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I know I said this in our last post but it’s a message that’s worth repeating – nearly half of recreational female runners are of menopausal age. What we cover today could have implications for lots of patients you see in clinic.
I often get asked for more information about menopause transition because I cover tendinopathy in my teaching, so I’ve done some research and wanted to share what I’ve found with you. I have to admit, I’m not I’m expert in this topic so I’ve teamed up with Claire Callaghan who is!
Claire recently recorded an excellent Perimenopause Masterclass where she presented with a brilliant dietician to discuss protein, calcium, Vitamin D, strengthening and lots more! It’s primarily aimed at the public, but health and exercise professionals are very welcome to come and often do attend. Visit this link to find out more.
In addition, this recent overview has a lot of great information specific to runners and athletes – Maximizing Running Participation and Performance Through Menopause (Rothschild and Collingwood 2023).
They state that menopause typically occurs between the ages of 42 and 58 years. It’s preceded by the perimenopause (or menopause transition) which on average lasts around 4 years but it can range from a few months to over a decade.
There are multiple physiological effects of menopause transition and falling oestrogen levels which we’ve summarised with suggested solutions for runners from Rothschild and Collingwood (2023) in the table below:
I would use this as a quick reference and focus on discussing individual options with a patient rather than sharing the graphic with them as otherwise it can seem quite daunting.
A key positive is that running and regular exercise has the potential to help in many of these areas so we want to support and encourage this if it’s part of someone’s goals.
How might we adapt rehab and running?
Due to the changes in oestrogen levels, tendon, muscle and bone health, it’s important to ensure progression of both rehab and running is adapted to suit individual needs. In many cases, a more gradual progression is needed with a focus on consistency rather than speed.
Training may need to be adapted, especially intensity. We need to ensure there is adequate recovery so include rest days after longer/ harder runs and plan a recovery week into the schedule roughly every fourth week (or as needed). Sleep impairment is very common during menopause transition and training may need to be reduced as a result.
Energy availability and nutritional needs should be considered. This is covered in more detail in Rothschild and Collingwood (2023) but I would recommend referring to a Registered Dietician or Sports Nutritionist for their expert input. This is especially important for a runner with osteopenia/ osteoporosis or a history of stress fracture.
Progressive strength work and plyometrics can improve muscle, tendon and bone health and support continued running. Unfortunately, they can be provocative for tendinopathy, especially when symptoms are irritable.
In these cases, it’s often best to focus first on what is tolerable in terms of symptoms and then gradually build to a level that can achieve the patient’s rehab goals. I often find starting with isometrics can be helpful:
What about Hormone Replacement Therapy (HRT)?
Hormone Replacement Therapy may help improve quality of life and symptoms during menopause, including sleep (Cintron et al. 2017). There is some evidence to suggest that HRT may also improve outcomes for some women with Gluteal Tendinopathy:
“Menopausal Hormone Therapy with any exercise plus education was associated with greater improvements in pain and dysfunction as compared with placebo cream in a subgroup of participants (BMI <25)” Cowan et al. (2021)
Raiser et al. (2024) suggest that there is evidence to support using HRT for prevention and treatment of low bone mineral density. However, they also point out that evidence specific to runners is limited and there are concerns about adverse effects such as increased breast cancer risk.
In addition there are contraindications to HRT including previous breast cancer, history of DVT, Pulmonary Embolism or blood clotting disorder, liver disease and migraine (Harper- Harrison and Shanahan 2023)
Lobo (2016) state, “In younger healthy women (aged 50–60 years), the risk–benefit balance is positive for using HRT, with risks considered rare”
Like all interventions HRT needs to be considered on an individual basis with the patient being aware of potential risks and benefits. It’s an emotive topic that can divide opinions which can cause confusion for patients. For more on types of HRT, benefits and risks see the NHS HRT Guidance. The Women’s Health Concern pages on HRT are also a good resource for clinicians and patients seeking more detailed information.
