TriDot Podcast .220

From Peri to Post: Candid Conversations from Triathletes onMenopause

Intro: This is the TriDot podcast. TriDot uses yourtraining data and genetic profile, combined with predictive analytics andartificial intelligence to optimize your training, giving you better results inless time with fewer injuries. Our podcast is here to educate, inspire, andentertain. We’ll talk all things triathlon with expert coaches and specialguests. Join the conversation and let’s improve together.

Vanessa Ronksley: Hello hello everyone! I can't even begin totell you how excited I am to be hosting this podcast today. We are going to betalking about a transition, but not T1 or T2. It's a life transition that isinevitable for 50% of the population, and one that usually gets a pretty badrap. Anyone have any guesses? Well, if you have guessed, and you are male,please, please, please stick around. I think that this episode is reallyimportant for coaches, husbands, partners, brothers, sons – you get the point.We will be talking about the menopause transition, and with me to set therecord straight and pump some positivity into the journey is Dr. TishDoyle-Baker and Joanna Nami. Dr. Tish Doyle-Baker has a Master’s of SportsScience and Exercise Physiology, a Doctor of Public Health, and a PhD inExercise Interventions in Chronic Disease. Her current research involves bothclinical populations and female athletes related to reproductive health. Shehas several grad students currently investigating the development of analgorithm to help female athletes with their performance readiness and lifelonghealth. Dr. Doyle-Baker is an Alpine ski racing coach, and you will often findher ski touring in the mountains or on epic kayaking trips. Tish, thank you somuch for joining us on the show today!

Dr. Tish Doyle-Baker: Thank you so much for asking me to be on theshow! And to get to hear Joanna, which is a bit of a thrill for me.

Vanessa:Also with us is Coach Joanna Nami. Joanna is better known as Coach JoJo, andhas been coaching athletes with TriDot since 2012. She's a co-founder of HissyFit Racing, a member of the Betty Design Elite Squad, and has double-digitIronman finishes on her accomplished triathlon résumé. She has raced theIronman World Championship three times, and is a lead instructor for TriDotPool School. Jo, thanks for being here! I think that this episode is one thatour listeners have been waiting for so long, and I can't wait to dive into itwith you.

Joanna Nami: Yay! Go menopause! This is going to be awesome, I'm super excited. Ilove being on the podcast with Vanessa, and it's quite an honor to be on withTish as well. This is going to be great.

Vanessa:And I'm Vanessa, Your Average Triathlete with Elite-Level Enthusiasm! As usual,we're going to start things off with our warmup question, we will move into themain set, and then we'll cool down with our Coach Cooldown Tip. It's going tobe a great set today, everybody! Let's get rolling.

Warm up theme: Time to warm up! Let’s get moving.

Vanessa:  I don't know about you, but I love a goodtradition, so I want to know what tradition, habit, or thing from another sportthat is not done in triathlon, which one would you want to see brought over?Let's start with our special guest, Tish. What would you bring over to thesport of triathlon?

Tish:Well, at the end of a race, particularly a ski race, if you're an adult or theend of coaching ski racing or any outdoor event, we all look forward to sometype of beverage. Hydration is a key, so why not enjoy the outcome with bothwater and a favorite beverage? For me, it's usually honey with tea, and onother occasions a really nice cold beer.

Vanessa:Yes, I actually have my honey with tea sitting with me right here today. Thisis not a sporting event, but it definitely warrants a wonderful cup of tea.What about you, Coach JoJo? What tradition or habit from another sport do youthink would be an awesome addition to triathlon?

Joanna:This was a tough one for me as I was thinking about it, but being in my house,I'm going to always say it. Lots of men in this house, lots of football goingon right now. I would think a lot of athletes would say, “How about a timeout?”A little timeout, a little coach huddle, could totally get to take a breatherfor a few minutes. Some people may consider this transition, but as a coach Isay, “No, transition is the fourth discipline. We are hustling!” So maybe atime would be nice during a full Ironman day to take a breather or chat withyour coach.

Vanessa:  I think that is a phenomenal idea, and onethat should be brought to all race directors all over, because that would bejust a great way to have a little reset of your mind, or potentially your body,and have no time penalty. Now, I don't think this will come as a big surpriseto anyone, but I have a fond love of celebration dances. So I'm thinking thatit should be 100% mandatory to dance down the red carpet. Or if you're not intodancing down the red carpet, you must have a celebration dance after the finishline. Like, how much fun would that be? I also have another idea, actually. Ithink it would be pretty awesome to have to complete something like the NewZealand All Blacks haka before jumping in the water at the swim start. I thinkthat would be really fun, and I don't think there's a better way to pumpyourself up before hitting the water.

Joanna:I love that, Vanessa. You know that in Ironman Maryland, the race director usedto have high heels at the end, right before you came down the finishing chute.And women could put them on and prance across, it was just kind of a tribute.Those kinds of traditions that were established in certain races is what madethose races so special. So I love that, when you're talking about dancing downthe finish line.

Vanessa:Well, let's throw this out to the people. I want to hear what you have to say,so make sure you're a member of the I AM TriDot Facebook page, and look forthe warmup question post, to let us all know what sports tradition you thinkshould be brought over to triathlon. I can't wait to see what y'all think.

Main set theme: On to the main set. Going in 3…2…1…

Vanessa:  You know you're a triathlete or a cyclistwhen you will talk to pretty much anyone about your bike. And when that bike isa Dimond bike, there is a lot to talk about. My Dimond Marquis is nothing lessthan a masterpiece. Every detail has been carefully engineered and crafted bythe team at Dimond Bikes. I had a very special custom paint job designed tocommemorate several strong women in my life, and the smile plastered on my faceoutlasted the longest ride I have ever done for my first Ironman race. Thebikes are industry-leading aerodynamic machines that look and feel awesome. Buteven beyond that, Dimond as a brand knows how to take care of their athletes.And with five different tri bike models, as well as road, gravel, and mountainbikes, your next bike should absolutely be a Dimond.  TriDot and Dimond are a dynamite race-dayone-two punch. Dimond provides you with the Ferrari of bikes, and TriDottraining develops your engine. So we are excited to partner with Dimond on somereally cool offers. If you are new to TriDot, we're offering six months of theMark Allen Edition of TriDot with the purchase of a Dimond. If you are alreadya TriDot athlete, we are offering either an upgrade credit or TriDot storecredit with your new bike. Head to dimondbikes.com for all the info and to dream up your very ownbike.

Astriathletes practice transition from swim to bike, or bike to run, they maycome up with a plan that is fully rehearsed, where all items serve a purposeand there is an order in which they choose to proceed. I'm not sure about you,but I practice this transition physically and mentally, with the hope ofgetting through it as quickly and as painlessly as possible. Now, I wish wecould say the same for menopause. Wouldn't it be nice if we could plan forthis, or have a protocol with a troubleshooting manual when things take a turnfrom what a female would consider to be “normal”. Thankfully, as time movesforward, this is more likely going to be a reality, as experts continue touncover the intricacies and solutions for what females experience. And my hopeis that after listening to this podcast, we can change the public narrative ofmenopause from doom and gloom to one of acceptance. I also hope that ouraudience will gain some tools and strategies that will allow them to feelknowledgeable, and have a greater sense of control during a time that can befilled with quite a lot of uncertainty. So I think the first thing that we needto discuss is what the menopause transition actually is. So Tish, can you giveus a rundown of what this means?

Tish:The menopause transition is probably bigger and broader than most individualsrealize. It can last over a 10 to 15, or a 16/18/20-year period. So the firstperspective is to understand that the transition period is quite individual. Itdoes go through certain stages, but it can be different for anyone. It's alittle bit like thinking of the sense of moving through your life course ofchanges. And recently, you'll see in some of the literature, that people areassociating chronological age with menopause. So many women are kind of unawarethat they might start to have changes related to their fluctuating hormonelevels – such as changes in mood, in their bleeding pattern, vaginal dryness,or difficulty sleeping –somewhere around ten years before menopause. That's thestart of menopause transition. So we could say it coincides with some of thesymptoms of aging. Now, while those stages are quite clearly defined, we couldalso further define those in years, since our introduction with the term“menopause” is commonly used in relation to menopause transition. But the ageof that might be different for everyone. So it may be helpful to note thatperimenopause, the start of it, begins in the early menopause transition stage,and that can extend into the early postmenopause stage. However long that maybe is different for everyone. So symptom identification is the way that we lookat transition. Menopause symptoms can manifest themselves, as we said, yearsbefore. And the preparation for menopause, even though you said maybe we can'tprepare, but there is this adaptability towards, and I'm going to say apositive journey towards it, and it should be an early goal in a woman's lifeto approach healthy aging with consideration that menopause is part of that.Many of us look forward to aging – I know I can say this because I'm older–because we have less responsibility, we have less association with the idea offertility, so we have other things that we can look forward to. And that meansthat we should think about healthy aging, we should think about menopause, andwe should do the exact same thing for both of them. And that is we shouldprioritize our diet, and prioritize sleep – because we probably can get moresleep now. Think about our sleep routine, and then think about how that mightdetermine what we feel or do in our mid-life experience. So if we talk about asystematic review of a number of evidence-based studies, we can see that manywomen report their symptoms, but often they forget about their attitude ortheir perception towards the menopause transition. So their results of thesestudies, these systematic reviews, demonstrate a relationship between yourattitude and what symptoms you experience, suggesting that a more negativeattitude surrounding menopause may lead to more menopausal symptoms. This is alittle bit like going back to thinking about your positive approach to trainingand being an athlete. If you are positive in your approach, you may actuallyhave a better workout. So let's think about how we can approach life andmenopause the same way that recreational athletes do, by increasing our chanceof reducing our symptoms through our exercise, sleep, diet, and positiveattitude. So yeah, that's a very good piece of good news.

Vanessa:That is a really wonderful piece of news for everybody, because I think when weprioritize the things that are important – like sleep and nutrition andexercise, which is what a lot of triathletes do to begin with – it seems likeit's setting us up for a little bit of success towards this transition. So Ithink that's a wonderful take-away already. We're only a few minutes in and wealready have a wonderful take-away, that it's important to prioritize thosethings, and it will have a more positive outcome.

Tish:When we think about post-menopause, we define it as 12 consecutive months ofamenorrhea, which means no periods or no menses or no bleeding, whichever termyou like. And that can be further divided into early post-menopause andlate-stage post-menopause. The way we differentiate this can be through thenumber of hormones that we have in our body, and the level of those hormones.For example, follicle stimulating hormone, or FSH, and estrogen, which mostpeople know, stabilize when we are in the final phase of post-menopause. Butfor some people, that final phase can be a long time, and they can have thosesymptoms for a long time. So early post-menopause is associated with symptomssuch as hot flashes and mood swings, and those two symptoms people talkprobably about the most, and they can be affected by exercise participation. Inother words, the lifelong goal of being an exerciser may actually keep thosesymptoms either reduced, or in some cases I might even talk about later on,that one or two types of exercise may not be the best when you're in that sortof early stage of post-menopause.

Vanessa:Yay!  That's another piece of good newsfor all triathletes out there!

Joanna:“Sorry Coach, I can't do it. I’m in the early stages of late menopause. I'vebeen restricted.”

Tish:Only for a day or two, though. Each of us is different with our symptoms, sosome people really suffer from terrible, terrible hot flashes. So if they'rehaving hot flashes during the day, then it's not a good time to be doingaerobic exercise. I actually had to learn that myself before, then I looked itup. I don't know why I didn't look it up first, but I learned – so I wouldexercise in the evening, and I would have had hot flashes all during the day atwork. Then just before I would go home I would do an aerobic workout. So youdidn't want to be around me, because I was already hot, and then I becamehotter, and then I became crankier. And then I realized, “Ah, I should be doingmy strength training on these days, not my aerobic exercise on these days.”

Vanessa:I used to teach high school biology, which some of our listeners may or may notknow. One of the topics that we covered in the curriculum for grade 12 bio wasfemale hormones, and I can assure you that my students would tell you that itis complicated. So what are the major hormones that have a role in thismenopause transition? Just give our listeners a little bit of an idea andexposure to these words, so that when they potentially see something in themedia, or they go and talk to their doctor, they have a little bit ofbackground information as to what they need to discuss or know about.

Tish:All right, so I often am known for being sarcastic. Sometimes when I'mlecturing, I would say we have two of the strongest and – then the least talkedabout, which is the wildest hormones – in our body. Before we do that, I thinkit's a good idea to take a step back and think about a diagram of what amenstrual cycle looks like. If we take the norm that has been sort ofperpetuated in the literature, which is 28 days, we have several hormones thatare in that. One I've already mentioned, which is the follicle stimulatinghormone, and then we have estrogen and progesterone, and then we have aluteinizing hormone. And they all fluctuate throughout the menstrual cycle, andthey fluctuate through different phases. So when your students say that it'sincredibly complex, they're right. And we have these interactions between twotypes of hormones, one is called ovarian, and one is called pituitary. So wehave the hypothalamus, the controller of our cells way up at our brain, we havethe anterior pituitary gland, and then we have the gonads, the ovaries. All ofthose have to work together, and that's a really important statement, becauseif the brain tells the body to do something because you don't have enough fuelin your system, it has to shut something else down to take the calories fromsomewhere else to fuel your system. That's why I think it's important forpeople to have a picture of the menstrual cycle in their mind. And with that,they can then segue in these hormones that change throughout the phases of themenstrual cycle, beginning with menses and ending with what we refer to as thelate luteal phase. So I think if anyone wants to understand their hormones, geta picture of that in their mind, and then that will help you understand what'sgoing on and why it's so complex.

Sothe follicle stimulating hormone stimulates follicular growth, and that'srelated to how the egg is going to eventually become part of the ovulation, andthen how that will then either go on to become implanted in the placenta, or itthen is shed out through menses. So when we think about these hormones, werealize that we can either suppress them or we can secrete them. One of theinteresting things about this – and Vanessa, you would know this from biology –is that we talk about feedback loops, how one thing can affect another thing.That's how regulation occurs, and we can think about estrogen, it's a bit of adriver of all of this. So estrogen starts off high in the menstrual cycle, andthen does a little bit of a dip, and then goes back up again but not as high asit was at the very beginning. So it’s driving the process. Then what we want todo is we want to get this ovulation to occur, so that's where this follicularstimulating hormone comes in, and it peaks when we have ovulation. But then wehave this one in the background that starts off really slow, nobody pays muchattention to it, and that's progesterone. Then progesterone peaks in themid-luteal phase, the latter part of the menstrual cycle, and thatprogesterone, in my estimation, holds a lot of value for people inunderstanding some of the things that occur when we get stressed, becauseprogesterone competes with cortisol. If cortisol is really, really high, thenprogesterone will be affected by that, and won't be quite as high.

Vanessa:Now, is this a major part of the algorithm that you're developing? Is themonitoring of stress levels and how that may impact menstruation for high-levelathletes?

Tish:So you want me to give away the secrets?

Vanessa:Of course, yes! Are you allowed to?

Tish:Of course. I mean, I wouldn't say that this is unusual, what we're approaching,but cortisol clearly is the way that we can measure this in athletes. So we cantrack their stress, either by a questionnaire, or we can also track it throughthis biological mediator of cortisol. There's many ways to look at this, and Ithink the other way that we could do this is just looking at training load, andthe internal and the external components of that. And obviously we have to lookat fatigue as well, and then we have to look at where in the menstrual cycle anathlete might feel their fatigue, and is it different before ovulation or afterovulation, and what happens to those hormones throughout the menstrual cycle.Because I would say that every athlete has a hormone signature, and it's notthe same as the next athlete. So our goal is that we really want to help everyindividual athlete do what they can do for themselves so that they can havetheir best performance.

Vanessa:Oh I can't wait for this to become mainstream and usable, and to give insightfor athletes, female athletes in particular. It's going to be a reallyincredible tool, so thank you for the work that you're doing on that.

Tish:We hope so.

Vanessa: Now,closely related to the hormones are the symptoms that someone in the menopausetransition might experience. What are these symptoms that a person would seewhen approaching the transition? And you had said that it can happen 10 to 15years, like it's a long process. So this could be happening for someone in thelate 30s, right? What kinds of symptoms should someone be noticing andrecognizing that this might be part of the menopause transition, and if that'seven important to recognize in the first place?

Joanna:Yeah, I'm not sure that everybody would notice in their early 30s. Even thoughthey might be going through the menopause transition, they might not notice anysymptoms. So all I can say is that the menopause transition is associated withsometimes temporary and sometimes long-term health consequences. The bodysystems predominantly that get affected are bone mineral densities, our breasthealth, our cardiovascular symptom, mood, and cognitive function. And then ofcourse, as I've already mentioned, a little bit related to sexual functioning.But those symptoms are classification, you could have many different symptomsthat nobody else has. For example, some women talk about their tongue swelling.They notice that, but nobody else has that.

Vanessa:So I'm just thinking, I know a lot of people have this question in relation tohaving an IUD, or some other form of contraception, where they actually don'tget their period. The question that they always ask is, “Well, how do I know ifI'm in perimenopause or even menopause?” Knowing that there's a whole ton ofother symptoms that might be related to this transition period, basically anindication that you don't need to just look at menopause in terms of having aperiod, and then having that cessation of period.

Tish:Not having a period is one perspective. You might have no period for fourmonths and then you have another period. So if you think about someone with anIUD, they don't have a period, but they could have all these other symptoms.

Joanna:You could definitely tell on other symptoms that you're going to experience.Not so much as hot flashes, but disruption of sleep. It's been rough for me –fatigue, headaches, migraines, a lot of symptoms that you are starting toexperience. You can tell.

Vanessa:Coach JoJo, you have a lot of athletes that are within this menopausetransition. Have you noticed any symptoms, or have they talked about what arethe typical symptoms that they have recognized in training and racing?

Joanna:I think it's tricky, because these symptoms could be caused by other things intheir life as well. They'll come to me and talk about, “I've been having a lotof headaches and migraines. I'm just really exhausted. I feel bloated.” The onethat really gets to me, and this is really what I usually attribute back tohormone levels and menopause transition, is they'll start to tell me that theyreally have a lack of motivation. They just don't have the desire, they don'thave the “go” to do things anymore. They're like, “I used to be so into this,and the workouts used to come so easy for me.” I like when Tish said thatsometimes, even their own attitude about doing a workout, they just feel likethey're not good enough in the middle of it, or they can't push to the levelthat they used to. I think those are tell-all signs that something is – I won'tsay “off”, but they're in the middle of something that needs to be addressed,or something that they need to have a doctor that's willing to talk to them andhelp them, and not just say that this is a natural part of life. Someone thatwill help them manage the symptoms, and a coach that is willing to understandand adjust training, so that they can be the best athlete they can be asthey're going through this transition.

Vanessa:Speaking of symptoms and this transition, are there any of these menopausetransition symptoms that are dangerous to health when training? Like, is thereanything that an athlete might need to consider, or to know when to stop, or topotentially alter their training schedule in terms of their overall wellbeing?

Tish:Symptoms are the outward signs, for example, of something that's going on. Iwould approach it from the perspective that, I think an athlete knowsthemselves very well. I don't think that the symptoms of menopause are relatedto extremeness, but they can be compounded with other things, such as familyhistory, that could be a flag for the athlete to go and get further medicalcare.

Joanna:I think it's finding a doctor that knows you, as well. The type of athletesthat I am coaching, these may be women that are going through the menopausetransition. And yeah, they may feel off, and they may not feel normal, butthey're not going to stop this lifestyle. This is what makes them who they are.They are athletes, no matter what age they are, so they need to find a doctorthat is willing to help them to be successful, along with their coach. But whenwe are talking about symptoms, another thing that is super important as tocoaching athletes that are experiencing these symptoms, and know that they'regoing through menopause transition, is recovery time. These athletes are goingto require more recovery. That has got to be repeated over and over and overagain. They may not think they do, but you're going to start to see theirtraining suffer, their stress levels rise, then they become really justdisheartened about training, feel like they can't meet their goals. And a lotof times it's just too much physical and mental stress, compounded by veryintense training, where sometimes we have to back that intensity off and allowfor more recovery time. I know there has been a lot of discussion regardinglong endurance training for female athletes going through menopause transition,as to NOT the typical three-week build/one week recovery system that we areaccustomed to, that periodization that we've been ingrained as coaches tofollow. There's a lot of variations that are popping up that would providewomen more recovery time, and be more successful in achieving their goals, andjust healthier overall well-being.

Vanessa:So in terms of that extra recovery time that's required, what would you dospecifically to an athlete’s program if they came to you and said, “I'm feelingreally fatigued, and I'm not motivated to do my sessions anymore.” When youflag that as needing more recovery time, what sort of thing would you implementinto their program?

Joanna:Well, there's two things I do. I look at it from a coaching perspective, andoften making hard decisions and giving them off days, giving them rest days.What two days off can do for a female athlete is amazing. But I also issuehomework, I distract them. Because they are so wired to train every day, and towork so hard, that sometimes they won't even listen. So I give them homework,such as, “I want an hour of easy yoga or a stretch session.” Or like Tish said,maybe that would be a strength training or a flexibility/mobility day. But Igive them an assignment, and then I issue homework as, “You've got to sleep anextra hour over the next five days in a row.” When they know it's going tobenefit their training, and I put it into the training as homework, even ifit's not swim, bike, run, then they're more apt to do it. But it's veryimportant that you be able to go in and lower intensity for those sessions.With TriDot we have some very high-intensity training, but that's alladjustable depending on the individual. And this applies across the board, thisis a given we should have for any athlete. When it comes to injury, or stressin life, a family situation, across the board we need to be able to adjustintensity and duration of sessions, and even issue a week off if needed. Allowan athlete to do a complete reset, where they spend time doing other activitiesthat are hobbies, other things that are totally separated from triathlon orrunning. So that they can free their mind, let their body completely recoverfor a week, and then slowly start back into it.

Vanessa:If an athlete doesn't have a coach when they're in this phase of their life, Ithink that it would be really beneficial for them to seek a coach, and to makesure that that coach is knowledgeable about the menopause transition, and havethe ability to recognize when they need that extra break. Because I know manytriathletes, they don't want to take a break. They need someone to tell them todo these things, and I think having a coach who's going to make that happen,say, “You need to do yoga, you need to take a week off,” is really important.

Joanna:If you can't afford a coach, if you start to think every day, as you're wakingup, really evaluating, “How do I feel today? Am I exhausted? Am I overwhelmed?”We have so much stress, and so many roles we play as women, so many hats wewear daily, that sometimes you've got to step back for a second, spend somequiet time, and just say, “Today is a day that I need to prioritize feelingbetter physically and mentally.” That may be just taking a walk, doing someyoga, meditating, praying, whatever you do. But those are days that are very,very important, and we need to slow down just a little bit in life, andrecognize that. A coach can be a great, great advisor for that, but if youdon’t have that, you need to start implementing some of those practices into yourdaily routine.

Vanessa:I think this is a perfect time for us to hear about another really good pieceof news. So, Tish, I would love for you to tell me if there are anyphysiological advantages an endurance athlete might have over someone in thegeneral population as they go through this menopause transition.

Tish:It's hard not to say this, but there is so much evidence that exists that thelevels of physical activity are linked with superior health. That's a statementon its own, period. But also, women who exercise also show that inperimenopause and postmenopause they have better muscle mass. And that's reallyimportant, because it segues into a couple of things that maybe I can just chata little bit about, that happen to us with both aging and part of menopause.The first thing that we see is that as we age, we get a loss of muscle mass. Soif you have larger muscular legs when you're younger, you can be assured thatthere will be a significant size decrease as you age, those muscular legs startto change. We lose some muscle mass as we get older, and that means that withinthat muscle mass, we can differentiate between the type of fiber types that welose as well. Just to be simple, we have slow-twitch and fast-twitch, and womengenerally utilize those slow-twitch ones exceptionally well, which is why we'reso good at endurance and things like that. But it's the high-end ones, thefast-twitch ones, that start to decline as we age. So I want to stop there forjust a segue, because if we look at women running marathons right now, those38, 40, 44-year-olds, they're running incredible times. They've had children,and they're just rocking it out of the park. That endurance bit is reallysolid, so that's one thing that's a good news story. But when we think aboutthe Type 2 ones, the fast-twitch fibers, we start to lose those as we age. Sowe lose a little bit of strength, it declines, and we lose some power as we getolder. So what we want to incorporate into our training routines is things thatwill maintain those, because at the end of the run in a triathlon, maybe youneed to do that quick sprint to get to your bike or whatever, so you need tohave a little bit of ability to do that. So things like plyometrics, orsprints, or hill repeats, or something called counter movement jumps, which islooking at eccentric/concentric, so up/down motion, helps to avoid the loss ofthose muscle fiber types. Then the next thing is we have the recovery, whichJoJo has really emphasized well. We need recovery so that we don't have thatrisk of injury. And estrogen has a protective effect against muscle damage,which we now know of course is decreasing as we move into the transition and topost-menopause. So that means right off the bat that we do need more recoverytime, and we need more sleep to rejuvenate ourselves. So even if you're not atriathlete, if you're a highly active person out there, you need more recovery,more sleep. Then I kind of want to just jump into this one, no pun intended, totalk a little bit about tendons. Because I think they give us a bit of adifferent picture. So we have tendons around our joints, and a lot of women inmenopause talk about how their joints ache, and then we get more tendoninjuries as we get older. So when we think about tendons, we can think aboutthis loss of collagen that JoJo's already mentioned once. But we do get a lossof collagen, that collagen breaks down and makes our tendons more susceptibleto these micro-trauma bursts. And when that happens, then of course we're goingto have pain and an increased risk of injury. So again, that speaks to how weneed to have recovery. And I want to give a head’s-up about Dr. Jared Fletcher,who is at Mount Royal University, because he's actually researching in thisarea, and his grad student is doing some work in this area. I'm on this committee,and she's looking at what happens to the tendon through the perimenopausetransition, which will be really interesting research down the road. Soestrogen is everywhere in the body, so it likely affects collagen, and we don'treplace it as fast as we age, so we heard that JoJo may think aboutsupplementation with collagen. We also know that the shape of the tendon itself– so if you can envision your Achilles tendon, the shape of that tendon thenchanges because of the change of collagen. So we have a compositional change inthat, and that compositional change actually tells us that we're going to havea mechanical change in our tendon. And when that happens, then we reduce thestiffness of the tendon, which means then of course, we won't have the sameability to spring off. We'll have a change in how our body hits the pavement,and we react to that, that's called ground reaction force. And we will also notbe able to have the same sort of eccentric deceleration that occurs. So there'sa lot of things that change related to estrogen and as we age, which seguesinto the fact that we really need to be thinking of estrogen, that is quite anadvantage for us when we're younger, and we need to find a way to maintain thatadvantage as we get older. And I think the human body has done that, by thefact that women are just so good at endurance exercise as we age. We get betterand better. So I think the idea that we think about in a tendon is that if wewant to maintain the tendon ability as we get older, those slower movementsthat we do, how we load the tendon, can make a difference. It's kind of fun tothink about, that as we transition forward in life, there are different ways tomaintain our physique, and those ways that we maintain our physique can be verypositive in terms of the types of activity we're doing, particularly if you'rea runner or a triathlete or a long-distance swimmer. We've just seen that moviewith Nyad, crazy that you could swim so long, so far, with the same pace,right? But I think that's why we come up with that expression, that women getbetter as they get older.

Vanessa:I love that expression. So we've talked about plyometrics as being somethingthat is important to incorporate into a training program. Also the loading ofthe tendons, like those mobility exercises that we've all been seeing onInstagram, just like you said, Tish, are super important. Can we dive into – Iknow this is a topic that a lot of people don't necessarily talk about, becausethere's been such a bad rap about it, but in order to preserve that estrogenand progesterone, can you tell us what the situation is with hormone therapy,and if this is something that everyone needs to consider, or just a smallpopulation of people? Talk to us about hormone therapy.

Tish:All right, so the first thing that we should say, and we've already said itseveral times, is that every individual is different. And therefore theindividual should go to their healthcare provider, and have that conversationwith their healthcare provider about their symptoms. And then with theirhealthcare provider, they can do a shared decision making in terms of whetherhormone replacement therapy is right for them. If we go back historically, wefound that hormone replacement therapy got a bad rap because of a clinicaltrial that was going on, and about five years into the clinical trial, therewas an increased risk associated with cancer. So they stopped the clinicaltrial because of that, but they didn't actually have an opportunity to really gofurther in that clinical trial. So I would say that today, hormone replacementtherapy has a very different perspective about it when you go talk to people.And I would actually say that the narrative is moving towards maybe hormonesupplementation, a different way of approaching it. When we think aboutsupplementation, we know that estrogen has many receptor sites in the body, andthat maybe supplementation – actually the ability to bind to the receptor sitesjust needs a little bit more estrogen to facilitate that – not a lot, but justa tiny bit – and that can make a huge difference in symptoms that someone ishaving. There may be some research right now that's occurring that looks atjoint health, and having those estrogen receptor sites around our joints wouldthen – if we were able to come to an agreement with our physician and theindividual to have supplementation, that might change their joint pain. And ifyou change joint pain you're going to be more active, and if you’re going to bemore active, you're going to be more positive, and really that's what we needin the end, is a positive attitude. So I don't think this is a no-go subject. Ithink this is a very responsible way to talk about how we can assist the bodywith maintaining ourselves in a way that contributes to function, and also ourbetter health. Because in the end, we could talk about collagensupplementation, or eventually we're going to talk about creatinesupplementation. Whatever it is, this really could fit within that line of things.

Vanessa:What are your thoughts on creatine supplements for perimenopausal, menopausal,postmenopausal women?

Tish:I think it comes around to what we've been talking about, is that we need toknow each individual and what's going on in their lives. First of all, let'sstart off with creatinine. It is actually lower in women than men, so we can'tcompare males and females. And if you're an exercise physiologist or anexercise scientist, you probably get really excited when someone mentionscreatine, because creatine metabolism is kind of a key of energetics. We cansynthesize creatine, so there's the biosynthesis of creatine, so we call thatan endogenous source. Or we get it from our diet as we've talked aboutpreviously, so fish, meat, dairy, chicken, that's also where we can get it fromexogenously. And creatine is so important because it maintains our intracellularstores of adenosine triphosphate, so ATP, as we call it. Old ATP, the“powerhouse within the mitochondria”, that's always the expression we use. Wecan't do anything without ATP, so because our systems require ATP, it meansthat if we have a lack of creatine occurring as we get older, there probably isa consequence of feeling fatigued because of that. Now the key is, can creatinemake a difference to us? If we were to start with diet first, I would say lookat someone's diet and see what they're eating. That's the number one go-to.Then I would say if diet doesn't make a difference, will supplementing withcreatine make a difference? And I think it's important to think about thiscreatine pathway, because we have two isoforms of creatine – we have the CKBB,that's the one that affects our brain, and then we have the one that affectsour muscle, CKMM. Those isoforms are so important for maintaining both ourbrain health and the rest of our health. You can see where I'm going with this,that if you don't have enough creatine, it's a little bit like not havingenough hormones, enough estrogen. You really do need creatine. But the amountof creatine that you need, I think is the key. So if we increase the uptake ofcreatine as we age, will the outcome be that we have decreased fatigue? And Iwant to say that there are a lot of knowledge gaps in this area still that wehaven't completely figured this out. But we can go back and say we know thatcreatine is localized within the muscle, we know that it's localized within thebrain. So it could be that a small amount of supplementation with creatinecould make all the difference in the world. And it's not going to be a hugeamount of creatine, 2.5 grams per day is probably a lot, and probably willmake a difference in someone's outcomes, as they get used to absorbing thecreatine in their system. Not everyone does well with creatine, because part ofthe problem with creatine is when you supplement with creatine it upregulatesand causes osmolality, so it increases the amount of water within the cell.That's a good thing in the sense that cellular swelling stimulates a pathway,the activity of it, but not everyone likes that. That feeling doesn't alwayswork with everyone. The other thing that creatine does is it helps us in termsof inflammation. There is an oxidative stress effect with creatine, which iskind of protective against inflammation. So although the research is equivocal,you could be on one side of the fence and show great results, and on anotherside of the fence and show no results. Again, I would say it's an individualsituation. For someone it might make a difference, and for others it might not.

Joanna:I’ll say, I think that's really great. Personal experience – I like how Tishsays it, it's based on the individual. You know, I wasn't thinking of takingcreatine until I met with my nutritionist, who is also an Ironman athlete,she's been in the sport for a long time. And when she suggested it I was like,“What the heck? I'm not taking creatine! I’m not getting juiced!” I was like, “What are you talking about?” Butthe amount she prescribed is so small, added to your smoothie, in combinationwith other supplementation and collagen, things that we've talked about. And Idon't know if it's psychosomatic, but I do feel better. I feel like, as Ironmanathletes, we are constantly suffering from inflammation. We are at a constantbattle with inflammation, so any tools we can use to keep us in the game longerare great. So that's been my experience with taking it.

Vanessa:Speaking of nutrition, Jo, I'm just curious if you have any insight forathletes in terms of nutrition, and how nutrition might need to change whenexperiencing this menopause transition? What do you think about that?

Joanna:One thing that we didn't talk about, which is probably the number onediscussion I have with my female athletes who are going through menopausetransition, is a lot of them come to me saying, “I've gained a lot of weight,and I can't seem to maintain a lower weight like I used to. I'm doing the sameamount of activity, I'm taking in less calories, but I just can't lose thismidsection weight.” The first thing I tell them is I'm not a certifiednutritionist, that is not my specialty. So I do suggest that if they really,really want to get a handle on that, two things – number one is doctor, bloodwork, see what's going on. Number two is to invest in a nutritionist that canhelp you with your macros. And most of the time, they're really depriving themselvesof what they need to maintain the level of training that we're asking them todo. So they're not adequately fueling their workouts. The timing is really off,when it comes to good carbs and good protein that is going in. So even a littlebit of investment in nutritional help can be such a game-changer for women thatare going through this menopause transition. So that is a symptom. When we'retalking about symptoms, that's one that definitely comes to mind. From myperspective as a coach, I'm constantly harping on them about getting enoughprotein. I know that most women are not getting enough in, and it's hard to.I'm not a big meat-eater. It's very tricky for me to maintain levels, gettingenough protein each day. But if you do work with a nutritionist, they canensure that you are getting enough of those in. As far as hydration throughoutthe day, we also all fall guilty of not hydrating throughout the day, which youcan feel terrible if you get behind. And then secondly, with supplements,that's where I get worried about people. Because people will start taking 50 to60 supplements per day, thinking that this is going to improve their wellbeingthey're going to feel better, they're going to have more energy, and a lot ofthat is not even being absorbed. So that's where I'd be careful. You need to bechecking with your physician on what you are taking, especially in combinationwith all other things. I do find that collagen, which Tish has touched on, andthe creatine have been helpful for a lot of my female athletes that are in themidst of this menopause transition. So that is something I would check with thenutritionist and your doctor about incorporating into your daily routine.

Vanessa:What kind of lifestyle adjustments can a female make in terms of stressmanagement to help health and wellbeing during this transition period?

Joanna:So from a coaching perspective – I often say your advisor, counselor, coach,therapist, all-in-one – because it's easier to look from the outside at otherpeople's worlds sometimes. Not so much your own always, but when you're lookingat an athlete that is extremely stressed, struggling in training, I’ll ask himor her to write out what their goals are right now. If there's five things theywant out of life, in the next month, in the next six months, next year – that'soften a wakeup call for some of them.  Weall talk about balance in life like, “I want to balance training, I want tobalance work, I want to balance family time, I want to have self-care.” Butwe're not doing that in any way shape or form. So that often allows them tosay, “Here are some goals, but this is this is a healthy way for me to approachthem.” So when we talk about lifestyle changes, when it comes to menopausetransition, I think we touched on it before, in that women are very guilty ofnot prioritizing self-care or making changes in their lifestyle. We say we'regoing to do it, and then we put on a different hat every hour. But sometimestaking a little bit of time to structure that and plan it – we're so good atplanning and structuring everything else. There are other things that we'veloved in life, in years past, that often get put by the wayside. Because ournumber one goal is to complete this Ironman, and to make sure, my kids haveevery meal perfectly healthy. I think we’ve got to cut ourselves some slacksometimes, but even having a coach or a therapist or a friend to talk to, andjust map out, “What are my real priorities? What are the really importantthings right now?” Create more balance in our lives, and that often meanssometimes taking a step back a little bit from training, from work, from allsorts of things, to just overall improve our wellbeing and make us happierindividuals.

Tish:That's a great segue then into thinking about – that you're going to have somesymptoms related to menopause. You're going to age, your physiological profileas an athlete is going to change. So if we know all that, then we know thatthere will be ups and downs with stress. So we should think about, “What is theplan when we do get stressed?” And we should work on that plan as we moveforward. So we could say, “Well, the best plan is to ensure that you do all theother things right. So exercise regularly, diet, etcetera.” But I think it'smore than that. I think it's the idea of knowing yourself, and knowing thatthese things may trigger your stress, and then trying to work on reducing thosetriggers. Stress is one of those things that we're going to have stress in ourlife. We're going to have lots of good stress, but we're also going to havelots of stress that causes us certain symptoms, like racing heart rate andfeeling anxious, etcetera. So we need to mitigate those stresses, and put aplan in place. That's just like being an athlete, is learning to adapt andchange on the fly, and that's what we need to do.

Vanessa:This conversation has been amazing. Thank you both to Tish and Coach JoJo forcoming on here and talking all things about menopause transition. I think I'dreally like to round out this conversation by giving people an idea of wherethey can go for evidence-based, informative, understandable informationregarding the menopause transition. Because a lot of people will go to theinternet, or they'll listen to their friends, and think that they should takethis supplement or that supplement. And it's not necessarily the best source ofinformation. So where can you suggest that someone could go if they havequestions or concerns, or if they want some really solid information?

Tish:Well, start off and defer and say that if someone really needs to get somethinganswered quickly related to a health issue, they should always speak with theirhealthcare provider. In Alberta in particular, our healthcare providers havemoved to something called shared decision making, but that means that you canhave a conversation with your healthcare provider, and it means that you're onequal footing. You can give some information that you might have looked up, andrun it by your healthcare provider. That's the first place I would say, thesecond thing is I would ask people to think about a way to find how to researchyour questions, and that you ensure that you look at the source of where thatinformation is coming from. Because it's important to have evidence-based, butit's also important to take that evidence and translate it into something thatis usable for the individual. Then I would say, when you're having aconversation with someone, fact check. Don't believe everything that everyone tellsyou, because our personal experiences create biases, and sometimes that createsa problem for us. So fact-check your conversation. Apart from that, there is alot of good information available on the internet, just be diligent in how youview it and how you use it. But then the last thing I would say is neverunderestimate, as we move through our life, the value of a quality routine, orthe value of a quality training program, and think about the tweaks that weneed there. Think about the adaptability, and think about pivoting, andunderstand that your key to your success comes from you. You really can't beata good diet and good sleep. So if you really have to, get some really nicepajamas and enjoy them.

Joanna:One comment I give to all of my athletes, whether female or male, is we allstrive for such perfection. And I tell them that in any training cycle, anytraining journey, any triathlon journey, it will not be perfect. It will not beperfect, so I don't expect perfection on a daily basis, I don't expectperfection on a mesocycle of training, that we do have to pivot, and we have tohave grace for ourselves. When we do that, we're going to be much happierathletes, much happier humans.

Cool down theme: Great set everyone! Let’s cool down.

Vanessa:Well, hello there, everyone! I'm Vanessa, your Average Triathlete withElite-Level Enthusiasm! And I know you've all been anxiously awaiting the CoachCooldown Tip. I am most pleased to have with me Louise Strydom. Louise is arock star on multiple levels, and she's joining me all the way from Pretoria,South Africa, where she lives with her husband and her 3½-year-old daughter,affectionately known by her athletes as Coach Junior. Louise is the owner andhead coach at Infinitude Multisport Coaching, and incorporated TriDot into herbusiness in 2019. She was a provincial age-group winner, and was also the firstSouth African female triathlete to get selected to take on Patagonman ExtremeTriathlon in Chile. She specializes in beginner and intermediate athletes, andhas had great success with helping athletes reduce training and racing anxiety.Welcome to the show, Louise!

Louise Strydom: Thanks so much, Vanessa. I'm really excited tobe on the cooldown!

Vanessa:I am so excited to have you here! We usually start off with something that mostpeople don't know about you. So something that you shared with me that mostpeople don't know, is that you cry – like hardcore cry, “ugly cry” you mighthave said – during emotional advertisements on TV. I am so with you on thisone. I know that the audience can't see us right now, but I'm like tossing highfives at the screen, because I get it, Louise. So what is it specifically thatgets the tears flowing for you?

Louise:Oh my goodness. So whenever there’s animals involved. One specific, it’s atelecommunications company, and you see this dog running over the fields, andjumping the fences, and in the back of it there's a phone ringing. Then hecomes into the house, and he's excited, and the answering machine goes on. Thenyou hear this voice that says, “How is it, Pilot?” And the dog just getsexcited and starts jumping, and then it shows this man is calling his dog fromJapan. I just like bawl my eyes out every time, and it’s like 15 years old. IfI see it, I'll cry.

Vanessa:Yeah, I totally get it. It's animals for me, and babies, and when people arekind to elderly people. Those are the three things that make me lose my abilityto control the tear flow.

Louise:And it’s the ugly cry.

Vanessa:Yeah, exactly.  It's a nice release ofemotion, so it's all good. All right, well, let's get to our tip. What do youhave for our listeners today?

Louise:So my coaching tip for every and any athlete – doesn't matter if you arebeginner, intermediate, age-group podiums, world championship slots – is toinvest in your training. When I say invest in your training, it's really tolearn about what your program is about. Why do you have Zone 2 workouts? Why doyou have threshold intervals? Why is there a developmental phase, a race-prepphase, an endurance phase? Why are you doing spin-ups? Why are you doingrunning drills? How's that helping you? Investing in your own training is goingto make you a better athlete. You're going to understand your body, you'regoing to understand where you are in your program, and training is just goingto be so much more enjoyable. Read articles, ask questions. If you don't knowthe answer, figure things out. Really, as much as you invest in a trainingprogram, what you pay per month, or you pay a coach, invest the time in reallygetting to know why you are training the way that you are training.

Vanessa:I hundred percent agree with you on this one. I know that when athletes inparticular join TriDot, it's like this massive influx of information, andlearning how to use the system and everything can be kind of overwhelming. Soone of the things that I think is important to add to that is, it takes time toget to know your training program, and to know that it's okay to not understandeverything all at once, especially the ins and outs of all of the drills, andthe reasoning behind that Zone 2, like you mentioned. I think it's reallyimportant to take it slow, and to make a point of learning something. Make agoal for yourself, maybe learning something new every week, or every session,or something like that.

Louise:Exactly. And there's so much information out there. So most of us, we log on tothe TriDot site, and you log in to your dashboard, and there you go. But thatwhole knowledge base, read about what is the TrainX score all about. Read whatis the RaceX all about. Read about Environorm. Educate yourself, so when you doget stuck in the program and you don't really know, like, “Oh wait, I read thatarticle, listened to that podcast.” Really, really educate yourself. Andthere's a massive Facebook group for TriDot. Go and type in whatever you're wondering about in the search bar, andsee if someone else has had the same question, and go from there. I think mostathletes would say, “I'm not sure if I'm coachable.” You are coachable, butjust take a little bit of time and educate yourself, because then you're alsogoing to feel that you are investing in your training. And at the end of theday, that’s what we do. We invest in coaches, and programs, and training.

Vanessa:I think, Louise, you have hit the nail on the head with a hammer with that one.I think it's really important to utilize that I AM TriDot Facebook page. It is full of questions, and like you said,just enter whatever you need to find out into the search bar, and guaranteedsomeone has asked that question before. And that goes for athletes who aren'teven using the TriDot training platform. It’s just like this little dictionaryof knowledge.

Tish:Yeah, exactly. And if you don't know the answer, Google it. But also just beaware of what sources you are going to follow. If it's some“randomtriathlondude012!” and his favorite page is Wikipedia, maybe not there.But education sources, there's Triathlete Magazine, there's Outside. Go for it,do the research, and do the reading.

Outro:Thanks for joining us. Make sure to subscribe and share the TriDot podcast withyour triathlon crew. For more great tri content and community, connect with uson Facebook, YouTube, and Instagram. Ready to optimize your training? Head totridot.com and start your free trial today! TriDot – the obvious and automaticchoice for triathlon training.

‍