Menopause, like menstruation,Ěýis often talked about in whispers. We »ĺ´Ç˛Ô’t shout about reaching the period of life when we’re no longer fertile, perhaps because many of the symptoms of menopause are intensely personal: Hot flashes. Night sweats. Weight gain. Mood swings. Painful sex. Insomnia.

It can also wreak havoc on physiological assets we’ve spent a lifetime cultivating, like lean muscle, strong bones, and the ability to bounce back from a challenging workout with eight hours of restorative, protein-synthesizing sleep. Until recently, many of these symptoms were written off as a natural part of aging, as inescapable as grayingĚýhair and wrinkles. But recently, : it’s a lack of estrogen—not advancing age—that’s behind much of the bone deterioration, fat gain, and lean-muscle loss associated with menopause. And that’s good news for aging athletes, since hormonal changes are easier to fight than the inexorable march of time.

Why It Matters

Officially, menopause is caused by the natural decline of estrogen, and it’sĚýdiagnosed after 12 consecutive months without a menstrual cycle. For Americans, this usually occursĚýaround age 51, but perimenopause—the preceding transitional phase—can last anywhere from several months to tenĚýyearsĚýand can begin as early as your thirties.

The detrimental effects of changing hormones typically begin with perimenopause,Ěýsoon after estrogen levels begin to fall.Ěý includeĚýa loss in bone density and Ěýand an increase in —p˛ą°ůłŮľ±ł¦łÜ±ô˛ą°ů±ô˛â . Estrogen loss also slows your metabolism and .ĚýIn part due to these changes, many people seeĚýĚýby the time they reach menopause.

You »ĺ´Ç˛Ô’t have to be an expert to realize that this all translates to feeling heavier andĚýslowerĚýand becoming more prone to broken bones. But while this may sound like a majorĚýbummer, »ĺ´Ç˛Ô’t stress: there are steps you can take to stave off the effects of estrogen decline.

Mitigating Menopause-Related Changes

“Menopause doesn’t mean the end of being a competitive athlete,” says exercise physiologist and nutrition scientist Stacy Sims, who researches training and recovery specifically in relationĚýto female physiology.ĚýSims’s prescription to outsmart estrogen depletionĚýlooks like this: “Lift heavy shit—carefully. Do high-intensity interval training and plyometrics. Up your protein. Do less volume and more intensity. Recover longer.” Here’s how all that breaks down.

Lift Heavy

“You have to try to prevent the loss of muscle and bone, and while cardio will make your heart and lungs fitter, it won’t increase—and might not even prevent—loss of muscle mass,” saysĚý, an exercise physiologist and a professor of geriatric medicine at the University of Colorado Health Sciences Center. “The research is preliminary, but it suggests that those who do resistance training seem to preserve the level of lean mass they had before menopause.” That’s enough reason to hit the gym, get a set of resistance bands, or find a buddy with a weight bench.

Sims is a huge fan of CrossFit,Ěýbecause it combines range-of-motion exercise and heavy resistance, but if you’re not into the competitive culture of CrossFitĚýor »ĺ´Ç˛Ô’t feel comfortable returning to the gym until there’s a coronavirus vaccine, there are plenty of other ways to add resistance to your routine. Dumbbells, resistance bands, and body-weight exercises work just as well.

Ditch Endurance Workouts for HIIT

Resistance training may be the most effective way to build lean muscle mass, but cardio still plays a critical role in keeping you strong and healthy during the menopausal transition and beyond. It’s linked to a healthy heart and lungs, helps burn fat, andĚý. But if you want to reap the most benefits from your cardio, choose high-intensity, calorie-torching interval sessions over long, slow-distance workouts.

“Estrogen naturally prompts your body to synthesize protein into lean muscle. When that’s taken away, you need a new stimulus,” Sims says.ĚýHigh-intensity interval training (HIIT)Ěýcan be that stimulus. It prompts your body to and more effectively than a slow-burn endurance workout. It also helps your body continue to process insulin efficiently, making you less prone to , which increases the risk of being overweight, having high blood pressure, and developing heart disease or .

Train Hard, Recover Harder

Athletes in menopause are prone to overtraining, particularly if they’re trying to regain the leaner, tonedĚýbody they enjoyed premenopause. “You might try to push harder and longer to get rid of this new belly fat, but ultimatelyĚýthat backfires, because it puts you in a state of low-energy, high-stressĚý,” Sims says.

To be clear, cortisol on its own isn’t a bad thing. Yes, it’s known as the stress hormone,Ěýreleased in traditional fight-or-flight scenarios, but cortisol is also responsible for that extra surge of adrenaline on the starting line of a race, and it can provide a little immunity to the pain and suffering that’s to come. Cortisol cycling occurs when you’re under constant stress, which can force your cortisol levels to stay elevated for far longer than is needed to outrun your rivals in a competition. Eventually, cortisol imbalance can lead to weight gain, exhaustion, and a loss in muscle mass—just what you »ĺ´Ç˛Ô’t want. The secret? More rest.

“You need to work out with intensity, but you also have to recover harder,” Sims says. “Everything just takes a little longer.”ĚýAnd remember that the ways you might have measured your fitness in the past—short recovery times, a toned stomach—aren’t good gauges of your hard work as you age.

Sims recommends shorter training blocks for aging athletes. Think along the lines of a two-week build-up of exercise, followed by one week of less intense movement, as opposed to three weeks on, one week off. She also recommends mobility work like foam rolling, dynamic stretching, and body-weight movementsĚýto offset stiffening tendons and ligaments. A heart-rate monitor or other fitness wearable, such as theĚý,Ěýwhich calculates recovery based on perceived strain and sleep quality, may also help you avoid overtraining.

Hormone-related sleep issues present another challenge.ĚýBoth estrogen and progesterone affect sleep quality and quantity; as your hormones drop, ,Ěýresulting in poor recovery. (Recurring bouts of hot flashes and night sweats »ĺ´Ç˛Ô’t help, either. And yes—you can blame estrogen loss for that, too.) But before you reach for the melatonin, Sims recommends downing a glass of tart 30 minutes instead. Not only has tart cherry juice been shown toĚýĚýand reduceĚýĚý(prompting ), it’s also one of the few food sources ofĚý

Change Your Workout Fuel

Declining estrogen causes your body to become more sensitive to carbohydrates and insulin, which wreakĚýhavoc on your metabolism. You may also struggle to digest fructose, which is a common ingredient in sports-nutrition products. “Change your diet to emphasize high-quality protein, fat, and carbohydrates from fruit, vegetables, and whole grains,” Sims says. She also recommends replacing fructose-containing sports-fuel products with those containing simple sugars such as glucose, dextrose, and sucrose, which fuel menopausal bodies with fewer associated gastrointestinal issues.

You also need to eat protein. A lot of it. Your daily protein needs vary based on activity levels. But for anyone in menopause, Sims recommends about 1.1 grams of protein per pound of body weight. For a 150-pound person, that’s more than 160 grams of protein per day.

While that protein should be spread throughout the day, Sims is adamant about one point: menopausal people need to consume a whopping 40 grams of high-quality protein with about fourĚýgrams of (one of nine essential amino acids) within 30 minutes of a hard workout to help build lean muscle and recover. Two scoops of most whey protein powders (or a leucine supplement) will get you there, but you can also get leucine from food sources, including eggs, soybeans, chicken, almonds, beef, salmon, and peanuts. There’s alsoĚý suggesting thatĚýgetting enough high-quality leucine may reduce cognitive impairment—sometimes called brain fog—that many people cite as a menopausal symptom. That’s because it helps decrease levels of tryptophan in the brain. While tryptophan is a generally beneficial amino acid that can be converted into serotonin and melatonin (which helpĚý andĚý), too much of it can make you feel fuzzy and fatigued.

Consider Supplementation

Make sure you get enough calcium andĚý. The National Osteoporosis Foundation recommends a total daily intake of 1,200 milligramsĚýcalcium and between 800 to 1,000 international units (IUs) ofĚý for goodĚý. For reference, a glass of milk contains about 300 milligrams of calcium, and one serving of salmon nets you between 250 and 1,000 IUs of vitamin D (wild-caught salmon boasts higher levels of vitamin D). If you aren’t sure you’re getting enough from your diet, »ĺ´Ç˛Ô’t hesitate to take aĚýsupplement.

Don’t Give Up

If you’re months or years past the menopausal transition, »ĺ´Ç˛Ô’t despair. There’s still time to mitigate itsĚýeffects on your body.

“Exercise can’t entirely reverse the effects of declining estrogen on the body,” the University of Colorado’s Kohrt says. “But there are so many potential health benefits, regardless of what you do. Anything is better than nothing—and it’s never too late to start.”

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Getting diagnosed with most kinds of cancerĚýused to be shorthand for being granted exercise clemency, a pardon for indefinitely skipping your workout. No one expects a cancer patient to hit the gym when they’re sick and bald, and until recently, any exercise undertaken while in treatment was considered a bonus. Also, no one really knew how much exercise was safe during active treatment.

Then, in October 2019, the American College of Sports Medicine (ASCM), the American Cancer Society,Ěýand 15 other international organizations published for people with cancer. For the first time, scientists from around the world wrote out a formal exercise prescription for those undergoing cancer treatment: at least 30 minutes of moderate-intensity activity three times per week, plus two weekly strength-training sessions. Researchers cited the fact that exercise not only bolsters physical and mental health, but that scads of new data proved the value of physical activity in helping treat and prevent cancer.

And that’s important, particularly ifĚýyou’re among the small population of young, otherwise healthy people who are diagnosed with cancer each year. Take Kikkan Randall, for example. The 37-year-old cross-country skier was diagnosed with breast cancer just threeĚýmonths after winning a gold medal with teammate Jessie Diggins at the 2018 Olympics in Pyeongchang, South Korea. The —blondĚýhair streaked with pink highlights, face still flushed from skiing her heart out—leaping on Diggins after she crossed the finish line is one of the most enduring moments of the Winter Games. Randall and Diggins broke a 42-year medal drought with their victoryĚýand became the first Americans to win gold in the sport. It was Randall’s 18thĚýOlympic race, and her last, as she’d already announced plans to retire after Pyeongchang. That was February 2018. By July, Randall was in a chemo-infusion suite, having the first of many treatments designed to intentionally break down the strong, healthy body that had just carried her to gold-medal greatness.

In treatment for breast cancer at 35, Randall was an outlier. When I was diagnosed last year at age 36—right in the middle of my cyclocross season, and just five months after Randall—I was, too: fewer than 5Ěýpercent of the 267,000 American women diagnosed with breast cancer each year are under 40. Sixty-two is the average age at diagnosis, and nearly half of all cancer survivors are older than 70.

As such, traditional exercise recommendations during chemo and radiation often include directives like: “Try to go for a short walk each day” or “Do a few gentle stretches if you feel up to it.” Data from 2018 published in suggests that lessĚýthan 25 percent of oncologists refer patients with cancer to exercise programming, despite conclusions published in the Ěýnoting that people with cancer safely could—and should—exercise during and after treatment if given a physician’s OK.

Until last October, the 2010 ACSM recommendations were all that cancer patients had to go by. And due to limited research data, they were just that—recommendations, rather than a specific prescription for exercise. In essence, they boilĚýdown to one piece of advice for cancer patients: “avoid inactivity.” It’s not surprising that many medical professionals, when faced with overwhelmed cancer patients, decided to go light on the exercise pep talk.

But for Randall, whose entire career had been crafted around precise physiological data, the idea of maintaining fitness with a short daily walk was absurd. Randall completed her active treatment (six rounds of chemotherapy and 33 rounds of radiation) in January 2019. The new exercise guidelines came too late to influence her workout routines during that time, but even if they hadn’t, Randall would have exceeded them in a bid to retain at least some of the fitness she’d acquired as an athlete at the top of her game.

During her active treatment, Randall adapted her workouts to match her energy levels and treatment schedule. She worked with her former strength and conditioning coach from the U.S. Ski Team to create a circuit workout to maintain strength, and she also spoke withĚý, a cardiac oncologist at the MD Anderson Cancer CenterĚýin Texas, for guidance on safely maintaining cardiovascular fitness.

Gilchrist, a former professional tennis player and collegiate national champion, specializes in developing exercise programs to help cancer patients mitigate the deleterious effects of treatment on cardiovascular fitness. She developed the at MD AndersonĚýand is an adviser for , a new app designed to help breast-cancer patients navigate treatment options and incorporate healthy habits, like regular exercise,Ěýinto their daily routines. As evidenced by Gilchrist’s research, which uses epidemiology to study the relationship between cardiorespiratory fitness and cancer treatment and outcomes, breast-cancer patients can and have regained precancer fitness levels. This gave Randall hope.

Having retired from skiing just months before, Randall was able to pivot to other sports she enjoyed in her bid to keep moving through treatment. She asked her oncology nurses if she could bring a bike trainer in to pedal onĚýduring chemo infusions (request denied), then compromised by cycling to treatments or hitting the gym first. She went mountain biking, skied the day after her lumpectomy, and even ran a 10K during chemo. Randall also competed in the 2019 ski race just after finishing treatment, though she admits she was lacking the extra gears she was accustomed toĚýand, looking back, says she “hadn’t fully appreciated the effect treatment had on my body.”

Randall worked out with far more intensity than most cancer patients while undergoing treatment, and, motivated by the she posted on her website, . But you »ĺ´Ç˛Ô’t have to exercise with the fervor of a retired Olympian or an aspiring bike racer to see major health boons.

The benefits of staying active are fourfold: that physical activity can reduce your risk of developing several common types of cancer, as obesity is . Exercise can also make treatment more effective by slowing tumor growth and even reducing tumor size on a cellular level, while decreasing chronic inflammation and . It can ease the effectsĚýof treatment by improving cardiorespiratory fitness and mitigating muscle loss. (Without intervention, your cardiorespiratoryĚýfitness levelsĚýcan nosedive as much as .) And it can promote positive changes in anxiety, mood, fatigue, and quality-of-life markers for physical, mental, and emotional health.

If you’re already physically active at diagnosis, you’re a step ahead of the pack. That said, working out doesn’t make you immune, as evidenced by Randall’s diagnosis just months after winning Olympic gold. But for Randall and other young, fit cancer patients, it’s a way of clinging to some kind of normalcy while your body is physically and mentally under siege. It also makes it easier to bounce back.

“Every day I’m feeling stronger, and I’m grateful I stayed so active during treatment,” says Randall, who won her age group in the 2020 American Birkebeiner ski race and less than a year after finishing treatment. “I’m optimistic by nature, but I feel confident I’ll come back from this to be just as good as I want to be.”

And perhaps the best news to come out of the new research, even for athletes who have already received a cancer diagnosis:Ěýall of that exercise is dialing back your chances of suffering a recurrence. And that’s as good a reason as any for lacing up your running shoes or strapping on your skis.

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