“I’m doing the work, but something feels off.”

If you coach or train women who run, cycle, swim or race triathlons in midlife, you have probably heard some version of this statement. The usual suspects show up: sleep gets unpredictable, recovery takes longer, joints feel crankier than they used to, body weight shifts despite consistent habits and energy can dip in ways that don’t match training volume.

A new survey-based study in the peer-reviewed journal PLOS One puts numbers behind what many health and exercise professionals are hearing from their clients: Menopausal symptoms are common even in highly active endurance athletes, and many women believe those symptoms are affecting how they train and how they perform.

That framing matters because it challenges an assumption you may run into— from clients, colleagues or even from athletes—that “because I’m fit, menopause won’t hit me that hard.” This study suggests fitness does not make symptoms disappear. It may help health outcomes, but it doesn’t guarantee a symptom-free transition.

Inside the Study

Researchers, at Old Dominion University surveyed 187 female endurance athletes ages 40 to 60, including runners, cyclists, swimmers and triathletes. Participants were recruited in the U.S. from February through August 2024 via social media, word of mouth and local and regional athletic groups.

To be included, women had to be consistently active. They needed to be participating for at least five years in their sport, training at least three days a week and completing at least three total hours of physical activity each week. The study intentionally focused on a physically active group rather than the general population.

Participants completed an online anonymous survey that asked them to self-identify menopausal status (premenopausal, perimenopausal or postmenopausal) and report hormone replacement therapy use. They also completed the Menopausal Rating Scale, a validated tool that rates 11 common symptoms from none to very severe. The researchers added weight gain as an additional symptom item (rated the same way) but did not include it in the total Menopausal Rating Scale score.

The survey went a step beyond symptom checklists. If a participant reported a symptom, she also reported whether that symptom had no effect or a slight, moderate or strong negative effect on her training and performance in her primary activity.

What the Researchers Found

The first headline finding is simple: Symptoms were widespread in this highly active group. Sleep problems were reported by 88% of participants, and physical and mental exhaustion by 83%. Anxiety (72%), sexual problems (74%), irritability (68%), depressive mood (67%), weight gain (67%), hot flushes (65%) and joint and muscular discomfort (63%) were also common.

On the surface, these women were doing well. Most participants rated their overall health as excellent (38%) or very good (46%). That combination of strong self-rated health plus high symptom frequency is a useful reality check. You can be fit and training regularly yet still deal with symptoms that shape your day-to-day training experience.

The second headline finding is the “so what” for coaching and clinical work: Certain symptoms were much more likely to be perceived as training and performance disruptors.

Among women who reported joint and muscular discomfort, 97% said it negatively affected training and 91% said it negatively affected performance. Sleep problems were also strongly connected to training and performance, as 92% of women with sleep problems reported a negative effect on training and 89% reported a negative effect on performance. Physical and mental exhaustion was similar (87% negative effect on training and 88% on performance). Weight gain was also commonly linked to performance concerns (79% negative effect on training and 88% on performance).

Not every common symptom translated into performance impact in the same way. For example, hot flushes were common, but most women reporting hot flushes said they did not affect training (67%) or performance (72%). Likewise, sexual problems and vaginal dryness were frequently reported, yet most of those women reported no effect on training or performance.

That’s an important nuance for your work with clients: Prevalence does not automatically equal performance impact. The symptoms you may need to address first, from a training standpoint, are the ones athletes themselves link to missed sessions, modified intensity, slower recovery and lower perceived capacity.

Factors to Consider: Severity of Symptoms and Perimenopause

The study also showed a clear relationship between overall symptom severity and perceived impact on training and performance.

Participants’ total Menopausal Rating Scale scores differed significantly based on whether they reported no negative effect, slight negative effect, moderate negative effect or strong negative effect of symptoms on training and performance. For training, the average total score rose from 8.5 in the “no negative effect” group to 19.5 in the “strong negative effect” group. For performance, the average rose from 8.8 (no negative effect) to 18.4 (strong negative effect). These differences were statistically significant.

In other words, women who felt menopause was meaningfully interfering with their training were not simply “more sensitive” or “less tough.” They were also reporting more severe symptoms overall.

Perimenopause, which is the stage of life marked by increasingly irregular menstrual cycles and hormonal variability, was associated with higher symptom burden in this sample. Perimenopausal participants had a higher average total symptom score than both premenopausal and postmenopausal participants.

This is a practical insight for health and exercise professionals: The athletes you work with in their 40s who are still cycling but noticing changes may be in the stage where symptom severity is most likely to spike, even if they have not yet had 12 months without a period.

What the Study Can’t Tell Us

This was a cross-sectional survey, meaning it captures a snapshot in time. The study’s authors note that it cannot prove that menopause symptoms caused changes in training quality or performance. It also did not collect demographic information such as race and ethnicity, education level or income, which limits generalizability. Menopausal status was self-reported (with clear definitions provided), and the survey did not collect detailed health history, so other factors common in midlife (stress, caregiving demands, other medical conditions) could contribute to some symptoms.

Those caveats matter, especially if you’re tempted to use the findings as a one-size-fits-all explanation for a client’s struggles. Still, the consistency and magnitude of symptom reporting, particularly in a group that is training regularly, is hard to ignore.

How to Apply the Study’s Findings as a Health and Exercise Professional

This study doesn’t hand you a menopause “protocol,” and it doesn’t test any specific interventions. What it does give you is a clear set of signals about what your midlife endurance athletes are likely experiencing and which symptoms they most often connect to reduced training quality and performance. Use that information to shape how you screen, communicate and program.

Make Menopause Part of Your Normal Intake and Check-Ins

A big takeaway is that high-performing, highly active women still report high symptom frequency. That means waiting for a client to bring it up may not be a great strategy. Many athletes won’t mention symptoms unless you create a safe, normal context to do so.

In practice, that can be as simple as incorporating a standard question into routine check-ins for clients in the 40 to 60 age range: How is sleep? How is energy? Any changes in menstrual cycle regularity? Any joint or muscular discomfort that feels “different” than typical training soreness? Any weight changes that are concerning or frustrating?

You don’t need to diagnose menopause. You’re creating a doorway for athletes to connect symptoms to training patterns and to feel seen rather than dismissed. The study’s authors point out that this is an underserved population that is eager for guidance. When you proactively invite the conversation, you are providing exactly that: guidance, structure and options.

Prioritize the Four Symptoms Most Tied to Training and Performance

From a programming and support standpoint, the study points you toward four main “performance levers” that athletes commonly perceive as disruptive: sleep problems, physical and mental exhaustion, joint and muscular discomfort, and weight gain.

That doesn’t mean other symptoms don’t matter. It means these are the areas where your day-to-day coaching decisions—recovery, load management, exercise selection, session timing and expectations—are most likely to intersect with what the athlete is experiencing.

If an athlete reports poor sleep, for example, that’s not just a wellness note; it may be a signal that intensity targets, recovery windows and injury risk deserve a closer look. The study authors highlight how common sleep problems were (88%) and note the importance of sleep for both performance and injury prevention.

Similarly, if an athlete reports joint and muscular discomfort, don’t treat it like background noise, especially given how often women linked it to negative effects on training and performance. It may be the difference between consistent training and a slow slide into reduced volume, reduced intensity or dropout.

Coach the Gray Area: Adjust Training Without “Pulling the Athlete Back”

A subtle coaching challenge in midlife is helping athletes adapt without feeling like they’re being told to lower their standards. The study found that symptom severity and perceived impact go hand in hand: athletes who said menopause had a strong negative effect had higher overall symptom scores.

In practice, that suggests you may need to individualize more aggressively when symptom burden is high, not because the athlete is less capable, but because the inputs to performance (sleep, recovery, musculoskeletal comfort, mental bandwidth) may be compromised.

This is where your process skills matter: shared planning, flexible options for hard days, permission to adjust intensity when fatigue is high, and clear communication that training quality includes recovery and consistency, not just pushing through.

Watch Perimenopause Closely

Perimenopausal women in this sample reported higher overall symptom scores than both premenopausal and postmenopausal participants. If you work with women in their 40s who are still menstruating but noticing changes, consider perimenopause as a possible context—and keep your eyes on sleep, exhaustion and joint pain.

Athletes may also assume menopause is only “after periods stop.” Helping them understand that symptoms often start earlier can reduce confusion and self-blame.

Build a Referral-Ready Network

Because this study is about symptoms and perceived impact—not treatment—your most powerful tool may be knowing when to refer and to whom.

If a client reports severe sleep disruption, troubling mood symptoms, significant joint pain or other issues that are affecting daily life (not just splits), encourage evaluation by an appropriate healthcare provider. The study also included women using hormone replacement therapy (28%), which underscores that many athletes are already pursuing medical options.

As a health and exercise professional, your role is not to prescribe hormones, recommend supplements or manage complex symptoms. Your role is to notice patterns, support healthy training decisions and help clients access qualified medical care when needed.

Keep the Long View: Staying Active Is Still the Goal

One of the study’s most important conclusions for professionals is also the most practical: Even though exercise is associated with health benefits in menopause, symptoms can still be prevalent in active women, and providers should address them to promote continued participation in physical activity.

That last part is key. Your work is not only about performance. For many clients, endurance training is part of their identity, their stress management and their long-term health strategy. If menopause symptoms begin to interfere, your skill as a coach or clinician can be the difference between adaptation and attrition.

When you take symptoms seriously—and treat them as trainable constraints rather than excuses—you help athletes stay in the game.