Our Apeiron Life Scientific Advisory Board members review each perspective post.
What is it:
Until recently, the general scientific community didn't consider female physiologic fluctuations into training and exercise recommendations. From different body compositions to cycling hormones, the type of training, how much, and how hard didn't include the variations women undergo in their lifecycle or even monthly changes. Not to mention perimenopause and menopause, which add another layer of intricacy to female training, so some alterations in training strategies may be warranted compared to men and/or younger women.
Perimenopause is the time when the female body makes the transition to menopause, when menstruation stops altogether. The common symptoms of perimenopause include irregular monthly periods, night sweats, hot flashes, and mood swings. Most women enter this stage in their 40s, which can last anywhere from a few years to over a decade, but individual differences vary widely. This transition from higher to lower levels of testosterone and estrogen can be tough for women, especially if they are used to being active, let alone competing at a high level. Although testosterone decline is an age-related occurrence and not specific to perimenopause, it still has noticeable effects at this age.
Purported claims:
In recent years, the scientific community has been catching up and calling attention to sex differences in exercise adaptation. The answer to whether female physiology, especially in perimenopause and menopause, demands a female-oriented approach to training is yes. Here are some reasons why:
Decrease in sex hormones in perimenopause requires women to increase workout intensity to get results
Cortisol levels increase in menopause
Loss of muscle and bone mass accelerates in menopause
Building muscle may be easier at a certain time of the month for women, in general.
Temperature control is diminished in menopause
What the science says:
The differences in sex hormones make women naturally gifted in endurance sports. Due to a higher proportion of type I muscle fibers (the slow ones) and the increased efficiency at extracting oxygen from the blood, women are better at utilizing fatty acids for energy, transporting nutrients into the tissues, and getting rid of waste products. Besides making women less fatigable, this also leads to faster recovery than men.
The flipside is that when testosterone and estrogen levels start to decrease in perimenopause, women need higher stress stimulus from exercise to improve cardiovascular outcomes, body composition, and energy metabolism (i.e., better fasting glucose and insulin sensitivity). Polarized training, where you go hard for a short period (HIIT or Tabata training) on some days and gentler on others, seems to work well for menopausal women. When it comes to interval training, shorter is better. Longer intervals (>60 secs) can increase the stress hormone cortisol, which is already elevated during menopause.
Strength training is always critical but especially as you get older. Muscle mass and bone density loss begins around the mid-30s and accelerates as menopause occurs. The estimate is that ~20% of U.S. women 50 years or older have osteoporosis. However, studies show that perimenopausal women respond well to heavy resistance training, increasing strength significantly and either improving or maintaining bone mineral density (BMD) in just six months of training. A meta-analysis with postmenopausal women showed that combined resistance training, a combination of resistance training and high-impact or weight-bearing exercises, can significantly improve BMD.
If you’re still menstruating and want to get the best adaptations from strength training, some studies say that the follicular phase (days 1-14 of the cycle), when estrogen levels start to peak, may be superior to the luteal phase (~day 15 to start of the period) in increasing muscle strength and mass. However, authors of very recent research into menstrual cycle and strength adaptations concluded that “menstrual cycle phase does not affect strength-related outcomes.” But more importantly, when it comes to lifting, women at any stage of their lives should not shun away from heavy weights. Not only does it build muscle strength and lean mass, it positively affects hormones by regulating estrogen levels and increasing circulating androgens -including testosterone. Heavy lifting has also been shown to burn stubborn and unhealthy belly fat that accumulates during menopause even better than cardio exercise.
Female sex hormones also affect women’s performance in hot weather. During the luteal phase, the core temperature rises slightly, and the blood plasma volume decreases by about 8%. These changes and the fact that women have a lower volume of body water than men make women’s tolerance for heat lower at this time of the month. In peri- and postmenopause, low estrogen can blunt the normal cooling responses as well as the thirst sensation and sweat rates making training feel even more challenging. When women prepare to race or exercise in a hot climate, they should give themselves twice as much time to adjust compared to men. Instead of 5 heat adaptation sessions, aim for 10. On a positive note, regular exercise has been shown to reduce the frequency of hot flashes in some women.
Our take:
Many active women feel deflated during perimenopause because hormonal swings can make once easy and enjoyable activities feel exhausting at certain times of the monthly cycle. Carbs and sugar-laden foods can also become harder to resist. While some women feel so out of sorts, they give up on exercise altogether, others make the mistake of burning the candle at both ends. They increase their training, especially with long, steady-state workouts (the so-called "fat burning zone") while decreasing their calorie intake because they feel like no matter how much they starve themselves, the pounds keep piling on.
A better strategy to beat the menopause doldrums is to polarize your training with varying tough and easy sessions and add muscle-building strength exercises with relatively heavy weights (reps between 6-12). True polarized training is considered as an 80/20 split with easy to hard workouts, but the main point is to get out of the mindset of always training at the same (usually easy and long) intensity and instead throw in some hard sessions 1-2 times per week. And make sure you get quality protein in every meal to enhance your protein synthesis. This will keep the internal furnace, your metabolism, working higher and give your cardiovascular and muscular systems the stimulus they need to stay healthy.
Although the evidence is premature to form workouts around the menstrual cycle, the Apeiron Life perspective is that physical activity throughout the lifespan is critical for enhancing function, wellness, and healthy aging. In addition to cardio exercise, it is very beneficial for women at any age to incorporate strength training for strong bones and to increase lean mass. As a bonus, women who engage in regular cardio and resistance training exercises have been found to feel less anxious and have an overall better quality of life during the menopausal transition compared to inactive women.
Will this benefit you?
Exercise at any time of a woman’s life is valuable, but during the transition to menopause, it might be even more so to offset the unwanted effects of fluctuating sex hormones such as hot flashes, mood swings, and weight gain. Even if you’re not interested in setting personal bests or gearing up for a big race, the physical and mental health benefits of exercise can ease your experience during this transition and help you lower the risk of osteoporosis and chronic diseases such as heart disease, which goes up significantly after the menopause.
If you still want to try it, here’s what to look out for:
Every woman has a different experience going through peri- and menopause. Symptoms and needs may differ, so getting expert-tailored support can help guide you to feeling your best. Contact your Apeiron Life Client Advocate for more information.
References and additional reading:
Sex difference in oxygen delivery, extraction and uptake:
https://cdnsciencepub.com/doi/10.1139/apnm-2017-0097
Gender differences in metabolism during exercise:
https://pubmed.ncbi.nlm.nih.gov/11101268/
Menopause and loss of lean and muscle mass:
https://www.mdpi.com/2077-0383/9/5/1588/htm
High-intensity resistance training in women and bone density:
https://pubmed.ncbi.nlm.nih.gov/9509822/
Postmenopausal women, strength training and BMD:
https://link.springer.com/article/10.1007/s00198-015-3034-0
Resistance training and body composition: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00752.2018?
Resistance training and intra- abdominal fat:
https://pubmed.ncbi.nlm.nih.gov/12048332/
Menstrual cycle and building muscle:
https://pubmed.ncbi.nlm.nih.gov/35471634/
Sex differences in exercise-induced dehydration:
2023 study on menstrual cycle and strength adaptations: https://www.frontiersin.org/articles/10.3389/fspor.2023.1054542/full#
https://journals.physiology.org/doi/pdf/10.1152/japplphysiol.00266.2021
Heat acclimation for men and women: https://onlinelibrary.wiley.com/doi/full/10.1111/sms.12417
Exercise and hot flashes:
https://www.tandfonline.com/doi/abs/10.3109/00016349009013303
Exercise and life-quality of menopausal women:
https://www.sciencedirect.com/science/article/abs/pii/S0378512214002965
Resistance training and preventing chronic disease:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563593/
Polarized training for menopausal women:
https://www.drstacysims.com/blog/why-menopausal-women-need-polarized-training-2
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