Menopause and Running
Menopause is a natural phase through which all women will pass. For some, it’s straightforward, for others, it’s a roller-coaster! Timing of menopause, severity and duration of symptoms and their wider impact are hugely variable. There’s no doubt that the physiological impact of menopause can affect running and injury risk, and our physios are mindful of this when treating peri-menopausal women. So what are the facts about the impact of peri menopausal health on running? Considered conversely, what’s the impact of running on peri and post-menopausal health?
Menopause – what is it?
The menopause is when a woman stops having periods. It happens when the ovaries stop releasing eggs or your ovaries have been removed and the amount of oestrogen hormone in a woman’s body falls. Most women in Australia have their menopause between the ages of 45 and 55 years, with the average age being 51 years.
The term ‘perimenopause’ is used to describe the time around the menopause during which women are making a transition towards menopause. At this time they may have some of the signs and symptoms consistent with hormonal changes and approaching menopause. Perimenopause may last from a few months to several years. 80% of women will experience menopausal symptoms that interfere with their quality of life, with one in four describing symptoms as severe.
The most common symptoms are hot flushes, night sweats, vaginal dryness, low mood and/or anxiety, fatigue, joint and muscle pain and loss of libido. Some less common symptoms are headaches and weight gain (Royal College of Obstetrics and Gynaecology (RCOG), 2019).
Potential impact of menopause on runners
Hormones, tendons and ligaments
The effect of oestrogen on tendons and ligaments is poorly understood. The research suggests that it has protective benefits for connective tissue (e.g. tendon) strength, healing and ability to take load.
95% of collagen in tendons is attributed to Type 1 collagen. Other type 1 collagen can be ‘seen’ in our skin. With normal skin ageing there is a decreased ability for the tissue to repair and regenerate which is why it looks ‘different’ to a younger persons skin. The same reduced repair function is occurring in other tissues of our body with type 1 collagen such as our tendons and ligaments.
Oestrogen appears to exert a positive effect on connective tissue and collagen regeneration and musculo-skeletal adaptations to loading and tendon stiffness. This may have a positive influence on outcomes following musculo-skeletal overload, trauma and orthopaedic surgery (Nedergaard et al, 2012, Le Blanc et al, 2017). In other words, with appropriate levels of oestrogen the tissues (e.g tendons/ ligaments/ fascia) recover well after stress/ over load.
However, there is minimal research which implies a direct connection between decline of ‘oestrogen- like’ compounds and Type 1 collagen strength – it just hasn’t been looked at enough yet.
Some studies imply a connection between declining oestrogen and pelvic prolapse (Le Blanc et al, 2017). Trunk and pelvic floor strength and control are vital for pelvic organ support, continence and coping with the increase in intra-abdominal pressure during running (Leitner et al, 2016).
Potential collagen changes with menopause highlight the need to not only consider changes to the commonly problematic gluteal (butt and hip), posterior tibial (lower leg) and achilles tendons, but also the need to address abdominal and pelvic floor changes. Another reason to continue pelvic floor exercises! More research is needed to understand how any positive oestrogen benefits influence tendons, and would be of interest given the high occurrence of tendon related pathology in peri-menopausal women.
According to Alison Grimaldi’s extensive research, gluteus medius tendinopathy is more common in females than males, with a ratio of 3-4:1, peaking in the perimenopausal period. Posterior tibial tendon dysfunction (PTTD) is also commonly noted in this group (Kohls-Gatzoulis et al, 2009) (Ross et al, 2018), with figures varying from 3.3 to 5%.
Joint symptoms of pain and stiffness are commonly reported during and after menopause, and are possibly associations with reduced oestrogen levels have been noted in several papers. However a true is lacking (Xiao et al, 2016, Watt, 2018).
Bone and muscle strength
Oestrogen plays an important role in the growth and maturation of bone as well as in the regulation of bone turnover in adult bone. Women can lose up to 20% of their bone density in the first 5-7 years post menopause, as oestrogen levels drop.
Muscle strength losses peri and post menopause are well documented. Reccent research shows up to 8% muscle strength loss per decade from the age of 30 if no steps are taken to counteract this. A recent Finnish study (Bondarev et al, 2018) of over 900 women showed menopausal status is significantly associated with reduced muscle strength, power and vertical jump height.
Some menopause symptoms have a direct impact on running, and possibly injury. The hot flushes can occur while running. This can be of great concern if it is a very hot day as well.
So why run your way through the menopause?
It’s not just a ‘doom and gloom’ picture – it’s important to remember this is a normal process.
Running can have positive benefits on physical and mental wellbeing of a woman (regardless of hormonal status).
In fact, maintaining regular exercise are ever more important in combatting the effects of hormonal and age related changes.
Lifting the mood
Women’s mental wellbeing has been shown to benefit from running with others (Grunseit et al, 2017). Interaction with nature through running outside may help with reducing anxiety levels (Lawton, 2017). Women’s running groups may also enhance social connections and a sense of being connected at what can be a time of physical and emotional change.
Offsetting “middle aged spread”
Menopause can negatively impact metabolism, visceral fat and lipid profiles (Saha et al, 2013), and higher engagement in physical activity is associated with a lower body mass index (BMI), visceral adipose tissue accumulation and a healthier metabolic profile in post menopausal women (Major et al, 2005). From a musculo-skeletal perspective, the documented link between high BMI, tibialis posterior tendon issues and onset and pain from arthritis, weight management warrants consideration.
Running and other exercise are advocated by the RCOG in management of perimenopausal symptoms and maintenance of bone health
A wealth of literature, NICE guidelines, NHS guidance and the international osteoporosis foundation support weight bearing exercise to strengthen bone throughout women’s lives to reduce risk of osteopenia and osteoporosis. Stiles et al (2017) examined the effect of high intensity of exercise on pre and post-menopausal women’s bone health in over 2000 women. They found that accumulating 1-2 minutes a day of high intensity physical activity, stated as equivalent to running in pre-menopausal women and slow jogging in post-menopausal women, was associated with better bone health.
Bondarev’s 2018 study showed high leisure physical activity levels providing the capacity to counteract the potential negative influence of menopause on muscle function. More active post-menopausal women showed significantly greater maximal knee extension strength and higher vertical jump height. This in turn may benefit running.
It is important women are empowered by information to help them through various life stages. Around the world, women are better educated and more likely to live into their 80s and 90s than ever before, and there’s no shortage of peri and post-menopausal female runners, from those doing their first couch to 5 k to completing marathons in astonishing times. Through a greater understanding of their health and how they can positively influence it, they can continue to enjoy running and exercise, reduce injury and stay well.