Menopause advice for cyclists – and other sporty women
This article appeared in the Journal of Cycle Coaching and was commissioned by the Association of British Cycling Coaches. The aim was to give coaches more information about how the peri-menopause and menopause affects many female cyclists. Thanks to the panellists of a #SCTalks Scottish Cycling webinar that I recently hosted for their input., too.
Cycling and the menopause: How does it feel?
“I lost all motivation”; “I was too tired to even think about cycling”; “my joints ached”; “muscle cramps left me in agony”; “I hated that I could no longer keep up”; “I was so out of breath”; “it was the saddle sores that were the worst”.
These are not the woes of a cyclist taking part in an endurance event or training for a major race, although they are exactly the issues you might expect. Instead, they are some of the reasons voiced by women for almost giving up cycling despite a long-held love of the sport.
Yet in the first instance, the women had no idea why they were suddenly finding their favourite activity such a struggle.
Joyce McKellar, a keen cyclist and a Scottish Cycling Board member, says: “I had always enjoyed cycling and it was my way of managing the stress of my work in senior management.
“But in my early 50s, I found I didn’t want to cycle any more. I was too tired due to terrible hot sweats, insomnia, anxiety and a lack of motivation.
“When I did make it out on my bike I had no energy and I had gained weight so it wasn’t as easy as it once was. My joints and muscles were sore, too.”
Another cyclist, Fiona Walker, was similarly halted in her tracks. Now 45, the cycling coach and race organiser says: “It was three years ago when I started suffering with irregular periods. They would happen unexpectedly and sometimes while on my bike. This was difficult to manage.
“Then, out of nowhere, I got saddle sores. These were recurrent and painful and really put me off the sport I’d been doing for most of my life.”
For 47-year-old Vicky Begg, a high-achieving amateur triathlete-turned-coach, there was a gradual dawning of realisation that “not every cycling day will be a good one”.
She reveals: “I took it for granted that I could cycle various distances and keep up with my usual crowd. These days, I will see how I am feeling at the start of each ride and if it’s not feeling right, I cut the ride short.
“I still have the will to cycle but not always the same turn of speed or sense of wanting to cycle hard to keep up.”
It was only after these women realised they were suffering a few other “more commonly known” symptoms, such as hot sweats and brain fog, that they each realised what was happening: They were entering the menopause years.
What is menopause?
Menopause is a natural process for all women when the ovaries no longer release an egg every month, resulting in the end of the menstrual cycle (periods) and, therefore, reproduction.
At the same time, this causes the hormones oestrogen and progesterone, which are produced by the ovaries, to decline.
The oestrogen reduction, which is the main cause of many menopause symptoms, is described as a downhill rollercoaster, in that there are fluctuations in hormone levels over many years and on a downward trajectory.
Testosterone reduction is also associated with the menopause. The ovaries are one area of the body that produces the hormone and the levels decrease with age.
In the UK, the average age for a woman to reach menopause is 51 and it is diagnosed as the cessation of menstruation for at least 12 months.
Meanwhile, peri-menopause, which are the years prior to menopause can last around five to 10 years. For most women, symptoms start in early to mid 40s.
The symptoms of the menopause are wide and varied. As well as heavier and irregular periods, hot flushes and brain fog, the list includes weight gain, especially around the midriff, migraines, hair loss, breast cysts, itchy skin, heart palpitations, watery eyes, cold flashes (like hot flushes but chilling), depression, anxiety, irritability, mood swings and loss of libido.
When thinking about sport and exercise, further symptoms that can affect performance include bone density, leading to stress fractures; reduced muscle mass; tight and torn muscles; muscle cramps; painful joints; compromised flexibility; fatigue; and digestive upsets.
Stephanie Kershaw-Marsh, a former nurse who is now part of the not-for-profit organisation Menopause Support, explains: “Many cells in the body have an oestrogen receptor and to perform at their optimum level they need good levels of the hormone. With a reduction in oestrogen, so many changes occur.”
Another condition, genitourinary syndrome of menopause (GSM), is common but less well known. Because oestrogen is the primary hormone that regulates the physiology of the vulvovaginal tissues, a reduction causes thinning of the skin, atrophy of subcutaneous fat and decreased hair growth.
Stephanie says: “For sporty women, GSM can be a particular issue because the walls of the vagina become thinner and there is a lower mucus production. The dryness may cause the labia, for example, to shrink and split, leading to saddle sores. Other women suffer bladder leakages and increased incidence of UTIs [urinary tract infections].”
It is probably no surprise there are also associated problems of mental health with peri-menopause, including issues of body image, reduced self-esteem and confidence and increased anxiety.
Menopause: Understanding and treatment
Despite growing awareness campaigns in mainstream and on-line media in recent years – and some celebrities, actors, presenters and athletes talking openly about their menopause – many women remain ignorant of the full effects of hormonal declines.
Treatment and research of the symptoms are also limited, especially given that menopause affects more than half the population.
Hormone Replacement Therapy (HRT), which comprises a “top-up dose” of oestrogen and progesterone, is an increasingly popular choice for women in peri-menopause and post-menopause.
Stephanie explains: “Oestrogen in HRT is plant-based and has the same molecular structures as that found in the human body. It is prescribed as a tablet, or as a patch, gel or spray applied to the skin.
“Unless a woman has had a hysterectomy, where the ovaries have been removed, it is important that they also take progesterone as well to protect the uterus. This is delivered as a tablet or via a Merina coil inserted into the uterus.
“Oestrogen can also be administered via a vaginal pessary, which is shown to be highly effective for issues such as vaginal dryness and GSM.”
HRT is not suitable for all women, especially those with a family history of some cancers and also blood clots. Progesterone supplements can cause side effects, too, similar to PMT [premenstrual syndrome].
There are some risks linked to HRT. A study reported last year in the British Medical Journal confirmed that HRT use is associated with increased risks of breast cancer, particularly for older women. However, it added: “[The study] suggests that, for longer term HRT use, the increased risks are lower than those reported in a recent meta-analysis that combined the results of 24 studies.”
Stephanie adds: “HRT also appears to have protective benefits for heart disease and osteoporosis. Emerging evidence shows it can help to combat the onset of Alzheimer’s Disease, too.”
Fiona, from Ayrshire, who suffered frustrating hot sweats, as well as erratic menstruation and saddle pain, found HRT to be a life saver. She says: “I had a Merina coil fitted to help with the heavy periods and then oestrogen patches for other symptoms a year later.
“The sores disappeared and the hot sweats went. I felt like I was back to the person I was before and I could happily cycle again.”
Joyce, who lives in Renfrewshire, was also prescribed HRT for several years in her mid-50s. Now 59, she says: “I found the treatment helped with many symptoms including anxiety, emotional ups and downs and night sweats. It allowed me to cope at work and at home and I was able to get back on my bike because I had more energy.”
While testosterone levels decline for women in menopause, the hormone replacement can only be prescribed for low libido, according to NICE (National Institute for Health and Care Excellence) guidance. Anecdotally, it is believed the hormone depletion is responsible for joint and muscle pain, as well as brain fog.
Alternative remedies are also said by many women to be useful during the menopause years.
When Joyce was advised by her GP to stop HRT after a few years, she turned to her pharmacist. She says: “The medical advice is different now I believe and women can stay on HRT for longer if they choose, but when I stopped I needed to find other ways to help with symptoms. I have found Evening Primrose Oil and Vitamin B6 to be really helpful.”
Evening Primrose Oil is claimed to reduce inflammation and can be useful for aches and pains, while Vitamin B6 helps to make serotonin, which can improve low energy and mood.
Other women choose Black Cohosh for reducing hot flushes; kava, for anxiety; St John’s Wort for mood; acupuncture; and cognitive behavioural therapy, among many others.
Menopause: Diet and exercise
In medical terms, lower levels of oestrogen cause women to lose the anabolic stimulus to build muscles. To combat muscle loss, weighted and resistance training are said to be helpful.
Dr Stacy Sims, an exercise physiologist and nutrition scientist, believes that power-based work is vital for women in the menopause years. Speaking on the Oxygen Addict Triathlon podcast, she explained: “Low intensity exercise as a way to build aerobic capacity doesn’t benefit the body so much as oestrogen reduces.
“Women need to focus more on increasing functional power-based exercise to maintain the integrity of muscle tissue and neuromuscular firing patterns.”
Plyometrics – primarily jumping exercises, which are focused on enabling your muscles to exert maximum force fast – allow women to build and hold on to muscle.
This form of exercise is helpful for bones, too. Dr Sims says: “In terms of bone mass, it is not enough to run. We need to stress the bones, such as by doing jumping exercises, to improve density of structure.”
Reduced oestrogen is known to lead to carbohydrate sensitivity because the body changes how it processes carbs. Dr Sims advocates a diet that is 40% complex carbs, from vegetables and grains, especially the “ancient” type; 30% plant-based fats; and 30% lean protein.
She says: “Women need more protein proportionally in the menopause years. The aim is to support lean muscle mass development.”
Cyclist and performance nutritionist Kris Kumari is 54 and four years post-menopausal. She describes her approach to coping in menopause as a “diet and lifestyle overhaul”. She chose not to use HRT.
She says: “I have used by professional knowledge to adapt my exercise and nutrition to adjust to the hormonal changes – and in several key areas.
“For example, I am choosy about my carbohydrates. I eat complex carbs to regulate and minimise fluctuations in blood sugar levels. This helps with my energy levels and enhances my mood.”
Kris, originally from Africa and now living in Scotland, aims to create a good gut environment with beneficial bacteria. She says: “I include prebiotics – that is, non-digestible foods – that feed and fuel good bacteria production. This ensures I have a healthy gut.These foods can help with mood, too, because a by-product of prebiotics being fermented by the probiotics in your gut is that this stimulates the release of serotonin, the feel-good chemical.”
Cycling for Kris is a way to stay fit and boost Vitamin D levels. She says: “Just 15 to 20 minutes of cycling in the middle of the day is enough. Vitamin D is important for the absorption of calcium for improved bone health. In autumn and winter, I take a Vitamin D supplement.”
The menopause also affects recovery times from exercise. Kris says: “We must take more time to recover and build strength and fitness from exercise. I make sure my diet is protein rich and I spread the protein over the day.”
Her bed-time routine aids rest and digestion. She says: “I ensure I have a portion of protein before I got to bed and I have cold tart cherry extract juice to stimulate melatonin levels for enhanced sleep.”
Menopause and mental health
Many women in peri and menopause experience mental, as well as physical, changes; often, they are inter-twined. Vicky, who has an MSc in Psychology of Sport, says: “Body image issues, lack of confidence and unfavourably comparing yourself with others, for example in terms of fitness, can be a crippling barrier to participation.
“It can sometimes feel like a vicious circle for women in that they might have put on weight or they do not feel as strong or fast as they once were. This can lead to lower motivation and, in turn, reduced fitness and further weight gain.
“It is important to be able to find people, whether this is friends, a club or a sports community, that is supportive of who you are as an individual athlete.
“Togetherness is good but also being with a community that is non-judgemental, so women are valued for their own achievements and participation rather than feeling extra stress or pressure.”
Motivation can be helped by setting dates to meet others for a bike ride or to attend a club session. Vicky says: “If you make a plan to do something with others you are much more likely to do it despite how you are feeling mentally on the day.”
As has been mentioned before, the type of exercise and allowing adequate recovery time are very important during the menopause years.
Vicky says: “Exercise in itself can be a great mood booster and it could be that you look at different types of exercise, such has strength training, as well as your usual routines, so that the focus is not always on what you used to be able to achieve, but rather on a new target such as becoming stronger.”
Coaching in menopause
While research is limited, although growing, there is evidence to show how female hormonal fluctuations, whether during the reproductive years or in menopause, can affect performance.
In the peri-menopause stage, hormonal ups and downs are highly changeable and frequently unpredictable.
Vicky says: “The more traditional periodised training cycle, where periods of progressively-loaded training stress are followed by rest, simply will not work for peri-menopausal women.
“A woman might experience, for example, weeks of intermittent fluctuations, bleeding, sleeplessness, hormonal shifts and emotional upset and therefore training during this phase is likely to be disrupted and very much reduced.
“This might be followed by weeks of relatively stable ‘activity’ both in terms of menstruation and emotional responses.
“Ultimately, the communication between athlete and coach becomes the crucial component in a successful training schedule and traditional micro, meso, macro periodisation will not suit.
“Individualised coaching can be very beneficial, but it needs to be far more adaptive and responsive with plenty of feedback from the athlete.”
The post-menopause athlete
While all the symptoms and tips might seem like a lot to take in, the more informed women – and men – are, the greater chance they have to remain fit and healthy into later years.
The past decade has seen a growing female participation in many sports, including cycling. Races and events show larger numbers of competitive women riding into their later decades, too.
Kris is a good example of how women can focus on being positive through and post-menopause. She says: “I have really, truly accepted the way my body is now. The menopause has given me the opportunity to take a holistic view to exercise and nutrition, and that is good for the future of my health and well-being, too. It has allowed me to re-set, renew and rediscover.”
My menopause: It started with cramps all over my body
It started with muscle cramps. Not the kind of lower abdominal cramps women normally associate with the menstrual cycle but severe, exercise-halting pain in my calves, hamstrings and glutes. At night, the cramps spread to my feet and repeatedly woke me up.
When a cramp spasmed in my upper abs area during a yoga session and my hands cramped as I opened the toothpaste tube, I knew I needed to seek medical help.
I was 45 and I had never heard the words peri-menopause.
For almost a year, cycling, as well as running and swimming, became fraught with anxiety. I could never be sure when a cramp would hit and when it did, I would be left reeling as I tried to ease the discomfort.
I was losing sleep and my mental health was affected because exercise is one of my greatest joys.
My GP was sympathetic but flummoxed. Muscle cramps are still a medical enigma and having tried all the usual remedies, such as better hydration, adequate salt intake, magnesium and even drinking pickled onion vinegar, she referred me to a neurology consultant.
Alarmingly, Parkinson’s and MS were mentioned but further tests ruled out these conditions.
While searching on-line for information, I spotted forums in the US for menopausal women where some mentioned cramps in their feet at night. I also realised I had other related issues, including frequent and heavy periods, itchy skin, migraines, UTIs and memory loss.
Looking back, I was also trying to cope with symptoms related to sport, such as bike saddle sores and and the sense I was slowing despite training hard.
The consultant agreed that naturally reducing oestrogen and progesterone could be the cause, although he admitted there had been very little research into menopausal women and sport.
I returned to my GP and asked to try HRT. She agreed and within a month the cramps had disappeared.
I am now 53 and I am still taking HRT. I have rarely suffered a muscle cramp since. In addition, many other symptoms, are kept in much better check.
I am also kinder to myself. I take more rest and I have added strength and conditioning sessions to my cardiovascular training. I try to do a faster speed session each week, too, as well as longer and easier runs and bike rides.
I only wish I knew then what I know now because i might not have wasted years worrying and without treatment.