go there to further study any of the below. 

Hormone Replacement Therapy 

HRT has gotten quite a bit of attention, as some have associated it with an increased risk of breast cancer. Women who have reached menopause have lower levels of estrogen and less chance of developing breast cancer. Because HRT increases estrogen levels again, it is often blamed for increased risk of breast cancer.

Before going much further, remember that part of the reason it is so important to let your doctor know as soon as you think you might be perimenopausal is so that your doctor can find a dose that works for you. This is something that you and your doctor should discuss in order to take the proper steps forward and see if HRT is what you need.

While the rest of the supplements and vitamins in this section might help, there is not a substitute for HRT in overall effectiveness for symptom relief if your doctor says HRT is needed. Like Dr. Spencer said, the earlier you address the symptoms and need for HRT, the safer it tends to be.

Contraceptives

In the earlier stage of perimenopause, it is common for some women to be advised by their doctors to take smaller doses of contraceptives. Contraceptives can help with alleviating symptoms of PMS (which can be worsened by the onset of perimenopause) and regulating the cycle. It is very important to talk about this with your primary care physician, as he or she will decide whether this is the right approach or if you should start on hormone replacement therapy.

Calcium

Calcium helps with strong bones. Superman has strong bones and therefore probably consumes enough calcium. So does Batman. The end.

Vitamin K2

Vitamin K is great for supporting healthy bones and the cardiovascular system when taken at levels around 50g/day. The RDI is fine for coagulation of blood and is not hard to meet through food intake alone, but reaching higher levels might be a little more difficult for some, which is why a supplement would be the better option.

Vitamin K is highly recommended for everyone, but especially those who are at a higher risk of lower levels of BMD or increased risks of cardiovascular diseases. Vitamin K also works synergistically with Vitamin D.

Vitamin D

This is one of the essential, yet most deficient, vitamins in people living in the Western world. Vitamin D is often referred to as the “Sunlight Vitamin” because it is synthesized in the skin when exposed to sunlight. Vitamin D is oftentimes consumed through dairy products that have added vitamin D and calcium; it can also be found in fish and eggs. Someone who works indoors and/or is a vegetarian might need to really consider supplementing to make sure adequate amounts are in his or her diet.

Vitamin D can help with overall mood, bone support, and prevention of heart disease.

Iron

Iron is an essential mineral that is used by the body to create hemoglobin and myoglobin. Hemoglobin is found in red blood cells and carries oxygen through the body. Myoglobin is found in the heart and skeletal muscles and also contains oxygen that is used when the muscle is in need of extra due to exercise or overuse.

Women who are experiencing heavier flows and those who do not eat red meat might be at risk of having low iron levels. A lack of iron can lead to a less-than-optimal supply of oxygen being carried throughout the body, as well as less oxygen in reserve via myoglobin after strenuous exercise.

Magnesium

Magnesium is another supplement that can help with sleep. Magnesium has been shown to act as a sedative in those who are in a deficit by lowering blood pressure, calming neuron excitability, and improving insulin sensitivity. While some of the studies appear to be more promising than others, magnesium is an important supplement for all to consider, especially those who eat a diet that is low in green leafy vegetables and nuts.

DHEA

Dehydroepiandrosterone (DHEA) is a naturally occurring hormone that can convert into testosterone or estrogen as the body needs them. While many take this for supposed anti-aging capabilities, the benefits appear quite unreliable.

The two most promising and supported benefits as they relate to peri/postmenopausal women are positive benefits to heart health and bone mineral density.

Before running out and stocking up on DHEA, there are a few things to consider. DHEA is currently not approved in many athletic leagues, so investigate regulations if you or your client plans on competing. Additionally, some studies have shown a rise in the risk of breast cancer for women who take DHEA, but this could be for similar reasons to studies showing HRT’s link with breast cancer.

“DHEA probably won’t hurt most people (especially women), but it has no benefit,” Dr. Kasey Nadolsky said. “Post menopausal females may have some benefits in obesity or those with adrenal insufficiency, but compared to HRT it is nothing.”

Protein  

While amino acids and proteins have all sorts of benefits and roles in our bodies, one of the most important considerations for protein is in maintaining lean body mass.

Remember, the goal is lean AND mean. Make sure you are consuming enough protein to maintain and possibly even build more muscle.

Isoflavones / Phytoestrogens

These are pretty much really fancy-looking terms for foods that contain estrogen-like benefits when consumed but are not already produced by the endocrine system. They are commonly found in seed oils, nuts, legumes, and some cereals and meats. As with the benefits that can be seen from HRT (not at the same level; these will NOT replace the HRT a doctor might recommend), the extra estrogen production can possibly help when one is experiencing fluctuations and, ultimately, lower levels of estrogen from day to day.

St. John’s Wort

Hypericum Perforatum is used as an antidepressant and is commonly associated with use for depression.

“Hyperforin is likely the component of St. John’s Wort that increases serotonin activity overall and this appears to be due to inhibiting serotonin and dopamine reuptake in an atypical manner.”  – examine.com

Vitex Agnus-Castus

Vitex agnus-castus was also a supplement that Dr. Spencer Nadolsky mentioned might help, but one that he more generally recommends to his patients struggling with PMS. This is, in part, due to studies showing that vitex agnus-castus might help more in PMS than in menopause even though it would seem that it could help with symptoms from both. This might be a supplement that is more useful for those experiencing worsening of PMS during perimenopause.

Melatonin

Another supplement to consider taking for sleepless nights is melatonin. Night sweats will not be controlled by melatonin, but you are likely to have an easier time staying or falling back to sleep with the help of melatonin.

Black Cohosh

One of the most common supplements taken for hot flashes is Black Cohosh. Black Cohosh is said to be the most popular supplement for menopause in North America. While there is a small benefit seen to controlling hot flashes and night sweats, Black Cohosh does not seem very potent and might even be eliciting a placebo effect.

If you want to know more about supplements that may help with menopause, along with really any performance or health goal, we’d highly suggest you check out Examine.com’s professional guides.

All the human supplement research, in one place:

353

How to combine supplements for your particular goals:

568


 

Dietary Recommendations

Disclaimer: One’s goals and life circumstances will dictate diet. Make sure you pick a diet that is actually realistic and works best for you or your client.

Protein

Protein is very important when it comes to losing weight or wanting to gain lean body mass. We need protein to maintain muscle mass during a caloric deficit (too many calories cut and not enough protein can leave the body breaking down muscle for energy), and in order to grow more muscle. Additionally, protein helps with  satiety and satisfaction after a meal, which can help control cravings.

More Information About Protein

For those looking to spare muscle during weight loss or put on lean muscle, find lean sources of protein to include in your diet. Depending on activity levels throughout the day and what type of diet you’ve found works best for your goals, somewhere around 25-40% of your daily calories should come from protein. This means that someone with a 1,600 daily calorie goal will eat between 480-640 calories or 100-160 grams (1 gram of protein = 4 calories) of protein per day.

Protein graph
Lean protein sources, courtesy of Dalton Oliver over at Training Game.

Carbohydrates

Carbs are the body’s preferred source of energy. Carbohydrates are found in fruits, vegetables, grains, and milk products. They range from simple to complex; the simpler they are, the more rapidly they are turned into energy. Complex carbohydrates are used at a slower rate throughout the day.

Carbohydrates are constantly under fire and regularly blamed for making people obese. While blaming carbohydrates for making someone overweight is very misguided, it does not mean that we are waving the green flag on eating yourself into a carb coma induced by all the sugary treats in your cupboard. Certain carbohydrates, particularly sugary treats, can lead many into binging and overeating, which can lead to putting on unwanted weight. Try to avoid keeping foods that encourage binging in your house and let them be something you only treat yourself to on occasion.

We recommend looking for different sources of carbohydrates when you are planning your meals for the day. Consume a range of simple to complex carbs, with more focus on complex carbs, as they tend to leave one feeling more full for a longer period of time. We usually recommend between 35-50% of daily calories coming from carbohydrates, with the latter being for more active individuals.

Common carbohydrate sources

Fat

Fat is a stored form of energy in the body and is usually consumed through animal products and nuts. While eating too much can be a bad thing, remember that our bodies need fat in order to survive and stay healthy.

There is evidence that excessively high numbers of saturated fats can be harmful, and it is because of this that some might choose to avoid fatty red meats as a common food source. Nuts (peanuts, cashews, almonds) and oils (olive oil, grapeseed oil, peanut oil) are all sources of polyunsaturated and monounsaturated fats – often called “good fats.” We recommend aiming for an even balance of each, with the least coming from saturated fats if possible.

Many prefer to keep fats around 25-35% of one’s daily caloric intake. This will change based on one’s activity level and needs.

Common fat sources


Finding Support

Menopause can be an extremely difficult and stressful time. Finding a support group is an excellent way to connect with women going through similar things and who you can share and discuss your experiences with.

Due to Jonathon’s research centering mainly around female-specific training, the following video was recommended to him to watch and in his own words: “THANK GOD I DID.” (Note: While the video is not dirty or offensive at all, it might not be something you want to play at work… unless your boss and coworkers are awesome like Jonathon’s)*

*[I should be clear that my “boss” is my beautiful wife and the “co-workers” are my 5 year old and 10 month old, so not the typical work environment for most. -Mummert]

After watching the amazing video of a uterus singing an educational song about menopause (which was REALLY funny and well done), we were interested in finding out more about the mind behind it.

We did a little digging, and found it was Ellen Dolgen. We then went on to find something we loved almost as much as the song, Menopause Mondays.

Menopause Mondays

Menopause Mondays is a group of women coming together and hosting a party, in which women can discuss menopause and what is to be expected before, during, and after the onset.

If you do decide to host your own Menopause Mondays party, we highly recommend considering sending a copy of this article out to everyone attending, so that they can have a read over before they arrive, along with the resources that Ellen has provided, to keep the conversation moving and educational.

Having a support group you can talk with and more importantly, who have an understanding of what you’re going through, can help make the whole process a lot easier. Throw in some good food and drinks and this might just be the best part of your week!

 

Recap

  • Menopause is a natural process that women will begin in their early- to late-40s. It should not be embarrassing or kept a secret, especially from your doctor! Women who are looking to learn more or wanting a support group should consider something like Menopause Mondays, and men who want (NEED) to better understand menopause should start with “The Singing Uterus” video because it’s funny AND educational.
  • Common symptoms we covered above to look for if you think you might be experiencing perimenopause are:
    • Irregular periods
    • Vaginal dryness / painful intercourse
    • Hot flashes / night sweats
    • Sleep problems
    • Depression
    • Irritability
    • Mood swings
    • Memory loss / lapses
  • Hormone Replacement Therapy is something that should be discussed with your doctor and can be more beneficial the earlier perimenopause is identified. These and contraceptives can help alleviate many of the symptoms of perimenopause.
  • Training and programming considerations for menopausal women:
    • Training for body composition
    • Training for coordination and balance
    • Training around hot flashes
    • Training for heart health
    • Training around lack of sleep
  • Our picks for vitamins and supplements that seem the most likely to be beneficial for those in peri/postmenopause based on current body of evidence are:***
    • Calcium
    • Vitamin K2
    • Vitamin D
    • Magnesium
    • Melatonin
    • Iron (Especially for those who are anemic and those who don’t eat red meat)

***Neither of us are RDs or medical professionals and these are based solely on our opinions after reading through the literature. Any new dietary or training changes should be approved by your primary care provider and/or RD before moving forward.

The Bow on Top (Wrapping it up):

The biggest takeaway here is the importance in starting a healthy and active lifestyle BEFORE symptoms start. While this will not always make going through menopause a breeze, it sure can help quite a bit.

There will be those reading who have started training later in life, and I want to assure you that the old adage “better late than never” works pretty well here. Don’t just decide it’s too late and do nothing about it. You can make a big difference in your future if you just start now!

Also, make sure to keep BMD numbers as high as possible so that there is more to work with as the body naturally begins to lose BMD over time. Simply adding in more walking to daily activity can significantly help in keeping those numbers higher for longer. Add in a little bit of weight training and proper diet and really get the most out of what your body is capable of while protecting your bones.

 

• • •

Next: Gender Differences in Training and Metabolism
The Menstrual Cycle and Contraceptives: A Complete Guide for Athletes

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