Running through the menopause – What's happening in your body and how to keep training strong
- Maryke Louw
- Apr 19
- 9 min read
Updated: Apr 30
The drop in oestrogen that comes with the perimenopause and beyond can have a real impact on a woman's muscles, bones and tendons – and that can affect how you feel when you run and make you more susceptible to certain injuries. In this article, we'll look at what's happening in your body during this phase of life and, more importantly, what you can do to keep running strong and stay injury-free along the way.
Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
Here's the video recording of the livestream Maryke did on this topic.
The different stages of the menopause and what they mean for runners
Perimenopause
This is the transition phase leading up to the menopause. It can start up to 10 years before the menopause itself, and it's the period during which your oestrogen and other hormone levels gradually start to drop.
You might notice symptoms like changes to your periods, disrupted sleep, mood swings, weight changes, hot flushes, a lower sex drive, and achy joints.
👉 One significant effect that directly impacts your running – but that you can't easily see or feel – is that this drop in oestrogen slows down your body's ability to repair and strengthen itself. This affects all the tissues involved in running, including your bones, muscles, tendons, and cartilage.
Menopause
You're officially classed as being in the menopause once you've gone a full 12 months without a period.
Postmenopause
This refers to the years after the menopause, starting from the day after you hit that 12-month period-free mark. Your hormone levels now stabilise at a permanently lower level.
Most women's bodies gradually adjust to these lower hormone levels, and you may find that some symptoms – like hot flushes and night sweats – ease off over time.
💡 But it's important to understand that because your hormone levels remain permanently lower, your body will always have to work a bit harder to repair, build, and maintain healthy bones, muscles, and tendons – and you'll likely need more recovery time after exercise than you used to.
Let's now look at each of the main body structures you use for running, how the menopause affects them, and how you can keep them healthy and sidestep injuries.
Effect on bone
Oestrogen plays an important role in building bone structure and maintaining bone density. One of the most widely known effects of the menopause is that women become more prone to bone loss, which can lead to osteoporosis and, in more severe cases, fractures.
💪 The good news is that weight-bearing exercise like running can help you build new bone, even when your oestrogen levels are low. Running is a great way to stimulate bone growth in your legs, pelvis, and lower back, and it can slow the rate of menopause-related bone loss.
However, because your body is now less efficient at repairing and rebuilding your bones after exercise, you need to make sure you give it enough recovery time to avoid injuries like stress fractures. And don't neglect the other factors that are vital for good bone health regardless of your hormone levels – like diet (especially for endurance runners), vitamin D, and sleep.
Exercise unfortunately isn't a perfect cure for menopause-related bone loss, and because of genetic differences, some women will respond to it better than others. The good news is that 💊 HRT has been shown to effectively reduce bone loss – research shows it cuts the risk of fracture at all bone sites by 20–40%.
💡 Don't forget about your arms and spine. Running mainly stimulates the bones in your legs, pelvis, and lower back, so you'll want to look after the rest of your skeleton too. Weight training has been shown to be an effective way of stimulating bone growth in the arms and upper back – a good reason to schedule a couple of strength training sessions into your week.
Effects on muscle
Low oestrogen levels affect muscles in many ways, but the most significant ones for runners include:
1 – A decrease in muscle mass (how much muscle you have)
Research shows that 💪 both strength training and 💊 HRT can reverse some of this loss and help women build more muscle. The effect seems even greater when you combine the two.
💡 This is another good reason to include strength training in your regular programme! Diet also affects your ability to build muscle, so make sure you're eating enough protein.
2 – A drop in muscle strength and power
Once again, both strength training and HRT can help prevent this. However, when it comes to muscle strength specifically, the research doesn't show any extra gains from combining the two – so you can maintain your muscle strength through strength training alone 💪.
Interestingly, the drop in muscle strength and power appears to be unrelated to the loss in muscle mass. Study participants frequently improved their strength without any noticeable increase in muscle volume.
So why might this be?
💊 One study used twins to test the effect of HRT on muscle function over a 7-year period (one twin used HRT and the other didn't). The researchers found that higher oestrogen levels enabled muscles to contract better and that these muscles contained more Type 1 (fast-twitch) fibres. So even without growing bigger muscles, the HRT group could produce stronger contractions thanks to this change in muscle fibre type.
💡 Runners can maintain their strength and power (regardless of whether they use HRT) by including exercises that stimulate fast-twitch muscle fibre production – like strength training, plyometrics, sprints, intervals, and hill reps.
3 – Oestrogen protects against muscle damage
Lower oestrogen levels mean you're likely to experience more muscle damage from the same workout during and after the menopause than you did before.
💡 Pay attention to how your body feels after workouts as you go through the menopause – you'll likely benefit from longer recovery times or ramping up your training a bit more gradually. If your muscles stay sore or tight for longer than usual, it's a sign you need more recovery time between sessions.
Effect on tendons
Research shows that when oestrogen levels drop during the menopause, the cells inside your tendons multiply less effectively and die off more quickly – meaning there are fewer "workers" available to repair and maintain the tissue. Tendons also appear to shift their composition, producing less collagen and more of other structural proteins in response to lower oestrogen levels.
For a runner going through the menopause, this likely means:
tendons that aren't quite as strong as before,
that may sustain more micro-damage during training,
and that may need a little longer to recover afterwards.
💪 The good news is that load-bearing exercise – running and strength training in particular – can strengthen tendons even during and after the menopause, so keeping active remains one of the best things you can do.
Whether adding HRT on top of exercise provides extra benefit for your tendons is less straightforward.
💊 The research in this area has produced mixed results, but a well-designed randomised trial looking at HRT as part of treatment for gluteal tendinopathy (pain on the outside of the hip – a common tendon problem in postmenopausal women) offers some useful insights. It found that women with a BMI under 25 had significantly better outcomes when using HRT compared with those who didn't – but this benefit wasn't seen in women with a higher BMI.
This is a good reminder of how complex our bodies are. It's likely that the hormonal and metabolic changes associated with carrying extra weight reduce the positive impact HRT might otherwise have on tendon health. And it's one more indication that there's rarely a single fix for any health issue – what works well depends very much on the individual.
💡 Top tips to help your tendons
Vary your training to include both harder and easier days, and allow enough recovery time after tough sessions.
Tendons respond particularly well to heavy, slow resistance training – yet another good reason to include strength work in your routine.
Research suggests that hydrolysed collagen and vitamin C-enriched gelatine taken before exercise can increase the gains from strength exercises for injured tendons. It's less clear whether they also help prevent tendon injuries in the first place. Read our detailed article on tendon repair supplements and how to use them for more information.
Effect on joints
Most of the joints in your body are synovial joints – the type formed where two bones meet. The ends of the bones are covered in cartilage and held together by ligaments and a strong surrounding capsule.
The space inside the joint is filled with synovial fluid, which is produced by the membrane lining the capsule. Unlike most other tissues, joints don't have their own blood supply – they rely entirely on this fluid for nutrients and oxygen.
There is good evidence that the drop in oestrogen during the perimenopause and menopause can speed up the development of osteoarthritis – a condition involving softening and damage to the joint cartilage, changes to the underlying bone, and low-grade inflammation of the joint capsule that causes pain, stiffness and swelling.
💊 On the positive side, research has shown that restoring oestrogen levels in women can reduce the risk of developing osteoarthritis or the risk of the condition progressing (if you already have it), with beneficial effects on cartilage, bone and muscle, as well as reduced joint inflammation.
💪 Exercise also plays an important role – strength training and impact activities like running can improve cartilage health, bone density, and muscle strength, all of which help to protect your joints.
Diet matters, too. Cutting back on processed foods, sugary foods and those high in trans fats can help reduce chronic inflammation throughout the body, including in your joints.
Should I consider HRT?
That's really a question for your doctor rather than us – but it's absolutely worth asking. The honest answer is that research in this area still has significant gaps, with very few studies focusing specifically on women who exercise regularly. The early signs are encouraging though, suggesting HRT may help you maintain a stronger, more resilient body for longer.
💡 And if HRT isn't the right path for you, or you simply don't want to use it – the good news is that runners can gain many of the same benefits through consistent strength training, paying closer attention to recovery, and making some considered changes to diet. These aren't consolation prizes; the evidence for their benefits is solid.
What we would suggest is finding a GP or doctor with a special interest in the menopause who can talk through your individual circumstances and help you make an informed decision.
How we can help
Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate.
