Former women athletes: what the research misses and what to check

The research gap, in plain numbers

A 2023 scoping review gathered 20 studies on the health of former athletes aged about 40 to 65. Most enrolled only men, and only four studied women exclusively. The authors called directly for more female participants and for analysis of sex differences.

The best-known study of lifelong endurance athletes' coronary arteries, Master@Heart, enrolled only men. So when you read that former athletes have better cholesterol or more coronary plaque, remember that those findings were largely drawn from male bodies and may not apply to you in the same way.

What is genuinely different for women

Women's bone and metabolic health are tightly linked to estrogen. During competitive years, estrogen can be suppressed by low energy availability, which may show up as late first periods, irregular cycles or no periods at all. The International Olympic Committee's 2023 consensus on Relative Energy Deficiency in Sport describes how this deficit affects health in athletes of both sexes.

In midlife, estrogen falls again, this time permanently. The Study of Women's Health Across the Nation (SWAN) found that fat mass begins rising and lean mass begins falling about two years before the final menstrual period, with fat gain nearly doubling in pace during the transition. A woman who was very lean and muscular may notice these shifts sharply.

Bone: protection with conditions

Impact and high-load sports such as gymnastics, running, volleyball and basketball build bone that can last for decades, mainly at the sites that took the load. Swimming and cycling build less.

Missed periods during training can take back some of that benefit. The National Institute of Arthritis and Musculoskeletal and Skin Diseases lists absent periods before menopause, including from extreme physical activity, and low body weight as osteoporosis risk factors. Bone loss also speeds up around menopause, so a past deficit and a present one can stack.

What tends to get missed

• Low iron stores: ferritin can be low before anemia shows on a blood count, causing fatigue, breathlessness and restless legs.
• Perimenopause in someone with irregular cycles: if your periods were never regular, the usual signs of the transition are harder to spot.
• Thyroid problems, which are more common in women and can mimic overtraining or midlife fatigue.
• Pelvic floor symptoms such as leaking with running or jumping, which are common in athletes and treatable.
• Heart risk: women's heart disease is under-recognized, and lipids often rise after menopause.

Perimenopause in a body that used to be predictable

Many athletes know their bodies in detail: resting heart rate, recovery, how a hard week feels. Perimenopause can scramble those signals. Sleep breaks up, recovery slows, hot flashes appear during or after training, and motivation or mood can shift without an obvious reason.

Perimenopause is diagnosed clinically, from your age, symptoms and cycle pattern, because hormone levels swing from day to day. A single normal hormone test does not rule it out. For bothersome hot flashes and night sweats, hormone therapy is the most effective treatment and also helps prevent bone loss, and the decision is individualized around your risks of blood clots, stroke and breast cancer. If you have a uterus, progesterone is added to protect its lining.

Training through the transition

There is no reason to stop competing or training hard because of perimenopause. Many women find that adjusting rather than abandoning their routine works best: more emphasis on heavy resistance training to protect muscle and bone, careful attention to protein and total energy, and more recovery time between hard sessions.

Cooling strategies help with hot flashes during exercise, and keeping alcohol low often improves sleep and night sweats. If symptoms are interfering with training, work or sleep despite these changes, that is a reasonable time to discuss treatment.

How HealifyMD can help

Your HealifyMD clinician will ask about your sport, cycle history, fractures and eating patterns, then may order labs such as ferritin, thyroid function, vitamin D, lipids with apoB and Lp(a), and metabolic markers. If you are in perimenopause or menopause, you can discuss hormone therapy in a video visit.

We do not perform bone density scans, pelvic exams or imaging, so we will tell you when one of those is the right next step. The Women's Hormone Therapy plan is $349 for the first month, then $99 per month, with prices confirmed after your eligibility review. The first month includes the evaluation and baseline labs.