Should Women Train on Their Period? | Dr Hazel Wallace | Extra Mile

0:00Hello and welcome to this week's episode of Untapped, the Extra Mile with me, Spencer Matthews. And me, Oli Patrick. And this week, we have a very special guest, Dr Hazel. Hi, thanks for having me. It's actually the first time we've had a guest. It's very exciting. A very, very special guest. An actual expert is on the show. Yes, well, hang on a second. You are also an expert, are you not? Well, there's degrees of expertise. We've brought in the big guns. Is Dr Hazel more of an expert than you? Yes. Wow. We must have her come in more often. I'm taking your job. No, no, genuinely. When I heard Hazel's coming, I'm like, I assume I'm not in the episode.

0:35That was a genuine assumption. I've never seen someone shoot themselves in the foot quite so hard. On this show, we do like having the greatest experts available, Ollie, as you know. But anyway, all good. Dr. Hazel is here. And today, we're going to talk about the much-discussed topic of cycle syncing. Yeah, it's very relevant. It's been in the news this week. And I think a lot of people are seeing information about it without context. And again, we would love to give a little bit of context to what cycle syncing is. So this general idea that, again, there is a menstrual cycle, and within that, there may or may not be ways of training or expected differences in performance.

1:10And I think the fitness community in particular, Hazel, has got right into this, thinking that there's certain things they are more capable of, less capable of, from a performance point of view. Does different stages of the menstrual cycle affect my performance, my well-being? can you help us because as much as we love physiology we don't have a menstrual cycle spencer and i we are a couple of guys that like physiology but when this came up we thought we should probably get expert advice the experts experts the experts experts dream so you're seeing you're seeing the cycle syncing everywhere can you can you give us a quick snapshot of what you're seeing and and what you think about this phenomenon and again with your extensive running experience we've got so many runners they'll love to hear that lilt into the running community yeah absolutely i think a really great place to start is like talking about what the menstrual cycle is and i i think a lot of people understand what it is but if we break it down into phases it's really helpful to talk about and to answer your question essentially so i feel pretty good about the menstrual cycle you feel like your knowledge is i think i've got spencer i don't see myself playing a huge role in this particular question okay well let's just go back to basics for everyone and listening.

2:23It's good for me to learn it again. I feel I've got it. Yeah. I feel I've got it but I'm not going to go refresher. Yeah I'm going to pretend I know it and then as you say it I'm going to nod every time you say something. I think that's my recollection. Do you know what Dr. Hazel a lot of our listeners are men and I think despite the fact that we probably all think we know what a menstrual cycle is as I would assume I knew what a menstrual cycle was I think it might be handy for you to just properly explain it and define it so that even the most knowledgeable men listening to this podcast can be enlightened by your knowledge.

2:55Yeah, got it. Okay. So menstrual cycle 101. Let's say there's on average a 28 day cycle. Some women are slightly shorter, some women are slightly longer than that. In that 28 day period, there are hormones fluctuating and they kind of dictate when you ovulate and when you have your period. So your fertility. So day one of your cycle to roughly day five is what we know as a period. I think everyone has heard of that at least, menstruation. Your hormones are very low during that time. After that, estrogen increases just before ovulation, which helps you release that egg. During that time, then we find estrogen comes back down and we're into the second part of the menstrual cycle where both hormones, estrogen and progesterone, rise again.

3:42So this is the luteal phase. The first half of the cycle is the follicular phase. Then we start the cycle again. So that's it in a nutshell. Follicular phase, luteal phase, ovulation in between. Love it. With hormones fluctuating all the time. Now, bringing this back to cycle syncing, the question is, do these hormone fluctuations impact how we perform, how we recover from exercise, endurance, and strength? And we do have a modest amount of evidence on this. And if we pool all the research together, basically, there may be a small dip in performance during menstruation, that early follicular phase, so the first few days.

4:23When you said the hormones are lowest. Hormones are low and it's during your period. Now, the big caveat to that is most of the research is inconsistent, inconclusive, and every woman is different. And this kind of dip is so small that it's probably not very significant for most people. So at this point, we shouldn't be telling women not to train during their period. it's actually going to be beneficial for things like menstrual cramps for performance there's nothing to say it's unhelpful or it's going to harm you in any way and I think the idea of cycle syncing which is each week of that cycle you should change your program so do your hard runs on during ovulation only do easy runs during your period it's not evidence-based and I think it's going to hold women back from exceeding and kind of performance um and even just thinking about longevity and like bone health and um metabolic health if we're telling women to rest half of the time yeah you're not going to get very far no i was talking with a coach previously about this

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8:22a decrease in performance on certain stages of the cycle, particularly for a performance athlete, that could be catastrophic if you live in the real world where you can't push back the London Marathon because it's in the wrong part of your 28-day cycle. So I think there's a real sense where people are trying to get on board with this. But what you're saying there is the data is not enough to predict performance. If we're mapping performance, if we're thinking of things like, we love VO2, we love Spencer's VO2 in particular. We like VO2 maps. What's your number at the moment? 64. Horrific. It's magnificent.

8:52We love VOT max. We love, you know, objective marks of strength performance. Is there any data that says there is a dip in performance across any key parameter in that sort of first week where those hormones are lower? Because, you know, I would think with lower estrogen, there would be theoretically a lower performance, but I'm not sure if that's true. Very small dip in strength and endurance performance. And then when it comes to things like recovery, We see recovery metrics actually decrease in that luteal phase. So the second half of the cycle. Now, again, we don't have a huge amount of data on this, but things like your heart rate increases, your resting heart rate, your heart rate variability decreases.

9:35And I wear WHOOP. I work with WHOOP. I know lots of women wear WHOOP. You guys wear WHOOP. It's so interesting how I can just predict when my period's going to start based on how my heart rate is increasing, my HRV is decreasing, so my recovery just gets worse and worse. Day one of my cycle, I actually feel better. So if I was to follow the cycle rules of these cycle syncing, I would actually be shooting myself in the foot because I perform better, I feel better during that time. And I think that just highlights that every woman is different. Now, women go to the Olympics on their period and they win gold medals.

10:10So we can't say that you can't be doing those things. But what I don't want to do is dismiss that some women have really disruptive cycles. They may have really heavy periods, painful periods, have other symptoms alongside that. They may feel really rough. And so we can't ignore that. There's also research looking at how women perceive their cycle to impact their performance. So there's some interesting research on, I think it was female football players. So they perceive that they performed worse during their period. but actually in tests of like reaction times, they performed better. So even how you think about it, this isn't to say that it's all in your head and like you just believe that you're weaker.

10:52No, but it's really important that we give women the right data so that they can perform because I often get DMs of people saying, I have this race coming up. It's happening on day two of my cycle. What am I going to do? And I'm like, don't panic. Also, it's out of your control when the race is, right? So if it makes little difference, which is what you're saying the data shows, is the best thing not to try to avoid it? Just only because, you know, if for whatever reason we were told you're not going to train as well on Fridays, you know, and all of a sudden that becomes a thing in your head that I'm never going to run my hard sessions on Friday because I just simply can't train well enough on Friday.

11:34and it is in our heads because we don't have a cycle, that is going to impact the training that you do. So for something that you can't control, like your menstrual cycle, what are women supposed to do in order to get rounds? Say you're looking for an edge in every single element. So you figure out data-driven through your WHOOP and doctors such as yourself the best possible time to run certain sessions and then the race falls at the worst time. you know can people overthink it yeah i think you can overthink it and i think you can take certain precautions to like help yourself perform better you know looking at the other variables your sleep your nutrition your training your deload week before then to make sure that you're in the best possible place because all of those variables impact how you perform and your cycle is maybe one or two percent of that yes if you're like a high performing athlete that will matter so maybe for you you do want to think about things and of course you can discuss like with your doctor and medication about impacting things but I think the overarching message is for most people it shouldn't mean that you need to cancel a race or not show up and I think I guess speaking as a woman practically speaking sometimes it can be like a bit difficult because I mean I've run a marathon on day two of my cycle I've had to stop during that race a man wouldn't have to do that that's going to add what 30 60 seconds on that's really annoying but I'm not a high-performing athlete due to pain or no just due to like I had to change my menstrual product product and so that's just a practical thing unrelated to my symptoms my hormones but it's just something women have to consider or like if you're wearing I don't know a white football kit are you going to be overthinking the fact that I'm on my period I'm wearing a white kit I'm on TV all of those things and those conversations are happening with female athletes now and their coaches and their teams can we cater for women to give them their most comfortable experience the last thing they think about is their period and they're just focusing on the game Would it make sense to just never have white kits for women?

13:46It's happening When I heard that I don't mind saying I've never once considered that never thought about it before you just said that I think it's absolutely wildly inconsiderate to put women in white kit if if i can't believe i've never even thought about that once you've considered it i mean there's a great even the england kit should just be red or black someone sort of broke someone pushed back and made red shorts who was that so it's changed in for the england team they pushed back um and also wimbledon because it's typically white skirts and a white undershort so now they've changed it to you can wear black undershort if you want um but it's crazy that's only just happened what a ridiculous it's hard to believe I mean it's hard to believe it's hard to believe but it's I guess it's like institutionalized tradition and people don't want to break that but like you're so right until someone speaks up and asks for it but you're a trailblazer Spencer no but I'm not at all I'm not at all but like I just I'd be so I'd be very vocal about that if I was a woman but you wouldn't believe I mean I worked in the gym industry and recently probably a while ago was in a center where there was no sanitary products in the bathroom and then coming out wearing individualized width was came onto their at their period and no one at the front desk knew what a sanitary product was and you're like you know that actually led to a huge societal change and there's groups that were mentioned before like the well hq who are trying to create i suppose um organizational change structural change because sometimes it's it's it's very difficult without a system in place from a question on blood because obviously you can do whatever you like you're the you're the co-host of this great oh that's such an honor um because i think there's often a sense again that there's a lot of blood loss you know in that sort of first part of the menstrual cycle and that could lead to a lack of blood and a lack of you know oxygen and anemia for an individual but i remember learning it was less blood normally than i might have considered what what is the blood loss hazel and would that in itself play a performance role above and beyond the hormones well we know that the risk of iron deficiency and iron deficiency anemia is highest in women of childbearing age because of menstruation.

15:54So you are losing a significant amount of iron. It's obviously higher in people who have heavier periods. So to say it's every person's going to be different in terms of like how many milliliters, but it is significant because one in three women of childbearing age have iron deficiency, anemia, I believe. One in three. So that's, you know, women between the ages of 15 to 49, which is much higher than men. And female athletes are at higher risk. And then And if you're a vegetarian, that's another risk layered on top. So menstruation is like the biggest risk factor. And actually, if you are someone who has a menstrual cycle and you go into your GP and you're iron deficient, they're not really going to be looking for other causes.

16:35They're going to say, you know, heavy periods, take some iron supplements. And so it is actually a significant impact. Really interesting. If we were trying to understand what women go through on a menstrual cycle, what is the kind of equivalent of the hormonal change? Would that be like our testosterone fluctuating? What are the effects of varying estrogen levels and hormonal changes on a woman? Is it mostly physical? Is some of it mental? What can one expect and how can you best explain it to a man? it's a actually a really good question and i think if you think about that

17:20surprisingly it's not a bad question at the beginning i wasn't sure he really pulled that through thank you and i was actually worried about threading the needle myself but it got there in the end so thinking about that 28 day cycle no day is the same in terms of how the hormones are in their levels so you are really feeling different on us on a given day. And estrogen and progesterone are known as like sex hormones. They impact reproduction, but they impact everything. So they impact your mood, your sleep, your gut health, your metabolism, your skin health, your hair health, all these. So you've got receptors everywhere, basically.

17:59So, you know, if we take your mood, you mentioned that some women, I think majority of women who report a change in their mood will report it just before their period starts again. So that late luteal phase, we don't really understand why it's differences in kind of hormone sensitivity. But, you know, thinking about other things like your metabolism, there's a small increase in your metabolic rate, how much energy you burn at rest in that luteal phase. And so women naturally feel hungrier. They typically eat more food and they'll have cravings for high energy foods like chocolate. So it's a bit of a, I mean, like culturally, we always say if you're due your period, you crave of chocolate but actually there's a biological reason why that's happening and love chocolate that was you this morning that was you so that was how you were feeling think about that's how we're feeling month a month yeah um do you have to fuel differently so if you're a runner for example and your metabolism is changing do you have to consider how you fuel when doing hard sessions or races therapy's biggest impact doesn't show up in some dramatic breakthrough It shows up in the smallest moments.

19:11You bite your tongue instead of escalating. You put your phone down instead of firing off that text. You say what you actually mean instead of what would hurt someone else the most. Nobody applauds those moments, but they quietly change your life. That's what growing feels like. And that's exactly what Grow Therapy is here for. Grow is therapy that works, covered by insurance. Sessions average$21 with insurance, and some pay as little as$0, depending on their plan. There are no subscriptions, no long-term commitments. You just pay per session. Grow connects you with thousands of high-quality, licensed therapists across the U.S., offering both virtual and in-person sessions, nights and weekends.

19:53You can search by what matters, like insurance, specialty, identity, or availability. And you can book a therapy session in minutes and begin in as little as two days, not the national 48-day average. See if you could pay as little as$0 for therapy in seconds at growtherapy.com slash start now. That's growtherapy.com slash start now. growtherapy.com slash start now. Availability and coverage vary by state and insurance plan. Hey, it's Toni from Toni Told Me. On Iyanla, The Inside Fix, a podcast from OWN, Iyanla Vanzan revisits the stories, teachings, and insights that made her show Fix My Life a must-watch for millions.

20:38With fresh eyes, she re-examines those lessons with greater clarity and shares new wisdom for the challenges we face today. Personal growth evolves over time, and there's always room to find new meaning in old lessons. Listen to Iyanla, The Inside Fix, wherever you get your podcasts. Hello, I'm Monica Reinagle, host of the Nutrition Diva podcast. Summer is here and with it, the hot and sticky weather. A morning working in the garden or maybe on the golf course can leave you more depleted than you realize. And plain water isn't always the most efficient way to restore the balance. That's where liquid IV comes in.

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21:34So this is like an area that is emerging, but we don't have conclusive evidence to say like you should or you shouldn't. But I have seen some sports nutritionists start tailoring their nutrition for female athletes based on where they're at in the cycle. because in sport and exercise, our main fuel sources are carbohydrates and fats. And how much we burn at rest or how much we burn, sorry, during moderate intensive exercise does vary based on where you're at in your cycle, follicular phase versus luteal. So there's like an argument that you should be changing carbohydrates, maybe in the luteal phase versus follicular phase, etc.

22:12I think personally that the changes are so small that we're maybe getting bogged down in the minutiae and we should just be really focusing on making sure that women are eating enough, getting a balance of macronutrients and addressing any micronutrient deficiencies. I may eat my words in five years time, but I think right now for, I guess for most people who are listening to this podcast, I don't want you worrying that, you know, you need to figure out different fat or carbohydrate ratios right now. But if you are someone who's in your luteal phase and you always notice that you're hungrier, chances are you probably are burning a bit more energy.

22:52And as a nutritionist, things that I'll do is like add in a strategic snack in the afternoon with some of my clients to prevent them like getting to dinner overeating at dinner because they've been ravenous all day and um even things like insulin sensitivity is a bit different in luteal phase so we're thinking about balancing our carbs with fats and protein so there's so much to talk about really we're talking the way in that some males believe they have a cycle so it's important whenever there's a conversation about do they really like so just what where where have you got that from but there's a general sense well the second you mentioned menopause people well men have an andropause a what?

23:28we have an andropause I think people are overcomplicating stuff like I've never even heard of an andropause I'm already slightly out of my depth here but an andropause what's that? it's not a real thing it's a smidge of a thing it's a smidge of a thing it's our natural depreciation of testosterone but it is which happens gradually with age it is just getting old it's not the menopause they're not equal can't you just top up just jab yourself with a bit of tests well you know if you if you if you want to keep your testosterone level you can can't you there's a great discussion about testosterone replacement therapy it's benefits and costs but you know optimized hormones is a valid strategy under the care of a good quality physician but it's there is a case that the female menstrual cycle is is is this extraordinarily complicated element and i think even in there we will have people listening to this who go i connect with that and someone who has connects with the complete opposite and i suppose you know the theme that I've always seen in this is, you know, you're telling us, which is brilliant, that the science isn't quite strong enough to dictate behaviors.

24:32But there will be individual variants. And if you track your cycle, you can start to understand how those patterns of, I need a mid-afternoon snack, or I need to push hard today. Because there'll be five people listening to this at the same stage of their cycle with different needs. You would then be an advocate for cycle tracking, I would imagine. Yeah. And I think... Without putting words in your When it comes to cycle syncing, I think being cycle aware and understanding your cycle. So if we take a runner, for example, if you do find you have one rubbish week of the month, normally in a four-week block we'll have one deload week.

25:08You could, there's an argument, that you could strategically plan your deload for that week that you usually feel a little bit off. Whether that's your late meetil phase or your menstrual phase. Because you were going to take it anyway. you might as well make it that week or and you could plan your races around that as well because i guess is it is it exactly the same each month if for some women if it's regular if some women have irregular cycles or even if your cycle is coming every month and then you go through a stressful period it could push it out um so you could if you wanted to but i think for most people you're going to be okay and even like if you try plan it doesn't always go to to plan like sometimes your cycle's two days late and then that can consistently happen.

25:51There's an injury risk. That's another because there's obviously there's training, there's deload. There's a sense that there's different periods in the cycle where we may be more susceptible. We still have a challenge, I think, in young biological females with ACL injuries and lower limb injuries. Yeah. What about injury prevention? Any logic that's robust in that space? Well, I think there's around ovulation when estrogen is high, there's increase in joint laxity. So ACL injuries are higher in women anyway. And so we also see potentially higher risk around ovulation. Now, I was speaking about this on a panel before and a physio put her hand up and she was like, I'm actually doing research into this.

26:33And we're looking at rehab protocols to prevent, to help mitigate that risk. so right now like it's not really changing performance but you could like argue you know increasing warm-up time make like preventing i don't know sudden changing movements but i guess if you're like a female rugby player you can't really prevent that like you have to do it so we don't have the answers yet and i think again bringing that this back to like average runners maybe like me it shouldn't impact you um the most important thing is that like you're warming up you're eating enough, you're taking your supplements, you're taking enough recovery between sessions.

27:09Yeah. So that would be, and again, I'm going to pull from your science. So high estrogen would be at the end of my menstrual cycle. So maybe days. No, high estrogen mid cycle. And then again, mid luteal. Okay. So those two bursts. So again, a coach might consider cautiously deploying plyometrics in a period of time or rapid. But again, that's one of those trickier ones because that's not driven by feeling lots of the others are driven by feeling that one to me feels more like if i was a coach i might hedge my bets on that a little bit so you can't do that if you're an england sevens rugby player yeah that's it and i i think the other thing is if you were if you have a female athlete or you're coaching someone and they're consistently getting injured i'd also be looking at are they fueling enough because that's the biggest risk factor for injuries in women that's That's fascinating.

27:57If a female runner wants to get faster, what should she actually pay attention to when it comes to her hormones? And what could she stop worrying about? I feel like if you're wanting to get faster, the most important thing is that you're training consistently. I don't think your hormones should have a huge impact on that. I imagine if we took all the best female runners in the world and looked at their hormones, I doubt they'd be that dissimilar or they'd be wildly skewed. and we just say actually doesn't really matter. So the most important thing is you don't want to fall into a state where your hormones are depleted and that would happen if you were in a state of something called low energy availability, which can happen to men as well.

28:40So that's where you don't have enough energy to account for the exercise that you're doing on top of like just daily living. We call it running low. Is that moving to reds? That moves into reds, yeah. What's reds? Relative energy deficiency in sport. so it's basically it's important but surprisingly it happens to everyone is it is just like feeling burnt out no it's it was like well i guess one of the symptoms would be feeling burned out but it was originally identified in women because your your main sign is your periods disappear become irregular but there are other signs and symptoms like your performance plateaus or it starts to worsen you've got low mood poor gut health increased fracture risk increased illnesses like coughs and colds um low libido that would be a big sign in men and all of that is these are all signs and symptoms but that's what's happening on the surface those low hormones are impacting things like your bone health uh your mood your gut health all of those areas so it's really important that we address it and don't just look over it that's brilliant because there was a there's a strange thing the loss of period became quite common in in elite athletes yeah and accepted and accepted so we i remember saying if your body fat gets too low um and you have a high training volume it's quite normal so you have a lot of elite athletes probably from the probably even as early as 2000s where it was accepted that the cost of that performance was you would lose your menstrual cycle and it would come back when you were able to regain in weight, nourish yourself properly and return.

30:15It's fair to say now. What, it would just go away? Because the body wouldn't be wanting to prepare for childbirth if it was starved of its sort of core resources. So the body's brilliant in the fact that if it doesn't believe it's got the capability to bring a new unit. That's a fascinating thing, isn't it? The physiology is just so clever. It just kicks the menstrual cycle to the curb because it goes, well, this person clearly doesn't want to have kids. Or the person that doesn't have the environment in which that child has a child. Yeah, it's not that it thinks that you don't have kids. It's that your body is primed for things that are dangerous.

30:50And so it down-regulates your menstrual cycle hormones because it's like, we don't have enough energy right now. We need to prioritize your heart beating, your lungs breathing, your brain working, your muscles getting energy so we can run away from a lion. Could that be quite useful? Maybe in times of famine because your metabolic rate comes down so you don't need as much energy. But now, no, not useful. But I mean, would some elite female athletes prefer to not have a menstrual cycle? Maybe practically speaking. But if we think about what's happening physiologically, their hormones are low and their hormones help with performance.

31:28So if your estrogen's in your shoes, and we know estrogen helps with strength, power, sleep, recovery. If that's gone, you're not going to be performing well. Your point is important. We have estrogen. You have estrogen too. And we have testosterone. These are hormones that are important. But estrogen is such an interesting hormone. We have receptors on our blood vessels. And so it helps our vessels dilate and expand. And so when we go through the menopause, we lose estrogen. We see your blood pressure go up, your risk of cardiovascular disease go up. And so apply that to women who are high performing athletes.

32:08We need estrogen for cardiovascular health. And then we mentioned like the kind of whoop heart rate variables and things like that. We're seeing that in real time in women as their estrogen fluctuates. So it's not fluctuating like that for you, but you have those hormones and they're really important for performance. A lot of people will have water filters now because again, lots of the people who are on either contraceptive medications or HRT will pass urine into the shared water system. So there was a sense there could be de minimis levels of estrogen in your waters. And you can get a specialized type of water filter that gets rid of that if you're overtly worried.

32:46I don't drink tap water for lots of reasons. Of course you don't. Well, no, but is tap water okay to drink? I think so. Is it? Actually, there's a study on London tap water. It's surprisingly clean. Is it? You've got to work out that there are things that mechanistically could be a problem over time. I literally, for somebody that has abused their alcohol, for someone that's abused their body for decades, I will avoid tap water like the plague. It's surprisingly clean. I drink alcohol and all kinds of stuff, but I wouldn't touch tap water. But it's not mineralized. If you've got mineral water, there's benefits.

33:20It's fine, is it? It's fine. Is it really? Christ. There's bigger fish to fry. You learn something new every day. So if someone has got it, again, they've got to the point where their cycle has gone because potentially they're training too hard or they're slightly undernourished, how would you manage that? What would be the first few steps to bring that cycle back? They should have it back, I assume. Yeah, I think the first thing is to not ignore it because, you know, some people think it's quite convenient that I don't have a cycle, especially if you're training a lot. It's really something that we need to look at because it's not normal.

33:50It's not healthy. It means that your hormones are very low and that your body's compensating by down-regulating those important hormones. So if they were coming to me, I would be wanting to understand what the hormones are like. So with blood tests and things like that, but we really want to refuel. So we're going to bring down your training volume and we're going to increase your calories. And sometimes this means, you know, increasing weight, especially if weight's being lost. And some people really struggle with that, but not just thinking about calories. We're like thinking about macronutrients.

34:24I've seen it where, you know, girls have whacked up their calories and their periods haven't come back because their carbohydrate intake is really low. So we want all macronutrients in there and regular eating windows. So like regular meals, not having big gaps in the day where your body feels it's panicked, it's unsafe and definitely not doing any fasted training. I know that's a big topic, but in women, especially who are exercising a lot, I'm just not a fan of it because it usually brings you down the wrong road. I think for most people as well, men and women, there's no benefits to fasted exercise, at least have something small before you're going out the door.

35:01Brilliant. So again, there is finally a spotlight on perimenopause and menopause. And again, it'd be great for some of our listeners to understand what this transition looks like, because lots of people feel that they are inhibited from a functionality point of view as these hormones they had through their early years now diminish. What is the sort of, can you just define quickly perimenopause and menopause and is there real performance deterioration driven by hormones or is it something else? Yeah so perimenopause is the transition from having regular cycles into the menopause and that's defined as 12 months since your last menstrual cycle so you've got a full year without period you're defined as post-menopausal then and the main thing that happens there is your estrogen declines and it's very low compared to how it was before.

35:49The perimenopause, it's kind of declining erratically. So you're still getting some of the symptoms, but you're getting some cycles as well through a bit of a transition period. And so, you know, people will say that when you go through the menopause, you get, you know, your metabolism breaks and, you know, there's lots of claims about like muscle loss and things like that. When we really look at the evidence, it's not as clear as that, you know, a lot of these effects are due to aging, not just the menopause itself. The whole kind of metabolism thing, actually, we don't really see differences in metabolism until like your late 60s.

36:28And again, it's pretty comparable in men. So it's mostly due to aging as opposed to what's happening with your hormones. Now, what I mentioned earlier with estrogen and its role in bone health and cardiovascular health is the most important thing when it comes to the menopause because you've lost estrogen which protects your bones it keeps your bones really strong and so when you go through the menopause your risk of osteoporosis skyrockets your risk of fractures increases so we need women to be strength training before the menopause making sure they're eating enough getting calcium and vitamin d and then also from a kind of metabolic point of view because their risk of cardiovascular disease increases.

37:11We're thinking about, you know, their metabolic health. Are they strength training? Are they doing cardiovascular training, eating well, a Mediterranean-style diet, managing their weight, all of those things, and other risk factors. So, yeah, there's an argument that, like, we need to start thinking about the menopause before we're in the menopause because you have to protect yourself from all these risk factors. Yeah, with the biggest single thing there being that you can't get away without the strength component. You can't. And I think like there's a real drive away from strength training, especially in like younger women to do Pilates and like low intensity exercise.

37:47And I'm like, we are going to have a pandemic of osteoporosis if this is what we're doing. I have a good argument with a mutual friend of ours. It's a good argument. She's sitting on the fence, Adrienne, who's a brilliant, again, wellness professional and whether Pilates is enough to keep you strong enough. Does she say yes? She thinks that she does Pilates like a wild animal. Yeah. But my understanding is it might keep you strong, but it wouldn't be enough to preserve muscle and bone. I think so. I think like it technically falls into the kind of strength training, resistance training category.

38:19But there are such variations in different classes that you can go to. Some are like so chill, it's like a stretching class. And then some are pretty hardcore. But I think to like build muscle, you need a stimulus and you need progressive overload. and I don't think you're getting that in Pilates classes. So if you're really serious about bone health and having strength and being independent when you're old, I would try include some weights in there. That's so good. We'll get comments on that. I think, and if people want to prove us wrong, let's have a body composition with skeletal muscle mass and then do your six, well, let's have 12 weeks of Pilates.

38:55Get us an improved result without any external strength training and then Hazel and I will accept it. And don't cheat the system. Don't cheat the system. don't you and it's not to say like no fake result no no chat gpt results i think like i that's not to say i'm anti any of those forms of movement it's just we have to include strength somewhere yeah i love that answer strength training lovely well you are very much in it but it's you know we've spoken about before it's often a blind spot for runners but if you take then again a perimenopausal menopausal female it's it's got to be a non-negotiable really yeah and well yeah And if you're a female runner, like absolutely.

39:34It's so important. But again, if you're doing, I don't know how many runs a week, you're in a marathon block, you're towards the end. Strength training always goes out the window, doesn't it? So try keep it in somewhere. Like twice a week is what we should aim for. If it's once a week at the end of your marathon block, fine. But like try bring it back in. Plus Pilates, not instead of Pilates. Look at that. Layers. Layers in this game. There are layers in this game. We thank you very much for joining us this week on Untapped Extra Mile. We will catch you next week with a fresh, I was going to say main episode again.

40:10It's not the main episode. Another episode with a guest of just Untapped and again the Extra Mile. This is a weekly cycle. It's the only cycle we've got. We have a cycle. And it's two episodes a week, every week without fail. and you can expect us to keep doing that until we're grey and old because I love it. It's fabulous. I'll tell you, and again, I do defer to Dr. Hazel Wallace, a genuine brilliant, the expert expert. So Hazel, it's been a total joy to have you in. Thank you for having me.

40:51Hey, it's Tony from Tony Told Me. Oni Anla, The Inside Fix, a podcast from OWN, Iyanla Vanzan revisits the stories, teachings, and insights that made her show Fix My Life a must-watch for millions. With fresh eyes, she re-examines those lessons with greater clarity and shares new wisdom for the challenges we face today. Personal growth evolves over time, and there's always room to find new meaning in old lessons. Listen to Iyanla, The Inside Fix, wherever you get your podcasts.

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