Menopause & Perimenopause in Sport

What are perimenopause and menopause?

Perimenopause is the transition leading up to menopause, when menstrual patterns and menopause-associated symptoms may change. In an otherwise healthy person aged 45 or over with relevant symptoms, NICE generally identifies perimenopause or menopause from symptoms and menstrual history rather than routine confirmatory laboratory tests. Menopause is identified after at least 12 months without a period when hormonal contraception is not affecting the picture.

Menopause usually occurs between ages 45 and 55, but it can happen earlier. NICE distinguishes early menopause at ages 40 to 44 and premature ovarian insufficiency (POI) before 40, for which assessment and management are different.

Experiences vary

NHS and NICE guidance emphasise that experiences vary. Possible symptoms include changes to periods, hot flushes and night sweats, sleep problems, mood changes, memory or concentration difficulties, headaches or migraine, palpitations, muscle and joint pain, vaginal or urinary symptoms, changes in libido and changes affecting bone health. A person may experience several symptoms, only one, or very few.

What this can mean in sport

The Centre has not identified robust evidence showing that menopause creates one predictable performance effect in cue sports or darts. We should therefore not tell women that menopause will automatically worsen their sporting performance.

Practical issues may still affect participation. Long tournament days, late finishes, travel, hot venues, prolonged standing, waiting between matches, toilet access and disrupted sleep can interact with an individual’s symptoms. These are reasonable welfare and participation issues to plan for without assuming every woman needs the same adjustments.

Practical ideas for participants

• Plan water, clothing/layers, toilet access and rest around what helps you personally.
• For long events, consider how sleep, food, travel and waiting time may affect your day.
• If concentration feels more difficult, use ordinary competition routines such as written schedules, preparation checklists and reset routines rather than assuming your sporting ability has disappeared.
• If a particular symptom is affecting participation, ask for the practical adjustment you need without feeling obliged to disclose your whole medical history.
• Regular physical activity is supported by NICE and NHS guidance for health, muscle strength and bone health; this is general health guidance, not an instruction that sport will treat every menopause symptom.

For coaches

Use RECOGNISE → LISTEN → SUPPORT → ADJUST → SIGNPOST.

• Listen privately and ask what would help.
• Keep expectations linked to the athlete’s actual goals and performance.
• Consider water, ventilation, breaks, clothing flexibility, seating and scheduling where practical.
• Do not diagnose menopause or attribute every difficulty to hormones.
• Do not advise an athlete to start, stop or change HRT, prescribed medicines or supplements.
• Do not make jokes or assumptions about age, mood, memory or competence.

For clubs and venues

• Provide usable toilets and sanitary disposal.
• Make drinking water available.
• Review ventilation and temperature where practical.
• Provide seating/rest options and reasonable breaks during long events.
• Offer a private route for requesting an adjustment.
• Do not put menopause status on general club forms unless there is a justified, governed purpose.
• Ensure older women can see the same social, competitive, coaching, officiating and leadership pathways as other participants.

When healthcare advice may be appropriate

NHS guidance advises contacting a GP if someone thinks they have menopause or perimenopause symptoms and wants to discuss options. It also advises healthcare assessment for changed/heavier bleeding patterns and for any bleeding after 12 months without a period. This resource does not reproduce a full clinical symptom or red-flag list.

People under 45 with possible menopause-associated symptoms may need a different assessment pathway. NICE recommends particular consideration of FSH testing for people aged 40 to 45 with symptoms and for suspected menopause under 40, while POI under 40 requires a specific diagnostic process and should not be diagnosed from a single blood test.

Treatment and support boundary

NHS and NICE guidance describe HRT and non-hormonal options, including menopause-specific CBT in some circumstances. Treatment choices depend on individual health, symptoms, preferences and risks. Eights and Arrows does not recommend an individual HRT regimen, prescribe treatment, interpret hormone tests or advise somebody to change medication.

Herbal and complementary products should not be assumed safe because they are “natural”. NHS guidance notes limited evidence for many such products and possible medicine interactions.

Common myths

Companion resources

Evidence and source notes

Important boundaries