Your legs feel heavy, your sleep is wrecked, and your watch says your fitness hasn’t dropped. In a 2025 survey of 187 experienced endurance women, 88% reported sleep problems and 83% reported exhaustion. If that’s you, you’re not imagining it.
Here’s the catch. Nobody has tested how to change training load for these symptoms. This article lays out what the survey found, what it can’t tell us, and how to adjust sensibly anyway.
What the study measured, and what it didn’t
The paper, in PLOS One, is by Hamilton, Yarish and Heron. It was an anonymous online survey. Women aged 40 to 60 qualified if they had trained in running, cycling, swimming or triathlon for 5+ years and 3+ hours a week. From 265 eligible women, 187 finished it.
Average age was 50.2. Of the group, 18% were premenopausal, 39% perimenopausal and 43% postmenopausal. About 28% were on hormone therapy. Most (84%) rated their general health very good or excellent.
Women filled out the Menopausal Rating Scale. Then they said how much each symptom affected training and performance. In short: this is what athletes felt. It isn’t lab data, and it isn’t measured performance.
The numbers: how common symptoms are in endurance women
Fit women still get hit. The authors say symptom severity looked similar to the general population. Being a trained athlete didn’t seem to shield anyone.
Think of your body as a phone battery. Poor sleep means it never fully charges overnight. You start each workout at 60%, not 100%. Your legs may be fine. The battery isn’t.
That’s why a good fitness number can still feel bad.
Why perimenopause scored highest
Perimenopause is the stretch of changing hormones before your final period. Here is how total symptom scores (higher is worse) compared.
| Stage | Share of sample | Average symptom score |
|---|---|---|
| Premenopausal | 18% (34 women) | 8.0 |
| Perimenopausal | 39% (73 women) | 14.2 |
| Postmenopausal | 43% (80 women) | 11.7 |
Translation: the rough patch often comes before menopause, not after it. Many women expect the worst later and get blindsided at 45.
Scores also tracked with reported training impact. Women who said symptoms had no effect averaged 8.5. Slight was 11.4, moderate 15.1 and strong 19.5. More symptoms, more trouble. That’s an association, not proof that symptoms caused slower training.
Joint and muscle discomfort: read the number carefully
Joint and muscle aches were reported by 63% of the whole group. Among women who reported that symptom, 97% said it hurt training at some level. That sounds dramatic.
Look at severity. Of those women, 39% rated the effect slight, 41% moderate and only 18% strong. Most felt it. Few were sidelined by it.
Aches are common and usually manageable. A strong effect on training is the minority.
From symptom to session: what each finding could mean for you
Here is how the top symptoms line up with reported training effects. The last column is our inference, not a study result.
| Symptom | Reported it | Said it affected training (of those reporting) | Possible adjustment (inference) |
|---|---|---|---|
| Sleep problems | 88% | 92% | Soften or move hard sessions after a bad night |
| Exhaustion | 83% | 87% | Swap intensity for easy aerobic work for a day or two |
| Joint/muscle discomfort | 63% | 97% | Trade impact work for cycling or swimming; keep lifting |
| Weight gain | 67% | 79% | Don’t chase it with extra hard sessions; ask a clinician |
Translation: nearly everyone who had these symptoms felt them in training. But the right response differs by symptom. One rule for all of them won’t fit.
Training load for menopausal athletes: what the evidence supports, and where it runs out
The study tested no training changes. No trial we found has tested weekly volume, hard/easy spacing or intensity mix in menopausal endurance athletes. There’s no research-based formula for your load.
What follows is evidence-informed inference and coaching judgment. It isn’t proven.
- Sleep is the lever to protect. It was the top symptom. After a bad night, a hard session may cost more than usual.
- Flex the hard days, not the whole week. Keep easy aerobic work, the kind covered in how Zone 2 builds the aerobic base. Move or soften intensity on days after a rough night.
- Keep heavy lifting and impact work. In the LIFTMOR trial, women over 58 with low bone mass lifted heavy twice a week for 8 months. Lumbar spine bone density rose 2.9% versus a 1.2% loss in controls. Those women weren’t athletes, but the result argues against dropping strength work.
- Don’t count on training to cure hot flushes. A Cochrane review found insufficient evidence that exercise reduces them.
Evidence on protein, heat tolerance and hormone therapy for athletes is thin or mixed. No athlete trials link hormone therapy to endurance performance.
Pushing through isn’t a plan.
What to tell your clinician
Some symptoms need a medical answer, not a training tweak. Don’t wait for a race block to end before you raise them. Consider bringing:
- Your sleep pattern. How many nights a week are broken, and whether night sweats wake you.
- Your training log. Weekly hours, plus any stretch where easy runs started to feel hard for no clear reason.
- Joint and bone questions. New aches, any stress-type pain, and whether bone health has been checked.
- Your treatment questions. Hormone therapy, protein and heat tolerance. The research for athletes is thin, so a personal talk matters more than a rule.
Severe or sudden symptoms deserve prompt attention. This article isn’t medical advice.
How to read your recovery data when symptoms are active
Your watch tracks sleep, resting heart rate and heart rate variability (HRV), the tiny beat-to-beat timing changes that reflect recovery. A small study of 35 peri- and postmenopausal women found only minor HRV effects from sleep disturbance. So HRV alone may miss a bad menopausal night. In short: trust the whole picture, not one number.
Pair HRV with sleep time, resting heart rate and how you feel. Overload shows up in clusters, as in the 7 research-validated signs of overtraining.
Here’s an illustrative case, not a real athlete. Dana, 51, runs 35 miles a week for a fall half marathon. Through September her night sweats double. She wakes at 2 a.m. most nights and lies awake for an hour. Her resting heart rate sits 4 beats above normal for six days. Her Tuesday threshold run feels like a race.
She swaps that session for 40 easy minutes. She keeps both strength days and shifts her long run back by a day. Two weeks later, sleep settles and the hard work returns.
Here are other swaps she might make on a bad-sleep day:
- Tempo intervals become an easy aerobic run at conversation pace.
- A hard group ride becomes a flat, steady spin.
- Track repeats move two days later, after a better night.
No formula told her that. Her signals and her judgment did. The same logic applies to adjusting recovery and intensity as a masters runner.
Where AthleteOS fits
AthleteOS has no menopause symptom tracker, and we won’t pretend otherwise. It adapts your daily plan from your watch’s sleep, HRV and resting heart rate (Garmin, Apple Health or Health Connect) and shows readiness in plain language. In the AI coach chat you can say, “Bad night, hot flushes, knees sore,” and it can swap or move the session. Start the 14-day trial. After that it’s $19.99 a month or $180 a year.
Limits to keep in mind
This was a cross-sectional survey. Menopausal status was self-reported, and hormone therapy use wasn’t controlled. We don’t know race, income or health history. Results show association, not cause.
Your body is data. So is the watch. Use both.