Dr. Josephine Perry on managing menopause in sport

As a triathlete in my mid-40s, even the word perimenopause feels daunting. Fear of entering this unknown period; of losing control of a body I have finally learnt to love, watching fitness drain away and facing a myriad of symptoms that will make performance harder does not appeal. And yet as a sport psychologist I see many female athletes handle this period admirably, with many seeing it as just another challenge they need to take on.

It isn’t a case of head on confrontation or mentally toughing it out. There are some physical symptoms that can impact sports performance. Dr. Juliet McGrattan, founder of the Run Through the Menopause course says the most frequent issues her sporting clients mention are their “changing body composition with weight gain and increased fat storage around the tummy, a lack of motivation and drive, low energy levels,  aching muscles and joints and slower recovery.” We can’t hide from these.

When medic and swimmer Dr. Catherine Munro hit perimenopause she searched for medical papers on maintaining sporting performance. There were none. All she found were warnings that she should expect to see a decline in performance through loss of power, risk of osteoporosis and sleep issues harming recovery. As a result it would be easy to stop trying – and around a third of women do reduce the amount of exercise they do (Research report: Menopause, Me and Physical Activity – Women In Sport) – but as sport can help with some of the changes, you shouldn’t have to stop.

So, here are five ways to help you as an athlete stick with your sport through menopause:

Know your personal benefits

Menopause can give us a feeling of loss or make us feel we lack of control but with some reminders about what sport gives us we can make it into more of an opportunity. As a doctor, going through menopause in the pandemic it was essential for Munro to swim – she needed it to relieve stress and feel well. “When I was working being able to switch off and just plough up and down the pool enabled me to deal with the many tough things one experiences working in A&E.

Open water, being in nature, the boost from the cold were also vital to physical and mental health.” Her swimming wasn’t just for leisure – she won the England masters open water 5km championships in 2019 and got silver in the 3k two years later – so it gives Munro a real sense of achievement.


It does get harder to perform at a high-level during perimenopause and acceptance helps us handle this. In 2019 when Jo Moseley was 54 she embarked on a 162 mile coast to coast paddleboard. She found the perimenopause made her challenge harder. “I had anxiety, a lack of sleep, was prone to injury (two frozen shoulders and plantar fasciitis), headaches and generally feeling sad and low.”

Moseley found acceptance was key. “My approach was ‘do what you can with what you have’. I just had to be kind to myself. I had to put myself on The Priority List and do what I could around the injuries and caring responsibilities. This was a big attitude step change but I found having a support system and a big goal helped keep me focused.”


It is tempting to bury your head in the sand and hope you are one of the 20% of women who don’t notice any menopause symptoms, but as the odds of this are not stacked in your favour, and the symptoms on average last around four years, we need the self-awareness of what is happening to be able to handle it effectively and adapt. Munro found that while HRT helped her overcome a number of her symptoms she couldn’t just stick to her 15-20,000 metres a week of swimming, she needed to adapt too.

The four adaptations it is suggested perimenopausal athletes make:

  • Investing in strength work. McGrattan says, “to really build muscle you need to lift heavy weights so you may need to buy some good home equipment or visit a gym.”
  • Do load bearing exercises to improve bone density and balance out the higher risk of osteoporosis that comes with lower levels of oestrogen.
  • Endurance training. A study in the European Journal of Applied Physiology (https://pubmed.ncbi.nlm.nih.gov/33389018/ found that the decrease in hormones during menopause impairs the cardiorespiratory system but that the changes can be reduced through endurance training.
  • Add in occasional extra rest days to counteract your body’s recovery processes slowing down.


Prioritise sleep

Sleep is one of the best performance enhancers for athletes and it can go a little haywire during perimenopause as we progesterone levels drop, impacting our relaxation and sleepiness. When we don’t sleep well we don’t adapt and recover from our training and we are more likely to feel stress or frustration. Moseley said for her prioritising sleep was incredibly important. “Sleep is the foundation of my wellbeing – energy, mental health and self confidence. I have a really simple but important sleep protocol which starts in the morning with fresh air and a walk and ends with bed by 10pm and a book.”


Finally, track what you do. As McGrattan reminds, “every woman is different and the changes are very individual so it’s often a case of seeing if there are any patterns for you and working with what you can change.” Or, to think of it in performance terms; ‘success leaves clues’ and keeping a training diary allows us to identify them. As well as the exercise you do, note down your periods so you know which stage you are in (peri or post menopause), symptoms you are experiencing and comments on what is working (or not)  for you.

If you can accept, adapt, track, sleep and identify the benefits then like Moseley and Munro, you can stay performing well right through perimenopause and beyond.

Some places to learn more about high performance sport during menopause:

The Hit Play Not Pause Podcast: https://podcasts.apple.com/us/podcast/hit-play-not-pause/id1533088916

Dr Juliet McGrattan’s course: https://drjulietmcgrattan.com/menopausecourse/

Jo Moseley – www.jomoseley.com

For more menopause stories, advice and interviews, head to the Menopause Your Way Stories hub. To browse and shop a curated edit of menopause products, visit the Menopause Your Way page on QVC.

The content of the QVC website is for information only. It is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the QVC website.

We understand there’s a lot of information out there on the menopause. You can read through the NICE guidance on menopause management, as well as the NHS overview on the menopause.

Photo credit: Jo Moseley – Frit Tam