Blame It on Perimenopause: Is That Really What’s Affecting Your Running?

ahunterarnold

Oct 2

3 min read

Episode overview

Poor sleep. Slower recovery. Mood changes. A body that suddenly feels unfamiliar. It must be perimenopause, right?

Maybe. But for women runners, the answer is rarely that simple.

Ashley and Trax talk with Dr. Kathryn “Kate” Ackerman, a sports medicine physician and endocrinologist, about what perimenopause actually is and why it can be especially difficult to identify in athletes. Symptoms such as fatigue, disrupted sleep, cycle changes and declining performance can also be connected to underfueling, RED-S, iron deficiency, thyroid issues, training load or some combination of all of them.

Strength and running coach Gaggi DeStefanis explains why strength training becomes increasingly important as women get older, how it supports muscle and bone health and how someone who feels intimidated by the gym can begin.

Finally, professional ultrarunner Amanda Basham shares what happened after she was diagnosed with early perimenopause at 36. She explains why she began questioning whether the diagnosis accounted for everything, how years of underfueling and poor sleep may have contributed to the way she felt and how addressing those individual pieces helped her climb out of a difficult period. She went on to finish 11th at UTMB in 24:18:09, more than five hours faster than her previous finish.

The takeaway: Perimenopause is real, but it should not become an automatic explanation for every change. Look at the whole athlete, address what you can and remember that you do not need every answer before you can begin feeling better.

In this conversation

What perimenopause is and why there is no single moment when most women know it has begun.
Why perimenopause can start in the late 30s or early 40s.
The early signs runners may notice, including cycle changes, sleep disruption, mood changes, brain fog and slower recovery.
Why perimenopause, underfueling and RED-S can produce overlapping symptoms.
Why losing your period because you train heavily should not be considered normal.
When laboratory testing may be helpful and why one hormone result rarely provides the complete answer.
Why runners should also consider iron levels, thyroid function, overall nutrition and training load.
How cutting carbohydrates can make it harder for an athlete to train, recover and maintain adequate energy availability.
Why athletes may be especially likely to normalize discomfort or continue pushing through symptoms.
How training may need to become more intentional as recovery needs change.
Why strength training matters for maintaining muscle, bone health and long-term function.
How to begin strength training without needing a complicated or perfect program.
Why Amanda questioned whether early perimenopause fully explained what she was experiencing.
How parenting, anxiety, chronic sleep disruption, elite-level training and unintentional underfueling affected Amanda’s health.
Why eating enough became Amanda’s first priority.
How letting go of the need for one definitive answer changed Amanda’s mindset.
Why taking training and recovery one day at a time helped Amanda produce her best UTMB performance.

Meet the guests

Dr. Kathryn “Kate” Ackerman, MD, MPH, FACSM is a triple board-certified physician in internal medicine, sports medicine and endocrinology. She is the co-founder and president of the Women’s Health, Sports & Performance Institute, director of WHSP Medical and an associate professor of medicine at Harvard Medical School. Her research focuses on female athlete health, RED-S, sports endocrinology and bone health.

Gaggi DeStefanis is a lifelong runner, fitness trainer and coach who works with athletes across the lifespan. She coaches girls’ cross-country and track and field, leads adult running programs and teaches Lift to Thrive, a strength-training course designed for women in perimenopause, menopause and postmenopause.

Amanda Basham is a professional trail and ultrarunner, Altra athlete, coach and mother of two. Her career includes top finishes at some of the world’s most competitive trail races, including an 11th-place finish at the 2026 UTMB.