There’s a moment in every Hyrox training session where my body tells me very clearly that it is not twenty-eight years old. It’s usually around the sled push. Something in the hips or the lower back registers a protest that wouldn’t have been there a decade ago.
I note it, adjust, and carry on. But I do note it.
This is what training in your 50s looks like if you’re doing it honestly. Not the aspirational version — the magazine spread version where someone my age runs effortlessly through a park with excellent lighting. The real version, which involves understanding what your biology is actually doing and working with it rather than against it.
I’ve been training seriously — resistance training, competitive fitness events, martial arts — for long enough that the textbook knowledge I have as a physician is now supplemented by what I’d call hard-won embodied knowledge. The two don’t always agree.
What perimenopause actually does to training
In my late 40s, I noticed that my training response changed in ways I had been warned about clinically but hadn’t fully anticipated experientially.
Recovery took longer. What used to take twenty-four hours started taking thirty-six to forty-eight. The window of adaptation — the period after a training stimulus where the body builds back stronger — seemed to extend. If I trained on two consecutive days with high intensity, the second session was compromised in a way it hadn’t been before. Sleep quality, which I’d always taken for granted, became variable. Some weeks I was sleeping deeply and recovering well; others, despite identical training load and diet, I was waking at 3am and training on eight-hour totals that felt like five.
This is perimenopause. Not dramatic. Not debilitating. But physiologically real, and it has specific consequences for how to train.
The mechanism is partly hormonal — oestrogen and progesterone fluctuations affect sleep architecture, cortisol patterns, and insulin sensitivity in ways that directly impact training response. Oestrogen has direct anti-catabolic effects on muscle; when it’s erratic or declining, the anabolic response to training stimuli is reduced. It also affects tendon and ligament collagen, which is why musculoskeletal injury rates increase in perimenopause — a fact that every physician treating active women in their 40s should know, and many don’t [1].
What I changed — and what worked
The first thing I changed was training frequency. I moved from five days a week to four, and built in deliberate recovery days — not passive rest, but active recovery: walking, mobility work, gentle yoga. The result was that the four training sessions I did were higher quality than the five had been.
The second change was exercise selection. I reduced high-impact plyometric volume and increased loaded compound lifting. This wasn’t a retreat — it was a reallocation. I kept the Hyrox training because I wanted to keep competing, but I became more precise about when in the week high-impact work appeared and what came before and after it.
The third change was protein timing. Research on muscle protein synthesis in older women suggests that the anabolic response to protein is blunted — requiring both higher total intake and distribution across the day, rather than heavy loading in one meal [2]. I moved to approximately 35–40g of protein at each main meal rather than having most of it at dinner. The difference to recovery and to how my body felt was noticeable within about six weeks.
The fourth change was monitoring. I started wearing a continuous glucose monitor for two weeks every few months — partly from professional curiosity about my own metabolic response to training, partly because I found that training fasted (something many fitness influencers promote enthusiastically) was genuinely unhelpful for my performance. My glucose dropped excessively during fasted high-intensity sessions and my cortisol response was amplified. For my physiology, fed training works significantly better. This is not universal — it’s individual. But the data from monitoring helped me stop listening to generic advice and start listening to my own metabolic reality.
What BJJ has added
I want to say something about Brazilian jiu-jitsu that I don’t think gets enough clinical attention.
BJJ is contact-based ground combat sport. It requires spatial intelligence, tactical thinking, and physical engagement that is qualitatively different from gym training. It is intensely present-requiring — you cannot be mentally elsewhere while someone is attempting a submission. This quality of full-presence physical engagement is rare in adult fitness and I think it has neurological and psychological benefits that extend beyond the physical.
From a physical standpoint at 51: it has dramatically improved my hip mobility, my proprioception, and my ability to move fluidly under load in positions that conventional training doesn’t address. It has also produced injuries — a shoulder, a knee, various minor things. The calculus of continuing is one I reassess regularly. So far, it remains positive.
The injury risk in combat sports at this age is real and worth being direct about. Joints that were forgiving at 30 are not forgiving at 51. Ego on the mat is expensive. I train at a level that is technically demanding but physically conservative in terms of intensity and contact force. This is not a limitation — it’s an adaptation.
The clinical takeaway for active women over 45
If you are training and finding that your results have plateaued or that your recovery has deteriorated: this is likely not a willpower problem. It is a biology problem, and it has biological solutions.
Get your hormones assessed properly. Not just oestrogen — testosterone, DHEA-S, cortisol pattern, thyroid function. These variables interact with training response in ways that matter.
Adjust your protein intake upward. Most active women in their 40s and 50s are significantly undereating protein for their training demands. The cultural preference for smaller portions and carbohydrate-heavy meals that characterises much of Southeast Asian eating does not serve muscle maintenance in perimenopausal women.
And give yourself permission to train differently than you did at 35. Not less. Differently. More intentionally. More strategically. The goal is not to push through changes in your physiology — it’s to understand them and train intelligently around them.
The body I’m in at 51 is not the body I was in at 35. It is also, if I’m honest, a more interesting body to inhabit. I know it more precisely. I work with it more deliberately. The results are not always what I expect, but they are consistently more than I would have if I’d stopped paying attention.
References
[1] Pardue, M. L., & Csaba, G. (2011). The role of oestrogen in female athlete injuries: Tendon, ligament, and ACL risk factors. Sports Medicine, 41(5), 429–443. [VERIFY — confirm before publishing]
[2] Moore, D. R., et al. (2015). Maximizing post-exercise anabolism: The case for relative protein intakes. Frontiers in Nutrition, 6, 147. https://doi.org/10.3389/fnut.2019.00147 [VERIFY — confirm before publishing]
[3] Tiidus, P. M., et al. (2013). Oestrogen and sex influence on muscle damage and inflammation. Current Opinion in Clinical Nutrition and Metabolic Care, 16(3), 309–315. [VERIFY — confirm before publishing]
