Perimenopause can turn everything you thought you knew about your body upside down – especially as an endurance athlete.
Suddenly, the workouts that used to feel effortless now leave you wiped out. Your sleep isn’t as restorative, your mood fluctuates more, your periods are all over the map and you might start questioning if you’ll ever feel strong or fast again.
For many endurance athletes, this phase is confusing and frustrating. You might wonder: Is this just aging? Is this the end of my athletic career? What am I doing wrong? On top of that, it can feel isolating when your doctor or coach doesn’t quite get what’s happening — especially when you “look healthy”.
Here’s the thing: It’s not just you. These changes are real, and they’re driven by shifting hormones that influence everything from recovery and energy to metabolism and mood. It’s not all bad news. There’s a lot you can do to adapt and stay in pursuit of your endurance goals.
When you understand what’s happening inside your body, you can make smarter, more strategic choices — and keep showing up as the strong, resilient athlete you are.
In this post, I’ll walk you through three science-backed strategies that will help you navigate perimenopause as an endurance athlete — so you can support your body, protect your performance, and continue doing what you love.
Strategy 1: Go Beyond Basic Labs — Get the Full Picture
During perimenopause, your hormones don’t just “decline” — they fluctuate dramatically, sometimes from week to week.
Estrogen can swing from very low to four times its baseline level, while progesterone may show up strong one cycle and be completely MIA the next. These hormonal surges and drops are normal — but they can disrupt nearly every system in your body, from metabolism and thyroid function to red blood cell production and recovery capacity.
This is where many endurance athletes get caught off guard. Standard medical labs are designed to detect disease, not dysfunction. They tell you if you’re outside the “normal” population range — but not whether your physiology is optimized for performance, recovery, or hormone balance.
That’s why deeper, functional lab testing is so valuable in perimenopause. It helps you identify early imbalances before they derail your training or recovery.
Why Standard Labs Fall Short
Conventional screening panels often include only the basics — hemoglobin, glucose, and maybe thyroid-stimulating hormone (TSH). But for a perimenopausal endurance athlete, these limited snapshots miss the nuances of how your hormones and metabolism interact.
Functional labs go beyond “is this normal?” and instead ask “is this optimal for your physiology, training load, and recovery?”
Key Markers Every Endurance Athlete Should Track
- Ferritin and Iron Status
Iron is essential for oxygen transport and mitochondrial function. During perimenopause, estrogen fluctuations can change how efficiently your body absorbs iron. Add in irregular or heavy bleeding, and deficiency becomes common.
Low ferritin can reduce VO₂ max, impair recovery, and mimic overtraining fatigue. Runners are particularly susceptible, but all endurance athletes are at risk.
Action tip: Test ferritin minimum once a year – preferably every six months if you train heavily or live/train at elevation. Your “optimal” ferritin should be higher than the standard lab reference range if you’re training at altitude.
- Thyroid Function
Thyroid disorders frequently surface during perimenopause. Shifts in estrogen and progesterone can alter thyroid hormone metabolism, and low iron stores can further suppress thyroid function. Under-fueling compounds the problem by lowering conversion of T4 to active T3.
The result: fatigue, slower recovery, low mood, and reduced metabolic rate — symptoms often misattributed to aging or overtraining.
Action tip: Request a full thyroid panel — not just TSH, but free T3, free T4, and thyroid antibodies — to identify subtle dysfunction early.
- Sex Hormones: Estradiol, Progesterone, and Testosterone
Testing sex hormones gives critical insight into where you are in the perimenopause transition.
- Estrogen (estradiol) supports muscle repair, mitochondrial function, and joint health. When it drops, you may notice slower recovery and more joint pain. When it spikes, you might feel overly emotional, experience breast tenderness, PMS symptoms, and heavier or more painful periods.
- Progesterone promotes restorative sleep, regulates mood, and supports tissue healing.
- Testosterone — often overlooked in women — contributes to motivation, stamina, and muscle integrity. Low levels can present as low energy, anxiety, and low sex drive.
Even though there’s no single test that “diagnoses” perimenopause, these markers together create a data-informed foundation for decision-making. They guide when and how to support your hormones — including if, when, and how to consider menopause hormone therapy (MHT).
Why This Matters for You
Knowing your unique biochemical picture helps you train, fuel, and recover in alignment with your body’s current physiology — not an outdated assumption of what “should” work.
This is a core part of what I do with athletes: help you select the right tests, interpret results in the context of your sport, and build a plan that supports your hormones and performance together.
Because the truth is — guessing costs you time, energy, and confidence. Data lets you lead from a place of clarity and control.
Strategy 2: Rethink Stress — In All Its Forms
Perimenopause amplifies stress — physically, emotionally, and hormonally — and that can have a major impact on training, recovery, and overall performance.
As estrogen declines, it changes how your body regulates cortisol, your main stress hormone. Estrogen normally helps buffer the HPA axis (your brain’s stress-response system). When estrogen levels drop or fluctuate, cortisol tends to stay elevated longer, keeping your body in a prolonged “fight or flight” state.
Layer that on top of endurance training — which is itself a form of physiological stress — and your system can start to feel like it’s running in survival mode 24/7. The result? Slower recovery, more frequent injuries, disrupted sleep, and that deep, lingering fatigue that’s hard to shake.
To stay in the game during this phase, you need to train smarter and recover harder. This may mean rethinking how you structure your workouts and recovery blocks. It doesn’t require turning your entire training plan upside down — small, intentional adjustments can make a big difference. Think of this as a long-term experiment: perimenopause brings a new level of variability, and your training may need to evolve more frequently over the next few years.
Training Adjustments to Consider
- Prioritize Strength Training
Resistance work is non-negotiable. It supports muscle mass, bone density, and metabolic health — all of which decline as estrogen drops. Strength training also enhances glucose regulation and boosts growth hormone production, which are essential for maintaining power, speed, and recovery. Simply put, it helps counter the natural loss of strength and explosiveness that can accompany lower estrogen levels.
- Adjust Endurance Load
This doesn’t mean giving up your long runs or rides — it means being strategic about how and when you do them. Maintain appropriate high-intensity efforts, but make sure to include true rest days. (And remember: rest doesn’t have to mean complete inactivity — low-intensity movement, yoga, or mobility work count too.)
- Fuel Adequately
Estrogen helps maintain lean muscle, regulate blood sugar, and reduce inflammation. When it fluctuates, blood sugar stability and recovery can both suffer. Consistent protein intake and balanced meals become essential. Underfueling increases cortisol, slows metabolism, and heightens the risk of bone loss. Eating enough — especially around training — is one of the most effective ways to protect both performance and hormones.
- Use Objective Data to Guide Recovery
As menstrual cycles become irregular, you can’t always rely on them as a recovery gauge. Instead, track objective metrics like heart rate variability (HRV), resting heart rate, and sleep quality. These markers help you recognize early signs of under-recovery and adjust before fatigue or injury sets in.
I like to use these physiological markers — alongside symptom tracking — to build individualized training and recovery strategies that keep the nervous system balanced. Because when your body feels supported, it adapts better, recovers faster, and performs stronger.
Strategy 3: Make Sleep Sacred
Sleep disruptions are one of the most common — and most underappreciated — symptoms of perimenopause (more common than hot flashes, in fact). If you’ve noticed your sleep changing, you’re not imagining it. Night sweats, difficulty falling asleep, or waking up between 1–3 a.m. are all signs that your nervous system and hormones are recalibrating.
These changes aren’t random — they’re direct physiological responses to fluctuating estrogen and progesterone.
Both hormones play vital roles in sleep regulation, circadian rhythm, and brain recovery:
- Estrogen supports serotonin and melatonin production, helps maintain thermoregulation, and stabilizes circadian rhythm. When estrogen dips, body temperature control falters, leading to night sweats and fragmented sleep.
- Progesterone binds to GABA receptors in the brain, exerting a natural calming, sedative effect that promotes deeper slow-wave sleep. As progesterone levels decline, many women experience heightened nighttime alertness or anxiety.
The result? Difficulty falling asleep, reduced REM and deep sleep stages, and earlier wake times — all of which lower your recovery “budget.” For athletes, this translates to measurable performance impacts: impaired glycogen restoration, slowed muscle repair, reduced aerobic capacity, and decreased focus or motivation.
Why Sleep Matters So Much More Now
Sleep is an active recovery process — not downtime. During sleep, your body engages in crucial physiological repair:
- Muscle regeneration through protein synthesis and growth hormone release
- Energy restoration via glycogen replenishment
- Immune and inflammatory regulation, reducing oxidative stress from training
- Hormonal recalibration, including cortisol rhythm normalization and leptin/ghrelin balance
In perimenopause, the baseline physiological stress load is already higher due to increased sympathetic nervous system activity and fluctuating cortisol patterns. Even a few nights of poor sleep can amplify this stress response — raising cortisol further, impairing glucose metabolism, and blunting the anabolic effects of training.
Evidence-Based Strategies to Improve Sleep Quality
- Identify What’s Disrupting Sleep
Not all sleep disturbances are hormonal. Nutrition timing, caffeine intake after noon, and dehydration can all affect sleep onset and quality. Temperature dysregulation, especially with fluctuating estrogen, often leads to early-morning awakenings.
Tracking sleep alongside training load, HRV, and nutrition patterns helps identify correlations. And one of the biggest disruptors? Alcohol. Even moderate intake delays REM onset, increases nighttime awakenings, and heightens night sweats by altering estrogen metabolism and glucose regulation.
- Support Hormonal and Neuroendocrine Balance
Nutritional and supplemental support can improve sleep quality by modulating the nervous system and cortisol dynamics. Magnesium glycinate enhances GABA activity, omega-3s reduce systemic inflammation, and adaptogenic herbs (when used clinically and appropriately) can improve HPA axis resilience. Talk to your healthcare team to make sure these are safe and appropriate for you.
For some athletes, menopause hormone therapy (MHT) provides significant improvement in sleep quality and recovery metrics. Estrogen therapy, in particular, has been shown to increase REM duration and stabilize thermoregulation. These decisions should always be made collaboratively with a practitioner who understands both hormonal physiology and the metabolic demands of endurance training.
- Optimize Environmental Recovery Variables
Temperature, light, and timing matter. Keep your sleep environment around 65°F (18°C) to minimize thermoregulatory wake-ups. Blue light exposure in the evening suppresses melatonin production, so consider dim, warm lighting or blue-light–blocking glasses after sunset. Light, breathable clothing (or sleeping nude) can improve temperature regulation, and a consistent pre-sleep routine helps reinforce circadian rhythm stability.
- Adjust Training Load and Recovery Cycles
Persistent sleep issues can signal a mismatch between training stress and recovery capacity. Elevated nighttime heart rate, reduced HRV, or early-morning awakenings can all indicate under-recovery or excessive sympathetic drive. Strategically integrating lower-intensity blocks, deload weeks, or fueling adjustments often restores sleep quality — and, by extension, performance outcomes.
When I work with athletes, sleep becomes one of the most sensitive and reliable biomarkers for overall recovery. Once we identify whether disruptions are hormonal, metabolic, or training-induced, we can make data-driven adjustments that restore deep, restorative sleep and optimize adaptation.
Because the truth is: you can’t out-train poor sleep. But you can recalibrate it — and when you do, performance, resilience, and confidence all follow.
You Might Be Wondering…
“Won’t hormone therapy or supplements fix all of this?”
Or maybe: “Is this just part of aging, and I should lower my expectations?”
Here’s the truth — hormone therapy and supplements can absolutely be helpful tools, but they’re not magic bullets. They work best when they’re part of a bigger, individualized plan that supports the way your body is functioning now.
And no, you don’t have to lower your expectations. This isn’t about giving your goals — it’s about adapting. When you understand what’s happening hormonally and strategically support your body through it, you can continue to chase big goals and perform at a high level — just with a smarter, more supportive framework.
Wrapping It All Up
Perimenopause doesn’t mean the end of your athletic journey — it’s simply a new training phase, one that asks you to bring more awareness, intention, and care to your body.
By getting detailed lab insights, managing total stress load, and protecting your sleep, you’ll have the science and strategy to keep doing what you love.
When you do, you’ll feel stronger, more in control, and confident that you’re training with your physiology — not fighting against it.
Next Steps
You can have a long and successful athletic career through and beyond perimenopause. You just need the right strategies, tailored to your unique body.
Stop guessing and start working with your physiology. Learn what your body truly needs, what’s nourishing you, and what’s inflaming you.
If you’re ready to go deeper, check out my Wild Pursuits program, designed specifically for the perimenopausal athlete. Or, if you’re not sure you want to go that deep yet, schedule a visit and let’s get started with your personalized plan.
Your body’s changing — but your goals don’t have to