Frequency and perceived influence of menopausal symptoms on training and performance in female endurance athletes

TL;DR

This cross-sectional survey of 187 female endurance athletes aged 40–60 found that menopausal symptoms were highly prevalent despite high physical activity levels, with sleep problems (88%) and physical/mental exhaustion (83%) most common. Athletes reporting more severe menopausal symptoms (higher total Menopausal Rating Scale scores) also reported a greater perceived negative effect of symptoms on training and performance.

Key findings

• Most common symptoms reported: sleep problems (88%, n = 164), physical and mental exhaustion (83%, n = 155), sexual problems (74%, n = 139), anxiety (72%, n = 136), irritability (68%, n = 128), depressive mood (67%, n = 125), weight gain (67%, n = 126), hot flushes (65%, n = 122), and joint and muscular discomfort (63%, n = 118). Most symptoms were rated mild or moderate.
• Symptoms most likely perceived to negatively affect training and performance: joint and muscular discomfort (97% negative effect on training, 91% on performance), sleep problems (92% training, 89% performance), physical and mental exhaustion (87% training, 88% performance), and weight gain (79% training, 88% performance).
• Total MRS scores differed significantly by menopausal group (p < .001): premenopausal 8.0 ± 4.7, perimenopausal 14.2 ± 6.0, postmenopausal 11.7 ± 6.1; perimenopausal scores were significantly higher than both pre- (p < .001) and postmenopausal (p = .009) scores.
• Total MRS score increased with perceived negative effect on training (no effect 8.5 ± 4.7; slight 11.4 ± 4.3; moderate 15.1 ± 5.5; strong 19.5 ± 7.8; p < .001) and on performance (8.8 ± 5.0; 12.1 ± 4.7; 14.1 ± 5.7; 18.4 ± 7.0; p < .001).

Methods

• Cross-sectional anonymous online survey (Qualtrics) of female runners, cyclists, swimmers, and triathletes aged 40–60, recruited February 6–August 31, 2024 via social media, word of mouth, and local/regional athletic groups in the United States. Inclusion required ≥5 years in the sport, ≥3 days/week, and ≥3 hours/week of activity.
• Of 384 completed screening surveys, 265 met criteria; 187 participants completed the survey (71% response rate). Primary sport: running 55% (n = 102), swimming 22% (n = 41), cycling 14% (n = 27), triathlon 9% (n = 17). Menopausal status: 18% premenopausal (n = 34), 39% perimenopausal (n = 73), 43% postmenopausal (n = 80); 28% (n = 53) reported current HRT use.
• Measures: self-reported menopausal status, the validated 11-item Menopausal Rating Scale (MRS, 0–4 per item, summed for total score), weight gain rated separately (excluded from total MRS), and perceived effect of symptoms on training/performance (none/slight/moderate/strong). Kruskal-Wallis tests compared total MRS scores across menopausal groups and across perceived-effect categories; significance set at p < .05; IBM SPSS v29.

Limitations

• Stated by the authors: cross-sectional design prevents causal conclusions about symptoms, training, and performance; no demographic information collected (race/ethnicity, education, income), limiting generalizability; menopausal status was self-reported (though definitions followed STRAW criteria); other personal factors (work stress, caregiving, other health conditions) and uncollected health history may contribute to symptoms; HRT, medications, and/or supplements may have influenced results.
• Evident from the text: the sample was predominantly runners and recruited via convenience methods (social media, athletic groups), and the MRS total excludes weight gain, so the total score may not reflect all reported symptom burden; figures for general negative effect on training/performance are reported as n = 183 and health as n = 182, indicating some item nonresponse.