Trail Running Through Menopause

Menopause doesn’t always mean hanging up your trail shoes.

Cathy Duffy 22.01.2025

Words: Cathy Duffy

Navigating through menopause doesn’t mean ending your time as a trail runner. In fact, we should be centring ourselves even more and thinking about it as entering into SUPERWOMAN-HOOD, because life doesn’t stop when we go through this new chapter, does it? Mile 27 coach Cathy Duffy has done extensive research into menopause, and brings us a two-part series on adjusting and adapting to this seismic shift in women’s bodies. 

I recall one night sleeping in my campervan in the Blue Mountains before heading out for a long run the next morning. It was the middle of winter and my husband was rugged up in full winter attire, under multiple bed covers, freezing. 

There I lay in a t-shirt and underwear, with no bed covers, feeling like the Sahara Desert would be a cooler option. It’s difficult to describe the unbearable wave of volcano-like heat that envelops your body – where one moment you feel like you are dying inside and the next when the heat dissipates, you’re diving under the bed covers as your body responds to the temperature around you. 

Imagine this over and over again. In my busy life I didn’t notice subtle changes until one day I paused and found myself sleep deprived, with brain fog, housing a body that just ached, and I’d scored my first injury in 10 years. Was I just getting old and my body couldn’t handle running like it used to? 

On reflection, I’d never learnt about menopause. In an attempt to rectify this, I opened my computer, yet found the contradicting information confounding. Even a discussion with my doctor, who informed me they didn’t deal with hormone replacement therapies, left me bewildered and none the wiser. 

So, I did two things. Firstly, I attended a Women in Sport Congress which highlighted the 100-year research gap between males and females. Thankfully, science is forging ahead with a vast array of dynamic and curious groups intent on carving out information pertaining to women. Secondly, I enrolled in a science-based menopause course by Dr Stacy Sims to plug my learning deficit. As I progressed through the course I was impressed at the scientific fortitude of the presenting information, which perhaps highlighted why there is so much confusion in Google-land; it’s a complex topic and can be hard to tease out simple, yet accurate information.  

As a perimenopausal trail athlete, this is what I learnt and want people to know.  

Let’s Talk About It

Think about your relationship with menopause. Is it something that is readily spoken about in your social circles? Do you talk about menopause with your trail running buddies? The reality is that society has come a long way from considering a menopausal woman a witch or someone who is mentally incapacitated, however society still has a long way to go towards ensuring access to robust information with open dialogue and acceptance that menopause is not a curse.  

So What Is Menopause?

Menopause is used by many as an umbrella term to describe the transition from perimenopause to post-menopause. In reality, menopause is one day on the calendar, which marks 12 menstruation-free months and occurs on average at age 51. 

Leading up to this specific point in time is perimenopause, which can last up to 10 years.  It’s during this time the ratios between two main hormones start to shift, which can result in a myriad of symptoms, often highlighting entry into this stage of life. After menopause you enter post-menopause which is the new biological state for the female.  For some, symptoms experienced during perimenopause can persist for years.

Key Hormones

Understanding the intricacies of female hormones is complex. There are multiple key hormones influencing the reproductive years, with the main stars of the show being estrogen and progesterone. These hormones have a reciprocal relationship for the greater good of providing balance in the female body i.e. estrogen promotes inflammation, whilst progesterone has anti-inflammatory properties, creating balance.  

What Happens To Your Hormones during Perimenopause?

A lot happens. To simplify a very complex topic, these are the key takeaways:

  • Estrogen is a dominant female hormone.
  • Estrogen receptors are in almost every system of the body, therefore the presence or absence of estrogen impacts the whole body.
  • Progesterone is another female hormone.  Progesterone works with estrogen to provide balance in the body.
  • During perimenopause, estrogen and progesterone levels change, and the ratio between these hormones also changes, which can result in varying symptoms.
  • After menopause, estrogen and progesterone levels flatline.  This is the new biological state for the female.

To follow on from the example regarding inflammation, during perimenopause estrogen can become more dominant relative to progesterone, thus increasing inflammation. Is that why I’m always achy?!

Given that the estrogen and progesterone relationship changes and then flatlines, what is the impact of this? As these hormonal powerhouses impact the muscle, bone, brain and metabolic systems, the impact can be significant.  

Our Muscles

I think we can all agree our muscles are important, not only as trail athletes, but as we age. As our body progresses towards a new biological state, the impact on the muscles is significant:

  • Muscles break down easier.
  • It becomes harder to build lean muscle mass (how much muscle you have).
  • The strength of muscle contractions and number of muscle fibres reduces.  
  • The muscles’ response to previous training stimulus is reduced.

This is yet another example of how ratios are important in the body. The ratio between protein synthesis (making lean muscle from consumed protein) and breakdown (breaking down the muscles to use the protein for energy) shifts. Breakdown rates become higher than synthesis rates, thus making it harder to maintain and build lean muscle.  

One of my biggest learnings, where the proverbial hammer hit me hard, was the training stimulus once used to promote muscle growth and repair was now less sensitive. We now need new ways to build lean muscle and strength.

Our Bones

Bone health is exceptionally important. Are you prone to stress fractures? Did you have a fall on the trail that didn’t seem like a big deal but ended with a fracture? During perimenopause our bone mineral density can decrease making our bones weaker and more susceptible to breaks.  

Our Brain

Our brain is powerful and controls many things. Some of the changes experienced during perimenopause include:

  • A decrease in serotonin (“happy hormone”) uptake. This impacts many things including mood, digestion and sleep. Think about that for a moment. This one pathway alone can lead to depression, anxiety, brain fog and gut issues.
  • The temperature control centre in the brain (hypothalamus) is impacted.  Did someone say “hot flush”? You may also find you heat up faster and your ability to cool down changes. You may also sweat later in a training session.
  • Pain tolerance levels change.
  • Appetite regulation is also impacted. 

Metabolic Changes

Many metabolic changes occur during perimenopause, with many of these altering your body composition, including:

  • Decreased lipid (fat) removal rate resulting in increased body fat with a focus on visceral or belly fat. Where you once may have stored fat on the hips and thighs, it is now stored in your belly which can increase your risk of cardiovascular and fatty liver diseases.
  • Decreased insulin sensitivity/increased insulin resistance leading to increased circulating blood glucose. As your blood glucose levels entertain the proverbial highs and lows life can offer, this can leave you feeling hungry, fatigued and storing more fat.
  • Decreased reliance on carbohydrates for fuel. The body does not use glucose (for fuel) like it used to; it now wants to store more of it as belly fat.

For trail athletes this can now challenge the way we fuel our bodies, not only during training, but day to day.

As An Added Bonus

It’s worth noting that many of the above can lead to: 

  • Increased total body inflammation.
  • Increased injury risk.
  • Increased sympathetic drive (fight or flight response) which leaves you feeling “tired but wired”.
  • Altered gut microbiome diversity. This is a big one impacting so much in the body:
    • In the gut is a bunch of microorganisms. These microbes are important as they help digestion, improve energy, help brain tissue growth, impact body composition, plus more.
    • As your hormones decline, these microbes seep through the intestinal wall increasing systemic inflammation whilst decreasing the diversity of the bugs left in the gut. So now you’re left with digestion problems, fatigue, impaired brain tissue growth and changes to body composition. 

In A Nutshell

The female trail-athlete may find:

  • They are more prone to injury.
  • It’s harder to maintain or build muscle.
  • Their body shape changes, with it now storing weight around the belly.
  • Motivation for training is low due to sleep deprivation, depression, anxiety or body aches.
  • Training during the warmer months, or for hotter events, now feels harder.
  • Energy levels during and outside training are lower.
  • They have an unhappy gut.