Why it matters to peri/menopausal athletes

Here are some simple tips to help you through your training as a peri/menopausal athlete. We tend to follow so many online guidelines, or from a downloaded programme on Training peaks, or something that we’ve read on Goop! (I hope not). Below are some recommendations from Dr. Stacy Sims on how you can apply some simple steps to manage your hydration and also busting the myth about drinking beet juice to enhance your performance. And should you pay for an expensive sweat test?

Hydration – how much do I need?

In my previous article I spoke of hydration and if we really need 8 to 10 glasses of water a day? In this article we are going a little deeper.

Elevated Plasma Volume

In a presentation by Dr. Stacy Sims, she discusses what you need to do to get your plasma volume elevated.   There are some generic sports recommendations, but they are not taking into account that there are specifically some sex differences in hormone pertubations that affect hydration and what us women need. 

You might ask why you need elevated plasma volume and the simple answer is successful adaptation through your training programme.

What you might consider before deciding on your hydration strategy, is that there are sex differences in renal water and electrolyte retention.  Many consider this subtle and probably not of consequence but the science behind this has not really been reviewed and a critical eye taken to the science and studies that are out there specific to women.

It has been known for a very long time that there are sex differences between sweat rates, sodium losses, blood sodium levels at the end of exercise and finally someone has quantified it in a particular study just this year 2019 .  From this study it is known that there are sex differences between total body sweat rates, like men sweat more than women, and that there are some women that do have greater sweat rates that can rival some men, but in general have a lower sweat rate.

Sweat rates are greater in the luteal phase , but it occurs at a later onset so when you are looking specifically at follicular versus luteal phase, there can be a little bit of a difference , but it’s that heat generation at the start that becomes the metric that most people are looking at.

We also know that there are sweat sodium loss differences . 

Women lose way less sodium than men do in sweat. In the high hormone phase, we have less sweat sodium because across the board, our body has been kicking out more total body sodium and not retaining more, due to a switchover in our plasma osmolality and our hormones responsible for retaining sodium aldosterone, because progesterone and aldosterone compete for the same receptor site.  When progesterone is elevated, aldosterone cannot tell the body to conserve more sodium so your body gets ride of more. 

Our sweat sodium is lower in the luteal phase than it is in the follicular phase, so when you are looking across the phases, and we know specifically that women have lower sweat sodium concentrations than men.  When we look at total body sweat losses, this isn’t quite as large of a difference but there are still losses and total body sweat sodium losses, and this is dependent on where they collected the sweat which is why in this study there was no great difference because they used sweat patches in the same locations of the body. 

We know that the type of sweating and the sweat onset are patterned differently across men’s bodies than women’s.  There is not a huge concern from Dr. Stacy that this is not quite so different but it’s very telling to know that sweat rates, and sweat sodium losses are different, because we are in that pervasive idea that women and men need to drink the same amount and you should use sodium tablets and you should use electrolyte tablets especially in long course racing, but AGAIN, this is driven more through marketing than science.

We know specifically that men and women have different hydration and sodium parameters.  This is because of estrogen and progesterone.  Estrogen is very specific to osmoregulation

Protein shake post training and cold tart cherry juice also helps with rehydration.

We know specifically that women have different hydration parameters to men.  So if you think about why this is, estrogen, progesterone! Estrogen is very specific to osmoregulation.  When you get too much “stuff” in your blood, your plasma osmolality comes up. When that comes up, it stimulates arginine, vasopressin for you to drink.

It stimulates your thirst, so when you get more concentration of stuff in your blood, you feel thirsty.  You need more water in your blood and estrogen is tied tightly to that.

What about Beet Juice for my performance?

Refer to an article about beet juice (contains nitric oxide) which is not beneficial for females seeking training adaption, with the acute data on exercise indicating that it decreases VO2max and oxygen cost of exercise, you are actually losing training stimulus; elite athletes use it for this very reason- to reduce the cost of O2 use so they can go harder for longer in a race situation, but not when trying to garner training adaptations).

We also know that estrogen is responsible for the whole nitric oxide vasodilation response, the more estrogen the more vasodilation, so women will vasodilate first before they start sweating.  That’s a consideration you need to take into play when you think about how much hydration you need.  Then think about progesterone which is more of a volume regulator.  When you have constriction in the blood or a drop in your total blood or blood volume, it is a signal for your body to retain sodium.   This is because sodium comes with water, and then we release aldosterone which is a slow response.

So it is a lag time really when you are thinking about rehydration. You need aldosterone to be secreted in order to allow your body to pull in more sodium and more fluid because both of these work together.

So you have AVP and aldosterone working together to maintain that fluid balance.   If you have high progesterone, you will have a reduction in aldosterone so if that happens your body will not receive the message to hold on to sodium so it kicks it out.

With elevated progesterone  (like 10 days or a week before your period), your body kicks out more sodium which also drops plasma volume and that’s two-fold:

1.           Estrogen and its actions on the kidney

2.           Progesterone kicking out more sodium

The above two actions reduce plasma volume during high hormone phase.

So we know that hydration between the two hormone phase becomes very specific because we need to be thinking about what we are drinking in the high hormone phase to boost that plasma volume.

The low hormone phase doesn’t need such a careful metric but Dr. Stacy doesn’t advise being a little more lax (ie. pay attention still)!

If you are still on an Oral Contraception pill, your thirst stimulation changes across the phases and also changes.  It is also known that with higher estrogen you have plasma osmolality that drops, and when you are in that lower range of plasma osmolality and keep drinking plain water, you’re at greater hyponatraemic risk.  Remember: The absence of thirst does not indicate the absence of dehydration

So considering all of these things now…. What do we do???

Dr Stacy is saying is that you cannot programme your hydration into exactly x amount of fluid every 20 minutes, for example.

To figure out what you really need to do as an INDIVIDUAL is do your own test.

Slide credit Dr. Stacy Sims

Look at what you are doing for your own training.

Do your usual hydration routine and use a urine dipstick that has a urine-specificity gravity (USG), and you want to see what happens with that USG change.

Carry out your usual hydration method during a specific training session and that’s your baseline (Test A).

You want to measure your urine-specific gravity before and after training, and if it’s longer than 2 ½ hours and you have a pee in the middle of it, see what your USG is doing  and see if your hydration drink is actually working for you.

Then a week later, do the same test but use a functional hydration drink (with no carb added and high electrolyte) so that you’re actually absorbing that fluid and then compare the USG outcome on both tests.

You can also have a competition with your teammates and see who can wake up the most hydrated! (or TMI??)

So the urine-specific dipstick is a really good way of determining how hydrated you are and what kind of things you need to do, as if you come out significantly dehydrated in test A and then you do all the recovery metrics and you believe you’re rehydrated, and then wake up the next morning and you’re still dehydrated then you going to get in a chronic state of dehydration or hypohydration, with slightly low body water that’s going to affect fatigue, recovery, cognition, and adaptations.

Then when you do test B, see what happens when you do a specific hydration intervention.

So that’s what you’re drinking, how often you’re drinking, and change it up and see.

What is your hydration metric at the end of test B, and then the next morning?

Stacy has a case study of a 70.3 athlete (because it’s more around that five hour mark!?) and there are a lot of questions surrounding what happens in that longer endurance. Hydration becomes more of a focus metric of how to keep going without needing an urgent loo stop, without having GI distress, and how to hydrate well enough in the heat?  Practice, practice, practice.

If you are going to have your hydration measured professionally, and they are not considering your hormonal phases or whether you are on oral contraception (or menopausal), then perhaps consider not spending the money and do your own test as specified.

Pee clear once a day!


Beware of These Lifestyle Factors Adding to Your Training Load


When managing your load, background lifestyle factors are just as important as training and racing demands. By considering other facets that make up an your daily load, you can help yourself stay on track for long-term progress.

Sleep (excerpt from article)

Inadequate Sleep

Subjecting yourself to training stimuli is merely the first step in prompting your progression. To close the loop on adaptation, you must be able to repair damaged muscle fibers, groove motor patterns in the brain, make physiological enhancements like increasing bone density and creating new blood vessels (angiogenesis), and more. Sleep is the foremost opportunity for all of these adaptations to occur, and if it’s compromised, training gains can be slowed, halted or even reversed.

According to a study published in “Sports Medicine,” the physical effects of getting insufficient sleep include increased muscle soreness, higher inflammation levels, increased perception of pain and effort and decreased psychomotor function. The author also touched on a largely unheralded way that restricted sleep can hamper your athletes: “Learning and memory deficits are also evident after sleep deprivation. It appears that sleep is important not only following learning for consolidation of memory, but also for preparing the brain for next-day memory formation. The ability to consolidate skill memory is important for skill performance, and thus sleep deprivation may have a negative impact on performance by reducing cognitive function.”

In other words, if you are continually getting poor sleep, you could be unable to hit save on the skills work you’re doing, and go into the next session predisposed to learn less efficiently and might struggle to recall and apply what you’ve already learned. Other than the obvious suggestion getting more sleep at night, the Sports Medicine study author suggests napping as an effective way to top up on your total rest. She referenced a paper published in the “Journal of Sports Sciences,” which found that athletes who took a 30-minute nap improved their sprinting performance. So if you’ve planned an interval or hill sprint session, and you’re feeling weary, cram in a short nap to improve your physical and mental output.


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