Menopause and the Triathlete: What the Evidence Can and Can't Tell You Yet

Many triathletes in the 40-to-60 age groups are going through, or have gone through, the menopause. Yet when they look for evidence about how it affects training and racing, they find very little. TriForward's "Mostly Men, Mostly Cyclists" and "Reading the Research as a Female Triathlete" both flagged this as one of the biggest gaps in sports science.

This article sets out what the research can tell you, and where it can't. It covers how common symptoms are in endurance athletes, what's known about hot flushes and heat, bone, and strength, and which practical steps are reasonably supported. It's deliberately honest about how much of this comes from non-athletes, or from studies that never included menopausal women at all.

It isn't medical advice. Symptoms, and decisions about treatment, including menopause hormone therapy, belong with your GP or a menopause specialist.

Perimenopause and menopause, briefly

Menopause is the point at which periods have stopped for 12 months. The years leading up to it, often in the mid-to-late 40s, are perimenopause, when hormone levels, especially oestrogen, fluctuate and then fall. Postmenopause is everything after.

For athletes, perimenopause can be the hardest phase, because hormone levels are unpredictable rather than simply low. Cycles may become irregular, symptoms can come and go, and training that worked last year may feel different this year. Many of the studies discussed below don't separate the phases clearly, which is one more reason to be cautious.

How thin the evidence is

In a 2024 editorial in the British Journal of Sports Medicine, McNulty, Olenick, Moore and Cowley called for action on the invisibility of women in midlife and beyond in sport and exercise science. Earlier work by the same group had found that only about 6% of studies in major sport science journals recruited women only. Their editorial argued that perimenopausal and postmenopausal women are likely to be a small fraction even of that 6%.

A 2025 scoping review by Gilworth and colleagues in Frontiers in Physiology illustrates the problem. It searched for studies on how heat stress affects exercise and work performance in women. Of 35,696 records, 41 studies met the inclusion criteria. Female participants had a mean age of 29. Not one study investigated perimenopausal or postmenopausal women.

So if you've ever wondered whether a heat strategy, fuelling recommendation or training method was tested on someone like you, the answer is usually no.

The 2025 survey of endurance athletes

The most directly relevant study is a 2025 survey by Hamilton, Yarish and Heron, published in PLoS One. They recruited US female endurance athletes aged 40 to 60, who trained at least three days and three hours a week, through social media, word of mouth and athletic clubs in 2024.

• 187 athletes completed the survey. 55% were runners, 22% swimmers, 14% cyclists and 9% (17 athletes) triathletes.
• By self-reported status, 18% were premenopausal, 39% perimenopausal and 43% postmenopausal.
• 28% (53 athletes) were currently using hormone therapy.
• Symptoms were measured with the Menopause Rating Scale, a standard questionnaire, and athletes rated how much each symptom affected their training and performance.

The most common symptoms were:

• Sleep problems: 88%
• Physical and mental exhaustion: 83%
• Sexual problems: 74%
• Anxiety: 72%
• Irritability: 68%
• Depressive mood: 67%
• Weight gain: 67%
• Hot flushes: 65%
• Joint and muscular discomfort: 63%

The symptoms athletes felt were most harmful to training and performance were joint and muscular discomfort, weight gain, sleep problems, and physical and mental exhaustion. For joint and muscular discomfort, 97% said it had a negative effect on training and 91% on performance. The paper's text doesn't state the denominator explicitly, but the follow-up questions appear to have been asked only of athletes who had that symptom. Athletes who reported a strong negative effect had higher overall symptom scores than those reporting no or slight effects.

The authors noted that symptom severity was similar to that reported in the general population. In other words, being an endurance athlete didn't appear to protect against symptoms.

Reading that survey carefully

The survey is valuable, but it has clear limits, several of which the authors highlighted:

• It's cross-sectional. It shows how common symptoms were, not whether they caused changes in training or performance.
• Status and effects were self-reported, and premenopausal women were included, so not every symptom was necessarily menopausal.
• Only 17 participants were triathletes.
• No health history or medication data were collected, apart from hormone therapy, and other midlife factors such as work stress and caring responsibilities weren't controlled for.
• The sample was self-selected, which may attract athletes with stronger symptoms or interest.

Inference: the survey tells you that you're far from alone if you're struggling with sleep, fatigue or aches. It doesn't tell you what to do about them.

Hot flushes, heat and racing

Hot flushes are sudden feelings of heat, often with sweating and flushing, caused by changes in the body's temperature regulation. For triathletes, the obvious question is whether menopause changes how you cope with racing in the heat. As the Gilworth review shows, nobody has tested it in athletes.

There is one interesting small trial. Bailey and colleagues, publishing in Menopause in 2016, randomised 21 symptomatic postmenopausal women (mean age 52) to 16 weeks of supervised aerobic exercise (14 women) or no exercise (7 women). Training started at 30 minutes three times a week at low intensity and progressed to 45 minutes four to five times a week at moderate intensity. Compared with the control group, the exercise group:

• Improved cardiorespiratory fitness by 4.45 mL/kg/min.
• Reported fewer hot flushes, with an estimated difference of 48 hot flushes a week.
• Started sweating and increasing skin blood flow earlier when heated, at a body temperature around 0.15-0.19°C lower.

The authors suggested exercise improved thermoregulatory control. But the sample was small, the control group had fewer hot flushes to begin with, and the starting programme suggests these weren't trained athletes. Inference: it shows that fitness may affect the mechanism behind hot flushes, not that more training will fix them for someone who is already fit.

What the Cochrane review found

A broader view comes from a 2014 Cochrane review by Daley and colleagues on exercise for vasomotor symptoms (hot flushes and night sweats). It included five randomised trials with 733 women:

• Exercise versus no treatment (3 trials, 454 women): no clear difference in the frequency or intensity of symptoms.
• Exercise versus yoga (2 trials, 279 women): no clear difference.
• Exercise versus hormone therapy: one small trial (14 participants) found fewer hot flushes with hormone therapy.

The authors concluded there was insufficient evidence to say whether exercise is an effective treatment for hot flushes, and rated the evidence as low quality.

Putting the two together: exercise is very good for many aspects of health in midlife, but it isn't a reliable treatment for hot flushes. If symptoms are disrupting your sleep, training or life, that's a medical conversation, and hormone therapy is one of the options to discuss with your doctor. TriForward doesn't recommend for or against it.

Heat on race day

With no menopause-specific evidence on heat and performance, any race-day advice is inference. Reasonable steps:

• Acclimatise properly before hot races. TriForward's "Heat Acclimation for Race Day" covers the general evidence, which wasn't tested in menopausal women.
• Be ready to adjust pacing if a hot flush hits during a race, rather than trying to hold target power through it.
• Use cooling strategies such as ice, cold water and shade, which are low-risk.
• Know the signs of heat illness, including confusion, nausea, dizziness and feeling unusually unwell, and don't assume they're menopause symptoms.

Bone: the clearest reason to act

Bone is where the evidence is strongest, although it still comes from the general population.

The Study of Women's Health Across the Nation (SWAN), reported by Greendale and colleagues in the Journal of Bone and Mineral Research in 2012, followed 862 women from four ethnic groups through the menopause transition. They found:

• Bone loss began about one year before the final menstrual period and slowed about two years after it.
• During the transition, bone density fell by about 2.5% a year at the lumbar spine and about 1.8% a year at the femoral neck (the hip), in the white reference group.
• Over the ten years around the final period, the cumulative loss was about 10.6% at the spine and 9.1% at the femoral neck.

For triathletes, this matters because swimming and cycling don't load bone much. TriForward's "Bone Stress Injuries in Triathletes" and "Lifting for Bone" explain why. Inference: a swim-bike-heavy athlete entering menopause with modest bone density has less margin than a runner or a woman who does regular impact and strength training.

Heavy lifting is safe and effective for many women

Older advice for women with low bone density was to avoid heavy lifting and impact. The LIFTMOR trial, by Watson and colleagues and published in the Journal of Bone and Mineral Research in 2018, tested that.

• 101 postmenopausal women with low bone mass (mean age 65) were randomised to supervised high-intensity resistance and impact training or a home-based, low-intensity programme for eight months.
• The high-intensity group trained twice a week for 30 minutes, doing five sets of five repetitions at more than 85% of their one-repetition maximum, alongside impact training.
• Lumbar spine bone density rose by 2.9% in the training group and fell by 1.2% in the control group. Femoral neck density was maintained (+0.3% vs −1.9%).
• Functional performance improved more in the high-intensity group.
• Only one adverse event was reported, a minor back spasm.

These women weren't athletes, they were older than most perimenopausal triathletes, and the programme was supervised and carefully screened. Inference: progressive heavy strength work with some impact is likely to be worthwhile for menopausal triathletes, but start with coaching, and check with your doctor first if you have known low bone density or a past fracture.

Muscle, joints and recovery

The survey found joint and muscle discomfort was the symptom most often felt to harm training. There's no athlete-specific research on why, or what helps. Inference: strength training, gradual changes in run load, and paying attention to sleep and fuelling are low-risk steps, but aches that are new, persistent or localised to one spot need assessment rather than assumption. Bone pain, in particular, shouldn't be written off as menopausal.

Sleep and fatigue

Sleep problems were the most common symptom in the survey, at 88%. Poor sleep affects recovery, mood and training quality. Inference: if sleep is disrupted, it may make sense to plan harder sessions on days after better nights where you can, and to treat fatigue as a reason to adjust rather than push through. TriForward's "Reading the Trend, Not the Number" covers how to use heart rate variability alongside how you feel.

Also be careful not to blame everything on menopause. Fatigue can also reflect iron deficiency, thyroid problems, low energy availability or overtraining. TriForward's "Under-Fuelled, Not Undertrained" covers low energy availability.

Questions worth taking to your doctor

Because so little is athlete-specific, a good appointment is one of the most useful things you can do. Questions you might bring, as a starting point rather than a script:

• Are my symptoms likely to be menopausal, or should other causes such as iron deficiency or thyroid problems be checked first?
• What treatment options suit me, including whether hormone therapy is appropriate given my age, health and history?
• Is a bone density assessment worthwhile, given my training history and any past fractures or missed periods?
• Are there any reasons I shouldn't start heavy strength or impact training?

Bring a short record of symptoms, sleep and training if you can. Inference: a doctor who understands that you train ten or more hours a week can give more useful advice than one who assumes you're sedentary.

A triathlon-specific scenario

This example is illustrative, not drawn from a study. A 51-year-old age-grouper has raced 70.3s for a decade. Over the past year her periods have become irregular, she wakes most nights, and her long runs leave her achier than before. She has also noticed she copes worse in hot races.

Based on the evidence above, she might reasonably talk to her GP about symptoms, including whether hormone therapy or other treatments are appropriate for her, and ask whether a bone density check makes sense. In training, she might add two supervised strength sessions a week, gradually including heavier lifts and some impact, keep run progression gradual, and plan heat acclimation before hot races. None of this is proven in triathletes, but each step is low-risk and supported by evidence from other groups.

Common mistakes

• Assuming fitness protects you from symptoms. The survey suggests it doesn't.
• Training through severe symptoms without medical advice.
• Relying on swimming and cycling for bone.
• Avoiding heavy lifting out of caution when supervised, progressive strength training is likely to help.
• Blaming all fatigue on menopause and missing iron deficiency, thyroid problems or under-fuelling.
• Treating evidence from younger women or men as if it applies directly.

What we don't know

• How menopause affects triathlon performance. No studies have measured it directly.
• Heat tolerance in menopausal athletes. A 41-study scoping review found no studies at all.
• Whether training changes help symptoms in already fit women. The trials are in mostly untrained women.
• The effect of hormone therapy on training and performance. It hasn't been studied in triathletes.
• Differences between perimenopause and postmenopause in athletes. Studies rarely separate them well.

References

• Hamilton HM, Yarish NM, Heron KE. Frequency and perceived influence of menopausal symptoms on training and performance in female endurance athletes. PLoS One, 2025;20(12):e0335738. doi:10.1371/journal.pone.0335738
• McNulty KL, Olenick AA, Moore S, Cowley ES. Invisibility of female participants in midlife and beyond in sport and exercise science research: a call to action. British Journal of Sports Medicine, 2024;58(4):180. doi:10.1136/bjsports-2023-107165
• Gilworth RE, Skinner BD, Hodgkiss DD, Lucas SJE, Lucas RAI. Mapping the evidence on the impact of heat stress on exercise and work performance in females: a scoping review. Frontiers in Physiology, 2025;16:1507398. doi:10.3389/fphys.2025.1507398
• Bailey TG, Cable NT, Aziz N, Dobson R, Sprung VS, Low DA, Jones H. Exercise training reduces the frequency of menopausal hot flushes by improving thermoregulatory control. Menopause, 2016;23(7):708–718. doi:10.1097/GME.0000000000000625
• Daley A, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews, 2014;(11):CD006108. doi:10.1002/14651858.CD006108.pub4
• Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ, Lee JS, Karlamangla AS. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). Journal of Bone and Mineral Research, 2012;27(1):111–118. doi:10.1002/jbmr.534
• Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 2018;33(2):211–220. doi:10.1002/jbmr.3284