Perimenopause and Athletic Performance: A Guide for Serious Women Athletes

You're Not Getting Weaker. Your Hormones Are Shifting.

You've been training for years. You know your body. You know what a hard week feels like versus a hard month. So when your performance starts slipping in ways that don't match your training load, it's disorienting. Your pace is slower. Your recovery takes longer. Your heart rate spikes in ways it never used to at the same effort levels.

This is not a fitness failure. It's perimenopause. And the more you understand what's actually happening in your body, the better equipped you are to adapt without losing the athletic identity that matters so much to you.

Estrogen does a lot of work in an athlete's body. It supports muscle protein synthesis, helps regulate body temperature, protects joints by supporting cartilage and collagen production, and plays a role in oxygen delivery to working muscles. When estrogen levels start fluctuating, all of those systems feel the impact. The good news is that this is a transition, not an end.

How Perimenopause Affects VO2 Max and Endurance

VO2 max, your body's maximum oxygen uptake capacity, does decline with age. But research suggests that menopause itself accelerates this decline independent of age. A study published in the Journal of Applied Physiology found that women in the menopausal transition showed steeper reductions in VO2 max than could be explained by aging alone. Estrogen appears to support the cardiovascular adaptations that keep aerobic capacity high, and when it fluctuates, that support wavers.

You might notice this as a feeling of working harder at your usual pace. Your lactate threshold may shift, meaning you hit that breathless, burning feeling at a lower intensity. Heat regulation becomes more erratic during this transition, which matters enormously for endurance athletes because overheating compromises performance and recovery alike.

This doesn't mean your aerobic capacity is gone. It means your training needs to account for the variability your body is experiencing. On days when your hormonal patterns create a better window, you may perform very close to your previous baseline. On harder days, scaling back is a strategic choice, not a weakness.

Strength, Muscle Mass, and Recovery Time

Estrogen has a meaningful role in muscle protein synthesis, the process by which your body builds and repairs muscle tissue after training. As estrogen fluctuates, muscle recovery slows. You may find that you need more time between hard sessions to feel ready to perform again. Soreness lingers longer. Strength gains come more slowly.

Progesterone, which also fluctuates during perimenopause, can have a catabolic effect on muscle in excess. This means some phases of your cycle during perimenopause may genuinely feel like your strength is temporarily reduced, not because you've lost fitness but because of the hormonal environment your muscles are operating in.

The practical response here is to prioritize protein intake more deliberately than you have in the past, particularly in the 30-60 minutes following training. Research suggests perimenopausal women need more dietary protein than they did in their 30s to achieve the same anabolic response in muscle tissue. Aim for 1.6-2.0 grams of protein per kilogram of body weight daily, and consider spreading that intake across meals rather than concentrating it at one sitting.

Injury Risk: Why Your Joints and Tendons Need More Attention Now

Estrogen supports cartilage, tendon, and ligament health. It plays a role in collagen production throughout the body, and collagen is the structural protein that keeps connective tissue resilient. When estrogen fluctuates, tendons and ligaments can become less elastic and more prone to injury. Female athletes in perimenopause report higher rates of tendinopathy, particularly in the Achilles, patellar tendon, and rotator cuff.

ACL injury risk is also worth understanding. Research has long noted that women have higher ACL injury rates than men during the reproductive years, with estrogen's effect on ligament laxity being one proposed factor. During perimenopause, the pattern shifts somewhat, but joint instability and reduced connective tissue resilience remain concerns for athletes who are changing direction, jumping, or training at high intensity.

Warming up more thoroughly than you used to is not optional during this transition. Spending more time on movement preparation, working on hip and glute strength to protect the knee joint, and building in more mobility work can meaningfully reduce your injury risk. This isn't about becoming more cautious. It's about being smarter.

RED-S Risk: What Lean Athletes Need to Know

Relative Energy Deficiency in Sport, known as RED-S, is a condition where an athlete's energy intake is chronically insufficient relative to their training load. It affects hormones, bone health, immunity, cardiovascular function, and psychological wellbeing. Female athletes are at particular risk, especially those who are lean, train at high volume, or have restrictive eating patterns.

Perimenopause creates a specific intersection of risk. As estrogen declines, bone mineral density decreases. If you're already an athlete with lower body fat and potentially insufficient calorie intake, the compounding effect on bone density is serious. Stress fractures become more likely. The hormonal disruption of RED-S layered on top of perimenopausal hormonal changes can make the transition significantly harder than it needs to be.

Signs that your energy availability may be too low include persistent fatigue that doesn't resolve with rest, frequent illness, recurring injuries, loss of your menstrual cycle (or irregular cycles), mood disruption, and poor sleep. If you recognize several of these, working with a sports dietitian who understands the menopausal transition can be genuinely valuable. Fueling adequately is not in conflict with being a serious athlete. It is what being a serious athlete actually requires.

Fueling for Performance During Hormonal Transition

Your nutritional needs have changed. This is not a moral failing or a sign that you need to diet differently in the usual sense. It's physiology. Perimenopause shifts insulin sensitivity, which means carbohydrates are processed somewhat differently than they were in your 30s. Blood sugar swings can become more pronounced, making carbohydrate timing around training even more important.

For performance fueling, the general principle of carbohydrates around training still applies, but pay attention to how you feel when you experiment with timing and types. Some athletes in perimenopause find that slightly lower-glycemic carbohydrate sources outside of training windows help with energy stability. During training and racing, fast-acting carbohydrates remain important and should not be restricted.

Hydration deserves more attention during this transition. Estrogen helps maintain plasma volume, the fluid component of blood. With fluctuating estrogen, some women find their hydration needs feel less predictable, and they're more sensitive to dehydration. Sodium intake is worth considering, especially during hot weather or long training sessions. If you're cramping more than usual or feeling depleted after workouts where you previously didn't, electrolyte status is worth exploring.

How Elite Athletes Are Navigating This Differently Now

The conversation about perimenopause and athletic performance has shifted significantly in the last several years. Elite athletes are speaking openly about their experiences in ways that simply didn't happen before. Runners, cyclists, tennis players, and team sport athletes at the highest levels have been public about the fact that perimenopause affected their performance and required a genuine change in approach.

Many elite women athletes are now working with physicians who specialize in sports medicine and menopause together, a combination that was rare a decade ago. Hormone therapy is increasingly being discussed not just as a quality-of-life intervention but as a legitimate performance consideration, with research examining how stabilizing estrogen levels affects muscle recovery, VO2 max, and injury rates in athletes.

The shift in attitude matters because it normalizes the experience. You don't have to pretend this isn't happening. You don't have to train through it as if nothing has changed and then feel like you've failed when your body responds differently. The athletes who are navigating this best are the ones who treated it as new information to work with rather than a problem to ignore.

Adjusting Your Training Without Losing Your Athletic Identity

Your identity as an athlete doesn't depend on hitting the same numbers you hit at 35. That's worth saying plainly, because for many serious athletes, the performance metrics and the sense of self are deeply intertwined. Adapting to perimenopause can feel like losing something fundamental, when really it's a recalibration.

Some practical shifts that many perimenopausal athletes find helpful: building more recovery days into training blocks, extending warm-up time to 15-20 minutes before hard efforts, prioritizing sleep as aggressively as you prioritize training, experimenting with training at different times of day to find when you feel most capable, and tracking your symptoms and energy alongside your training to identify patterns.

Tracking those patterns is genuinely useful. When you can look back over several weeks and see that your harder days tend to cluster around certain hormonal shifts, you can start planning training with more intelligence. Apps like PeriPlan let you log symptoms and energy levels daily so you begin to see your own rhythms, which gives you real data rather than just a vague sense that things feel unpredictable. You know how to train smart. This is just a new layer of data to incorporate.

Building a Support Team That Gets It

Not every sports medicine physician or primary care provider understands the intersection of perimenopause and athletic performance. You may need to be specific and persistent in asking for what you need. An ideal support team for a perimenopausal athlete includes a gynecologist or menopause specialist who is familiar with active women, a sports dietitian who understands both performance nutrition and hormonal changes, and a coach who is open to adapting your program.

If your current provider dismisses your performance concerns as just aging or just stress, that is not an adequate response. There are legitimate, evidence-based interventions that can support you, from nutritional adjustments to hormone therapy to periodized training adaptations. You deserve providers who engage with your full picture.

Women's sports medicine is growing rapidly, and resources specifically for perimenopausal athletes are more available than they were even five years ago. Seeking out a provider with a menopause certification through NAMS (the North American Menopause Society) or similar credentials is a reasonable place to start.

Medical Disclaimer

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.