How the menopause affects a runner’s body

During the different stages of the menopause women experience a dramatic drop in oestrogen levels. Oestrogen has been shown to play an important role in maintaining strong and healthy bones, muscles, tendons as well as joints. In this article we’ll discuss how the drop in oestrogen during the menopause can negatively affect a woman’s musculoskeletal system and what female runners can do to get the most out of their training and prevent injuries.

In this article:

• The different stages of the menopause

• Effect on Bone

• Effect on Muscle

• Effect on Tendons

• Effect on Joints

• Should I consider HRT?

Here's the video recording of the livestream Maryke did on this topic.

The different stages of the menopause

Perimenopause: This is the period during which a woman is making the transition to the menopause. It can start around 10 years before the menopause and is basically the period during which your oestrogen levels start to drop. This is when you start observing symptoms like changes to your periods, sleep, mood, weight, hot flushes, decreased sex drive, painful joints etc.

Menopause: You are classed as being in the menopause when you’ve not menstruated for a full 12 month cycle. The symptoms are very similar to those of the perimenopause but usually just more severe.

Postmenopause: This refers to the years after the menopause. Most woman’s bodies will get used to the new lower levels of oestrogen and you may find that the menopause symptoms slowly decreases.

Image from the Cleveland Clinic https://my.clevelandclinic.org/

Effect on Bone

Oestrogen plays an important role in building the structure of bone as well as maintaining bone density. One of the most widely known effects of the menopause is that a woman becomes more prone to bone loss that can lead to osteoporosis and in extreme cases fractures.

The good news is that weight bearing exercise 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 and pelvis and can slow the rate of bone loss due to the menopause. There is some evidence that you get an even better response if you combine weight bearing exercise with hormone replacement therapy (HRT).

Top tip: Don’t forget about your arms and spine. Running only stimulates the bones in your legs, pelvis and maybe lower back. Weight training has been shown to be an effective way of stimulating bone growth in arms and backs – a good reason to schedule in a couple of strength training sessions in your week.

Effects on Muscle

Low oestrogen levels appear to affect muscles in 4 ways:

1. It causes a decrease in muscle mass (how much muscle you have). One study found that strength training as well as HRT could reverse some this loss. This study did not show any added benefit if you combined HRT with strength training, BUT the participants in this study weren’t people who regularly trained. So it may be that runners who train regularly may find benefit from combining HRT and strength training. A lot more research is needed in this area before any definitive guidelines can be published.

Top tip: This is another good reason to include strength training in your regular programme! Diet also affects your ability to build muscle so make sure that you eat enough protein.

2. It causes a drop in muscle strength and power unrelated to the loss in muscle mass. One study, where they used twins to test the effect of HRT on muscle function (one twin used HRT and the other didn’t) over a 7 year period, found that the higher levels of oestrogen enabled muscles to contract better and that the muscles contained more Type 1 (fast twitch) fibres.

Top tip: Make sure you also include exercises that will stimulate fast twitch muscle fibre production and develop muscle power (like plyometrics, sprints and hill reps).

3. Oestrogen protects against muscle damage. This means that low oestrogen levels may mean that you get more muscle damage from doing the same exercise when you’re in the menopause than when you were younger.

Top tip: Adjust your training as you go through the menopause to allow your muscles to recover fully and reduce your risk of injury.

4. Women are better at using fat as an energy source for muscle cells. This is one of the reasons why females have better endurance than men during low intensity exercise. This superior fat-utilisation unfortunately changes with the menopause. There are some studies that suggest that HRT can improve women’s ability to break fats down, but this has not been specifically tested.

Effect on Tendons

Menopausal women seem to be more susceptible to tendon injuries like Achilles tendinopathy, gluteal tendinopathy and De Quervain's tenosynovitis.

When we exercise our tendons, ligaments, muscles etc. all sustain micro-trauma. This is normal. The body uses the rest period after exercise to rebuild these structures so that they’re stronger than before you did the exercise.

Tendons are extremely strong structures and are mostly built from collagen fibres. Research has shown that low oestrogen levels lead to an increase in the breakdown of tendon collagen fibres and also a much slower production of new fibres. Tendons change also seem to change their composition to having less collagen and more elastin and aggrecan in reaction to low oestrogen. This means that a woman in her menopause may sustain more micro-damage in her tendons when she trains and they will likely take longer than before to recover from the training.

Top tip: Make sure that you vary your training to include high and low load days and that you allow enough recovery time after hard sessions. Tendons react very well to high load resistance training that’s performed at a slow speed, so yet another reason to schedule in some strength training.

Effect on Joints

Most of our joints in our bodies are synovial joints. Synovial joints are formed where two bones come together. The bones’ endings are covered in cartilage and are held together by ligaments and a strong capsule that surrounds the whole joint. The space inside the joint is filled with synovial fluid. This fluid is produced by the synovial membrane that lines the capsule. Joints don’t have arteries and veins going into them – they get all their nutrients and oxygen from the synovial fluid.

There is strong evidence that the drop in oestrogen during the peri-menopause and menopause can also increase the rate at which osteoarthritis develops.

Increasing oestrogen in women with signs of osteoarthritis has been shown to have a positive effect on joint cartilage, bone and muscle and decrease the inflammation in their joints.

Top tip: Strength training and impact activity can also increase your bone density and muscle strength. Diet can have a big impact on chronic inflammation in the body and you can decrease it by staying away from foods that are processed and high in sugar and trans fats.

Should I consider HRT?

We don’t know. The truth is that there’s still a massive gap in the research when it comes to this topic with very few studies investigating women who exercise on a regular basis. Oestrogen’s also not the only hormone that’s affected by the menopause. But the early signs are that HRT may be beneficial to help you maintain a strong body for longer.

HRT is not for everyone and you may not be able to take it for health reasons. There’s also a lack of research into more natural sources that can help to balance your body and attenuate the effects of the menopause.

We would suggest that you discuss it with your GP or find a doctor who has a special interest in it. But in the meantime, take some time to review your training schedule and see how you can adjust it to compensate for the changes your body is experiencing. As mentioned before, diet also plays an important role in inflammation and building muscle and bones so it may also be worth visiting a dietitian/nutritionist – again look for someone with a special interest in the menopause and exercise.

Need more help?

Need more help with your 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.

References:

1. Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16.

2. Nedergaard A, Henriksen K, Karsdal MA, et al. Menopause, estrogens and frailty. Gynecological Endocrinology 2013;29(5):418-23.

3. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58.

4. Xiao Y-P, Tian F-M, Dai M-W, et al. Are estrogen-related drugs new alternatives for the management of osteoarthritis? Arthritis research & therapy 2016;18(1):151.