Training Through Menopause—with Dr. Stacy Sims

Training through menopause can be a challenging time. Dr. Stacy Sims spotlights the myriad ways female athletes are impacted by menopause in Next Level. Just as she ignited the conversation around the menstrual cycle and the tell-tale signs it has for coaches and athletes with Roar, she now tackles this important topic in a second ground-breaking book, delivering some radical advice for female athletes and coaches.

RELATED: Separating Fact from Fiction for Female Athletes—with Dr. Stacy Sims

For some athletes, menopause can be a tumultuous time, disrupting their training routine, lifestyle, and emotional well-being. Dr. Sims encourages coaches to engage in the menopause conversation with their athletes. By offering a perspective that is rooted in female physiology and flexibility, coaches can ease the athlete’s experience and keep their enjoyment of sport intact.

Video Transcript

Emma-Kate Lidbury  0:05

So Stacy, you’ve helped change the conversation around menopause significantly, I would say, really helping to bring it into the mainstream, and obviously helping scores and scores of female athletes in the process. What is it that coaches really need to know when they’re working with female athletes who are going through the menopause.

How menopause interrupts training adaptation

Dr. Stacy Sims  0:22

Unfortunately, a lot of the signs and symptoms of perimenopause are very similar to low energy availability. So the question always is, how do I tell the difference?

So first and foremost, have your athletes fuel for what they were doing and recover from it, so that we can look and make sure that the delta is appropriate for energy in/energy out.

The second is actually taking a look at the training, because we know from research that there are sex differences from birth, which for the most part is about muscle and muscle mitochondria. So we don’t have to worry about volume. I know that scares a lot of endurance athletes who are like “What? No, I want to keep my volume.” But unfortunately, with a lot of volume and moderate-intensity training, it backlashes on the peri- and postmenopausal athlete. With that moderate-intensity training, it increases baseline cortisol—which then feeds forward to increasing abdominal adiposity, reducing ability to adapt to training—we see a loss in lean mass, and of course, we start seeing a higher incidence of bone stress injuries. We see a lot of soft-tissue injuries and joint pain at this time too because of hormone changes that are happening.

So as a coach, understanding that when you start seeing missteps in training adaptation—maybe your athlete is complaining about putting on weight and doesn’t know what to do, making sure they don’t fall into training more/eating less—we have to look at the type of training. So we want to really polarize the training. So we have really, really slow, easy, easy recovery.

But the bulk of the training is all about quality. So we have heavy resistance training, we have true high intensity, like VO₂ workouts or sprint intervals, because we’re looking for nervous system adaptation. Often warming up before a sprint interval session or VO₂ session by doing some plyometrics. So we’re doing some box jumps or some squat jumps just to get the central nervous system listening. Because that’s the main thing that we start to lose when we lose estrogen is that central nervous system response for power and speed. So we have to change up the training and really make sure that we are fueling for and recovering from each session.

A new approach to training in menopause

EK  2:36

Okay, so what should the [complexion] of a training week look like then? Because obviously when you say the word polarized I think 80/20: 80% low intensity, 20% high intensity. Are you saying that should be flipped, or … ?

Stacy Sims  2:48

Yes.

EK  2:49

Okay.

Stacy Sims  2:50

Yeah, because we’re dropping the volume significantly, and we’re looking at the quality of work. So we want to look at non-race season: three—minimum of three heavy resistance training sessions a week, and minimum of three of those are sprint and high-intensity sessions. And we can have a recovery in between, which might be 30 minutes that’s super easy, easy walk/run where it’s embarrassingly slow. But the quality is about that sprint and high intensity like true high-intensity work and resistance training.

EK  3:22

So do you—have you heard of, or have you, maybe you’ve personally experienced any feedback or backlash from athletes who have maybe spent decades flipping—you know, doing 80/20 training the other way around; the prospect of doing 80% of their training high intensity and/or heavy resistance?

Stacy Sims  3:39

Absolutely. I know, I have. Almost every day I hear it.

EK  3:44

Okay.

Stacy Sims  3:45

Yeah, a lot of ultra-endurance athletes are like, “Where do I get my long miles in? How do I do this? How do I be an ultrarunner? How do I train for Western States 100?” And again, we have to bring it back down to the stress the body is under when we’re in peri- and postmenopause with higher baseline cortisol, not being very stress-resilient, seeing changes in our heart rate variability. So it’s not that you’re not going out and doing the long stuff, it’s just that it is not the bread and butter and the bulk of it because that is not what the body needs right now. You’re trying to do quality during the week, or you can split it and have Monday, Tuesday quality; Wednesday is that long, slow, slow stuff; Thursday, Friday’s quality; and then [on the] weekend, you’re recovering. And then the one week of recovery, this is where I have my ultra-endurance athletes do lots of mobility work, seeing how they move, not changing up their patterns of going to the gym, but changing what they’re doing. And then having one or two really long but super, super chill sessions. So it’s not a group ride. It’s not going out with the boys. It’s making sure that you are in control so that you are keeping it really easy so that your body is fully recovered. You’re getting the mental stimulus of being able to go long, and then you can start the quality again in the next two-week cycle.

EK  5:05

Yeah. So I mean, really, this perfectly underscores the message of, well, firstly, the message of women are not small men, but also the importance of understanding how different female physiology is and the impact of that on training. Because it is quite literally the opposite of what your male counterpart would be doing if they’re preparing for Western States or Leadville 100 and so on. So …

Stacy Sims  5:05

Exactly.

Fueling and recovery in menopause

EK  5:05

And so then when it comes to fueling and recovery for these athletes—for the pre-menopausal, perimenopausal, menopausal, or postmenopausal—how does fueling and recovery then change? And what advice do you have for coaches to help these athletes on when it comes to fueling and recovery?

Stacy Sims 5:49

Yeah, so for peri- and postmenopausal women, the post-exercise protein intake is super important, where we’re looking at 35 to 40 grams post-exercise, within that 30 to 45 minutes. Because as our hormones change and we get older, we become more anabolically resistant–our muscle tissue becomes really anabolic and resistant. And we need that. And we also need regular doses of protein throughout the day. That becomes the big nuance, when we’re talking about protein [and] protein intake. When we’re pre-menopausal, we can get away with a little bit more because we have estrogen that really helps with lean mass and recovery.

But the biggest thing is carbohydrate availability, regardless of age. So we need to make sure that when we are pre-menopausal, we are increasing our carbohydrate intake in and around training in the high-hormone phase so we have more carbohydrate availability. Because if we are not paying attention to carbohydrate availability, then we’re not going to be able to hit those intensities or those workloads that we want.

And that’s the whole idea of training, is going and getting that really strong training stress to be able to adapt to it and then recover from it. We know that with peri- and postmenopause, we need more recovery. Total recovery. So we look at periodizing within the week of the training. So you might have two morning sessions, and then one evening session, so you have a 36-hour recovery. So it’s not skipping days, but it’s looking at where those sessions are to give the body more recovery between sessions.

Communication and flexibility are the keys to good coaching

EK  7:14

Yeah, makes sense. And then how do you advise coaches to best guide their athletes through these different phases of menopause? Because as you’ve obviously highlighted, it’s a time—it can be a very challenging time. With an increase in—it can be, for some—an increase in anxiety, an increase in sleep disturbance, and a lot of a lot of things related to that. How do you best advise or how do you advise coaches to best guide their athletes through this?

Stacy Sims  7:45

First and foremost, not ignore it. Because perimenopause/menopause is the taboo conversation that the menstrual cycle used to be. Sure, there’s still taboo around that, but it shouldn’t be in the closet anymore. We shouldn’t be, you know, saying, “Oh, well, you can’t sleep because you’re overstressed. Go on an SSRI.” It’s more, “You can’t sleep because there’s changes in your neurotransmitters.” So we need to look at getting some help with that. Maybe we’re looking at L-theanine to help with sleep. Or maybe we’re looking at moving your training sessions more towards the morning so the evenings are more parasympathetic.

So understanding that these changes are going on so you can manipulate the training with your athlete. And there are days where she’s going to feel like she’s bulletproof. So let her really attack those sessions, those high-intensity sessions on the days she feels bulletproof. And there could be days where she has key workouts and she’s like, “I am flat. I can’t do this.” Allow that change. Be ecologically valid by having those conversations with your athlete and being flexible within the framework: Giving her more empowerment over her training and the feedback that you get, because then that feeds forward to better mental resilience. And also that she understands that this is something her body’s going through, but it’s not a permanent situation. It’s just a really sucky situation at the moment. But there are things that you can do by changing training, by increasing protein intake. And you can still keep progressing, but we have to really dial that training differently to help with these changes, and have that conversation about these changes and not ignore them.