Observational study finds menopause symptoms common among female endurance athletes — Evidence Review

Menopause symptoms are highly prevalent among female endurance athletes, with many reporting negative impacts on their training and performance, according to a new study published in PLOS One. Related research generally supports these findings, indicating that hormonal changes, sleep disturbances, and physical symptoms can interfere with athletic activity for women in similar populations.

• The new study’s findings align with existing research showing that both menopausal and menstrual symptoms frequently disrupt training, motivation, and performance in female athletes, particularly through sleep disruption, joint discomfort, and mood disturbances 1 3 4 5 11.
• Prior studies confirm that sleep issues and fatigue are common during periods of intensified training and hormonal transition, and these factors are associated with reduced performance and increased perceived exertion in both elite and recreational athletes 6 7 8 9 10.
• Research on menopause and physical activity further suggests that high activity levels may mitigate some negative health effects of menopause, but do not fully prevent performance-related symptoms, underscoring the need for tailored support and interventions for athletic women during the menopausal transition 11 14 15.

Study Overview and Key Findings

Understanding how menopause symptoms affect highly active women is important as more women maintain athletic lifestyles into midlife. While physical activity is generally associated with reduced menopause-related difficulties, this study highlights that even among dedicated endurance athletes, menopause symptoms remain a significant challenge, particularly for training and competition. The research addresses a gap in the literature regarding the prevalence and impact of these symptoms in older female athlete populations—a group that is growing but often overlooked in sports science.

Property	Value
Study Year	2025
Organization	Old Dominion University
Journal Name	PLOS One
Authors	Heather Hamilton, N.M.Y.
Population	Female endurance athletes aged 40-60
Sample Size	n=187
Methods	Observational Study
Outcome	Menopause symptoms and their impact on training and performance
Results	88% reported sleep problems, impacting training and performance

The study surveyed 187 female endurance athletes (runners, cyclists, swimmers, triathletes) aged 40-60 who trained at least three days per week. Using the Menopausal Rating Scale, researchers found that sleep problems (88%), physical and mental exhaustion (83%), sexual problems (74%), anxiety (72%), irritability (68%), depressive mood (67%), weight gain (67%), hot flushes (65%), and joint/muscular discomfort (63%) were common. Symptoms most likely to interfere with training and competition included joint and muscular discomfort, weight gain, sleep disturbances, and exhaustion. Notably, 97% of athletes who experienced joint discomfort said it negatively affected training, and 91% said it hindered performance. About a third of participants reported menopause had a moderate or strong negative effect on training.

While the study’s cross-sectional design and limited demographic data restrict generalizability, the authors conclude that menopause symptoms are both prevalent and impactful among female endurance athletes, with severity similar to that seen in the general population. The findings highlight the importance of recognizing and addressing menopause-related symptoms to support continued physical activity and performance in athletic women.

Literature Review: Related Studies

To contextualize these findings, we searched the Consensus scientific paper database (containing over 200 million papers) for relevant literature. The following search queries were used:

1. menopause symptoms elite athletes
2. sleep problems endurance training impact
3. performance effects menopause athletic women

The table below summarizes key themes and findings from the related studies:

Topic	Key Findings
How do menopause and menstrual symptoms affect female athletes' training and performance?	- Both menopause and menstrual symptoms (e.g., joint pain, fatigue, mood changes) commonly interfere with training, motivation, and performance for female athletes, especially during hormonal transitions 1 3 4 5 11. - Many athletes attempt to control or manage their menstrual cycles to minimize negative impacts on competition and training 1 2.
What is the prevalence and impact of sleep problems in athletic women, and how do they relate to performance?	- Sleep disturbances are frequent among female athletes, often intensified during periods of hormonal change, high training loads, or overreaching, and are strongly associated with impaired exercise performance and recovery 6 7 8 9 10. - Both menopause and intensive training can independently and jointly contribute to sleep disruption and related performance deficits 6 7 9 10.
How does physical activity influence menopause symptoms and physical function?	- High levels of physical activity can mitigate some negative menopause-related effects on muscle strength, power, and overall health, but do not fully prevent symptoms or their impact on training/performance 11 14 15. - Masters and peri/post-menopausal athletes are capable of rigorous training, but still experience menopause symptoms that may constrain participation 3 14 15.
What are the nutritional and management considerations for female athletes during menopause?	- Adequate energy and protein intake, hydration, and tailored nutrition can support performance and health in menopausal athletes, but individualized approaches are needed due to hormonal variability 15. - Education for athletes and coaches on menopause and menstrual cycle impacts is important for optimizing health and performance 1 12 13 15.

How do menopause and menstrual symptoms affect female athletes' training and performance?

A consistent theme across related studies is that both menopause and menstrual symptoms can significantly disrupt training and competition for female athletes. The new study’s finding that the majority of endurance athletes experience sleep problems, exhaustion, and joint discomfort—with direct negative effects on training and performance—is echoed in research on both menopausal and younger elite athletes. These symptoms are not only prevalent, but also perceived as barriers to optimal performance and motivation, prompting some athletes to seek ways to manage or control their cycles.

• Menopause and menstrual symptoms such as fatigue, pain, and mood disturbances are frequently cited as reasons for reduced motivation and performance, with athletes often seeking strategies to manage these effects 1 4 5.
• The desire to minimize the impact of symptoms on competition leads some athletes to actively regulate their hormonal cycles, for example through hormonal contraceptives 1 2.
• Masters athletes, including weightlifters, report that menopausal symptoms can constrain training, even among those with high training volumes and experience 3.
• The prevalence of depressive mood and irritability among peri- and post-menopausal athletes is similar to that of the general population, but these symptoms can still interfere with athletic participation 3 11.

What is the prevalence and impact of sleep problems in athletic women, and how do they relate to performance?

Sleep disturbances stand out as a major factor impacting both health and performance, especially among female athletes dealing with hormonal transitions or high training demands. The new study’s finding that sleep problems are reported by 88% of participants, with substantial effects on training, is supported by multiple studies documenting sleep disruption during periods of overreaching, competition, and hormonal change.

• Overreached endurance athletes experience declines in sleep quality, increased illness, and reduced performance during high training loads 6 9.
• Elite athletes often fail to meet sleep recommendations during training and competition, with sleep particularly impaired on competition nights and during periods of high stress, travel, or early/late training sessions 7 10.
• Sleep loss, whether due to menopause, training, or other factors, is consistently associated with declines in exercise performance, especially in endurance and strength tasks 8 10.
• Both hormonal changes (menopause, menstrual cycle) and training-related stressors independently and additively increase the risk of sleep problems in athletic women 6 7 9 10.

How does physical activity influence menopause symptoms and physical function?

While high levels of physical activity are generally beneficial for overall health and may counteract some negative effects of menopause, they do not appear to fully prevent menopause symptoms or their impact on training and performance. The new study confirms that even among highly active women, menopause symptoms are common and impactful.

• Physically active women may experience better muscle strength, aerobic capacity, and walking speed during menopause, but still report declines compared to premenopausal peers 11 14.
• Longitudinal studies suggest that while physical activity supports maintenance of some physical functions, menopause is associated with reductions in muscle strength and power regardless of activity level 14.
• Masters athletes are capable of rigorous training and top performances, but menopause symptoms can still constrain their participation and require adaptation 3 14.
• Nutritional strategies, including adequate protein and energy intake, may help counteract some menopause-related declines, but symptom management remains important 15.

What are the nutritional and management considerations for female athletes during menopause?

Managing menopause symptoms in athletic women requires more than just maintaining high activity levels; individualized nutrition, hydration, and education are also critical. Recent position statements and reviews emphasize the need for tailored support, as hormonal fluctuations influence energy, protein, and fluid needs.

• Female athletes should monitor and adjust their nutritional intake to meet changing needs during different stages of the menstrual cycle and menopause, with particular emphasis on protein and hydration 15.
• There is a lack of research on sex-specific supplementation, but iron and creatine are highlighted as beneficial for peri- and post-menopausal women 15.
• Education for athletes, coaches, and healthcare providers about the impacts of menopause and the menstrual cycle can improve management and support for female athletes, potentially reducing barriers to participation 1 12 13 15.
• Open communication and increased awareness of hormonal health can help address the reservations and lack of knowledge often reported by athletes 1 12 13.

Future Research Questions

Despite growing evidence that menopause symptoms impact female athletes’ training and performance, many questions remain. Larger, longitudinal, and intervention-based studies are needed to clarify mechanisms, develop targeted strategies, and support optimal health and performance in this expanding population.

Research Question	Relevance
What interventions are most effective for reducing menopause symptoms in endurance athletes?	Identifying evidence-based interventions can help athletes and providers better manage symptoms, maintain participation, and improve performance during menopause 14 15.
How do different types and intensities of physical activity affect menopause symptoms and performance in athletic women?	Understanding the relationship between training modalities, intensity, and menopause symptom severity may allow for more individualized and effective training plans for women during the menopausal transition 11 14 15.
What are the long-term effects of menopause on injury risk, recovery, and health outcomes in female athletes?	Long-term studies are needed to determine how menopause influences not only performance but also injury rates, recovery, and broader health metrics in athletic women 3 14.
How do nutritional strategies impact menopause symptoms and performance in female athletes?	Targeted nutritional interventions (protein, creatine, iron, hydration) may help alleviate symptoms and support performance, but optimal approaches for this population remain unclear 15.
Does improved education and communication about menopause and menstrual health improve athlete well-being and performance?	Enhancing knowledge and support systems may reduce barriers and improve outcomes for female athletes, but more research is needed to assess the effectiveness of educational and communication interventions 1 12 13 15.

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This comprehensive review highlights the need for continued research, education, and targeted interventions to support the health and performance of female athletes experiencing menopause symptoms. Addressing these challenges will be increasingly important as the population of active midlife women continues to grow.