Menopause for Athletes

I love working with active women, and being an active woman myself I recently completed a five week course by Dr Stacy Sims on “menopause for athletes”.  When you’re a middle of the pack runner like myself it’s hard to think of yourself as an athlete, however the advice from the course is applicable to anyone wanting to maintain their strength and love of their sport as they get older.  

Photo by Ante Hamersmit on Unsplash

Dr Stacy Sims wrote the book Roar and has a fantastic Ted talk “Women are not small men” which are well worth checking out. This course went a lot deeper into the specifics for women going through peri-menopause and menopause.

Peri-menopause is defined as the five years prior to your periods stopping.  This is the time when your body composition will start to change because your hormones are fluctuating, in particular estrogen and progesterone levels.  Changes that occur in body composition duirng peri-menopause can stay with you for the rest of your life.  We become more insulin sensitive and gain belly fat, so this is when we want to really start honing our nutrition and training – and not by training harder and eating less!

Menopause is the point when you haven’t had a period for 12 months, and then we move into post-menopause. This is where diet and training interventions are important to maintain strength, to maintain lean mass, and reduce the risk of lifestyle diseases like type 2 diabetes and metabolic syndrome.

During peri-menopause the estradiol hormone starts fluctuating.  This hormone is responsible for tissue growth, bone health, blood glucose control, and when we start losing it this is when things start changing from a body composition and a mental standpoint - mood swings, sleepless nights, hot flashes or other vasomotor symptoms.  The imbalance between estradiol and progesterone can cause vasomotor symptoms, brain fog, fatigue and lack of adaptation to training.  Menopause hormone therapy (MHT) can be helpful but will depend on your personal circumstances and is best discussed with your GP.  Adaptogenic herbs (a group of plants used for reducing stress) such as schisandra, ashwaganda, maca and rhodiola can also be helpful.

EXERCISE

While MHT can be effective for vasomotor symptoms, vaginal dryness, sleep issues and mood, it is not effective for building lean mass or mitigating body fat gain. This is where exercise comes in.  The most effective exercise for peri and post menopausal women are:

-       High Intensity Interval Training (HIIT) - repeated, extremely hard bouts of work interspersed with periods of recovery

-       Plyometric training (jumping) – this actually cause a change in gene transcription that improve metabolic function (muscles become more efficient at using and storing to carbohydrates), and also improves bone strength

-       HEAVY resistance training – work in the 6-8 rep range rather than in the 12-15 rep range.  

Photo by Anastase Maragos on Unsplash

The combination of heavy resistance training and high-intensity work increases your post-exercise growth hormone, which is a signal for tissue growth for developing and keeping lean mass. A lot of women worry that lifting heavy will cause them to bulk up, but we don’t have enough circulating testosterone for this to happen, so no you won’t look like Arnie in Terminator!

Women who are peri and postmenopausal are primed to use maximum fatty acid oxidation for long slow running and cycling but lose their strength and power.  Introducing more HIIT and resistance training will help build power and strength. Make sure appropriate rest and periodisation is built into your training too.

NUTRITION 

We know that the majority of our body composition changes occur during the late perimenopause timeframe, this is where we increase our body fat and lose our lean mass. So this is the time to implement the training and nutrition changes to counter the hormone fluctuations. However, it is not too late when you hit post-menopause to gain lean mass and lose body fat with these specific interventions.

We know that the gut microbiome has a direct influence on all the systems of the body. The more diversity that you have, the better your gut microbiome is and so the better responses for your immune system for staying healthy, for brain health, for tissue repair, for countering anxiety and depression. Exercise also contributes to the diversity, eating a wide variety of plant foods is important to enhance the growth of bacteria that's responsible for positive health outcomes – the fibrous food being the prebiotics that feed the gut bacteria.  

We also need to watch out for low energy availability especially if you are increasing training load, when you  tend to have that muted appetite and dehydration. Fuel for the activity and fuel for recovery.

Focus on:

-       Peri and postmenopausal women are the group that does the best on plant-based diets, primarily for increasing that prebiotic aspect and diversity of gut bacteria, but also for insulin control.  You don’t need to become vegetarian but certainly focus on getting a large variety of plant foods in your diet.  

-       Include a greater intake of plant based fats (avocado, nuts and seeds) – this will increase your omega 3 to omega 6 ratio to counter inflammation and reduce inflammation

-       Quality protein intake.  When women hit peri menopause that’s when our protein intake requirements increase.  If we want to develop lean mass, then follow exercise with protein to get that anabolic stimulus that estrogen used to give us.

-       Nutrient timing is super important. If you are looking to adapt from training, enhance tissue repair, improve mood, and not get into low energy availability, nutrient timing is one of the most critical aspects to consider.  This means thinking about fuelling before, during and after exercise.  In particular, having protein within 30 minutes of exercise.  This reduces cortisol, and works with exercise stress to stimulate the anabolic response that estrogen used to give us to build lean mass and keep our skeletal muscles strong and working for us.  We also know that spreading protein intake throughout the day is much better for maintaining lean mass and stimulating muscle protein synthesis than big doses sporadically. So, if you're doing a hard, high-intensity session, and you're adequately dosing with protein afterward, this will help drop cortisol levels, bring the body out of the breakdown catabolic state and extend the window for lean mass development.

-       Get most of your carbs from really high quality sources such as pulses (including pulse pasta), fruit and veggies, quinoa and buckwheat, black and brown rice and wholegrain bread.  I love this image from Canada’s Food Guide which gives a great visual representation of how we can achieve this.

Prioritise colourful fruit and veg, especially cruciferous vegetables.  These reduce the overall effects of estrogen in the body and provide fibre for the gut microbiome.  Cruciferous vegetables including broccoli, cauliflower, bok choy, cabbage, brussels sprouts and kale are often referred to as superfoods - and for good reason. It is the glucosinolates found in these cruciferous vegetables that appear to have powerful anti-cancer effects actively protecting the cells from damage, and even potentially acting as toxins to malignant cells. While research as to these benefits is still in early stages, there are plenty of other benefits this group of leafy greens offer including acting as natural anti-inflammatories, helping to eliminate toxins from cells and helping to regulate blood glucose levels, which make them a daily must in every diet. Enjoy them both cooked and raw to reap the wide range of nutritional benefits they offer.

 Two popular diet trends are NOT recommended for athletic peri/post menopausal women:

-       Fasting (alternate day or intermittent fasting) – this may contribute to improved health and longevity in specific populations, but not in the athletic female population.

-       We know that the ketogenic diet increases cortisol, increases risk for thyroid dysfunction and cardiovascular risk factors for women. 

 WHAT CHANGES HAVE I IMPLEMENTED?

So, what changes have I made as a result of this course?  I went through menopause rapidly 4 years ago at the age of 46 as a result of an operation.  I had already worked out that I need to be really choosy with the quality of my carbs and increase strength training.  But now I’m actively including HIIT and increasing my weights and trying not to grumble too loudly when plyometrics are involved at my gym class.  I’m actively including protein after my workout and really trying to increase my plant foods.  I don’t love broccoli, but I’m adding frozen cauliflower in when I make a smoothie (you can’t taste it, promise), including either kale or rocket at lunch and eating brocollini a few times a week. My energy levels have increased, I’ve lost a small amount of weight and my running speed has increased - I set a 4 year parkrun PB on the weekend.  Fingers crossed!

Need more quick, easy, healthy meal ideas? Go here.

Have you been thinking for a while that you would love to find out more about your gut health or why your weight won’t shift no matter what you do? Or maybe you just want to feel less bloated, have more energy and understand what food you are meant to be eating?

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Rachel is a university qualified Clinical Nutritionist based in Balmain.  She is also the busy working mum of two teenagers, so is practical and realistic with her advice . Rachel offers private consultations to improve your family's health and well-being. You can find her on Facebook and Instagram for more healthy tips and tricks.