Menopause and VO2 Max

I’m still thinking about the innocuous comment the other week asking when I’m going to give up running. I think possibly because it coincides with my birthday fast approaching and a continuous debate I have with a runner in my club insisting that they only have a “window of opportunity” to make big improvements on their pbs before they get too old to see anymore progression in their performance; I swear their sideways glance shouts “YEAH, LIKE YOU”.

So I just continue to do what I always do - run, enter races and look for the research. And yes, we know that research on perimenopause and postmenopausal female athletes remains sparse, but more is slowly emerging, and I want to start putting it into context what it all actually means for the average, female runner.

Thanks to the internet and social media, it does feel like there is a plethora of information increasingly available on how to stay running/active whilst transitioning through menopause, but there’s also an equal amount of misconceptions and misinformation out there. For example, that women cannot build or maintain muscle effectively, or that endurance and cardiovascular performance inevitably declines after menopause, and that you’ll never get faster. I feel like we have gone from menopause and perimenopause never being talked about with zero information, to opening up Instagram and seemingly constantly being told to “lift heavy shit” or “eat more protein” or “take creatine supplements”. My feed is flooded with sponsored posts and targeted ads from PT’s trying to convince me to “lose your belly fat”, arghhhh! I feel overwhelmed and I’m in the sports industry, so I can only imagine how others feel.

What I want to know, for myself and so I can share clear, concise, practical and actionable advice with others, is what does all of this mean to the everyday, peri and postmenopausal, female runner who isn’t ready to give up?

I’ve been post-menopausal for several years, and as I’ve watched the rise in awareness of women’s health, I’ve really felt that the focus and education around menopause has been all about the risks of taking HRT. At times the health promotion around menopause has felt a bit like the fear mongering of the early 80s AIDS campaign, dodgy campaigns that put so much fear into all us teenagers that it’s a surprise any of us ever dared to have sex!

Although this slowly (too slowly) is starting to shift, there is still the fear from the Women's Health Initiative (WHI) study, published in 2002, the findings still linger like a bad smell, saying don’t but I’m asking WHY do we need to…. eat more protein, add strength training into our week, lose the belly fat….and HOW?… haven’t I got enough to do?!

It’s something I really want to start breaking down, translating and sharing for all of you who are as overwhelmed as I am (or perhaps any women in your life who you think would find it useful).

Today, I want to focus on why cardiovascular health is so important to females.

If we as menopausal women want to keep running, keep improving or sustain our performance then we need to make sure all the valves, vessels and intricacies of our cardiovascular system are kept in tip top condition, so let’s break it down.

VO₂ Max – in its simplest terms, VO₂ Max is the maximum amount of oxygen your body can use during intense running. Look at it as though it’s your engine’s horsepower – it determines how efficiently your muscles get oxygen to keep running – the higher your VO₂ max, the longer and harder you can run before you get tired.

As runners, our cardiovascular system, (heart, lungs and blood vessels) all play a huge role in our VO₂ max. Improving and adapting your VO₂ max is key to getting faster, basically improving how much oxygen you take in and deliver to your muscles will improve your heart size and strength, a stronger heart pumps more blood per beat which improves oxygen delivery. More capillaries (tiny blood vessels) form around muscles, increased blood volume and greater lung efficiency, all enable oxygen transfer to become more efficient, and isn’t this what most runners want, to run faster and to be more efficient?

The bad news – as we age, for both males and females, the adaptations slow down which makes it a lot harder for runners to sustain and improve their VO₂ max.

And for females these hormonal changes can have even more of a direct impact on cardiovascular function resulting in further decline in VO₂ max.

The role of Oestrogen and Progesterone on cardiovascular health

Oestrogen helps support the regulation of blood pressure, blood flow and blood clotting as well as contributing to the maintenance in the flexibility of blood vessels, particularly arteries. Flexible arteries expand and contract with each heartbeat, so the reduction in Oestrogen increases the risk of stiffer blood vessels and hardening of the arteries.

Oestrogen protects the stroke volume of your heart, so less blood is pumped per heartbeat leading to decreased maximal heart rate, reducing the ability to train at high running intensities. A lower HRmax means the heart cannot pump as much blood per minute during intense running, limiting the oxygen supply to the muscles.

Oestrogen also regulates cholesterol levels, so a decline leads to an increase in LDL cholesterol (thought of as the bad cholesterol) and a decrease in the HDL (the good cholesterol), contributing to a higher risk of your arteries becoming narrowed, making it difficult for blood to flow through them.

Oestrogen also plays a role in maintaining muscle mass and strength, which in turn affects the muscles ability to utilise oxygen efficiently,

Progesterone also plays a key role in maintaining blood vessel health, although its effects are less pronounced than those of Oestrogen. It can help balance the effects of Oestrogen and support overall cardiovascular function.

Yes, I know, that all sounds like a lot of bad news.

But the good news is, if we know the impact that these hormonal changes have on our body and more importantly our cardiovascular system, we can train specifically to either maintain or improve VO₂ max.

Best running sessions to improve VO₂ max-

High-Intensity Interval Training (HIIT) - Any short, hard efforts (e.g., 4 x 3-minute intervals at near-max effort with 2 minutes rest) will help improve your heart’s efficiency.

VO₂ Max Intervals - 3-6 minutes at 90-95% of max effort with 3 minutes recovery, as you get stronger repeat several times.

Hill Repeats - Running uphill at high intensity boosts your heart and lung function, learn to love those hills.

Tempo Runs – Warm up 1 mile then run at a sustained effort at 85-90% for 1 mile, then cool down 1 mile. Increase the middle miles as you get stronger. Tempo runs are brilliant at improving your oxygen efficiency.

Progressive Runs – Start your run at an easy pace, then slowly pick up the pace mile by mile or add short bursts of speed during long runs, this all helps maintain your aerobic capacity.