Menopause doesn’t have an age.
It has a story — and for some of us, that story starts way earlier than expected.
When I hit surgical menopause as a younger athlete, I thought I knew what to expect. I’d already been through temporary menopause before opting for the hysterectomy — the kind induced by medication during the years I spent battling endometriosis. I figured that experience had prepared me for what was coming.
Spoiler: It hadn’t.
Surgical menopause is a different beast. It’s not a taper; it’s a cliff dive.
So when I read Dr. Stacy Sims’ article on early and surgical menopause, I appreciated her effort to broaden the conversation. But like most of what’s out there, it still misses the lived realities of women whose menopause doesn’t follow a calendar. It skips the context of why so many women end up here — and what actually helps them thrive afterward.
The Missing Context: Why So Many Women Arrive Here
For countless women, surgical menopause isn’t a choice; it’s a last resort after years of pain, misdiagnosis, and frustration.
Endometriosis, adenomyosis, PCOS, and fibroids are often the culprits. They’re not just “period problems.” They’re full-body conditions that hijack hormones, inflame the nervous system, and dismantle quality of life long before menopause ever enters the picture.
And yet, the conversation around surgical menopause rarely acknowledges this.
We’re told what estrogen does, but not what the trauma of losing it overnight feels like when your body’s already been through a war.
That context matters — especially for women who still identify as athletes, competitors, and performers in their own right.
What Stacy Got Right (and Why It Still Isn’t Enough)
Dr. Sims nailed some basics: defining POI, distinguishing hysterectomy from oophorectomy, and emphasizing the importance of strength and protein. That’s the foundation.
But when it comes to application, especially for women who are active, competitive, or rebuilding after years of reproductive challenges, the advice stops short.
Here’s where it breaks down:
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The idea that you “stop MHT at 50–51” is outdated. There’s no expiration date on hormone therapy.
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The assumption that progesterone isn’t needed without ovaries skips over its benefits for sleep, mood, and brain health.
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“Lift heavy and do HIIT” is overly simplistic — especially for a body still recalibrating after hormonal collapse.
Menopause doesn’t look the same for a 38-year-old athlete as it does for a 52-year-old easing out of perimenopause. We deserve guidance that reflects that.
The Reality of Abrupt Menopause
When your ovaries are removed, hormones don’t decline — they vanish.
That single event reshapes everything from your connective tissue to your metabolism.
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Collagen turnover slows. Tendons tighten. Muscles fatigue faster.
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Sleep becomes unpredictable. Mood regulation takes more effort.
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Recovery requires twice the attention it used to.
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And suddenly, your same fueling strategy no longer works the way it once did.
If you’ve had a hysterectomy, pelvic floor and deep core retraining are non-negotiable before ramping up running or lifting. It’s important to learn how to re-stabilize the system that holds everything together.
And underneath it all is an emotional component no one talks about — the sudden loss of hormones, fertility, and familiar rhythms can make even confident athletes feel like strangers in their own bodies. It’s not weakness. It’s biology meeting identity, and learning to rebuild both with intention.
The Hormone Conversation We Actually Need
Let’s clear up the biggest myths still circulating:
Myth 1: You need to stop MHT at 50–51.
Truth: There’s no age limit. The current evidence supports continuing hormone therapy as long as it enhances quality of life, protects bone and cardiovascular health, and remains safe for the individual. You don’t “age out” of it; you individualize it.
If you want a deeper understanding of how to navigate hormone therapy and training adjustments, my Mastering Menopause Guide breaks down how to align your movement, fueling, and mindset to your hormonal landscape — at any age or stage.
Myth 2: No uterus = no progesterone.
Truth: Progesterone isn’t just about endometrial protection. It supports sleep, cognition, and emotional regulation. For women in surgical menopause, that can make the difference between surviving and feeling stable.
Myth 3: Testosterone doesn’t matter for women.
Truth: It absolutely does. Surgical menopause erases ovarian androgen production, affecting libido, energy, and muscular strength. Low-dose transdermal testosterone, under medical supervision, can help restore balance and vitality.
Hormone therapy isn’t about vanity. It’s about function — physically, cognitively, and emotionally.
You Don’t Have to HIIT Your Way Out of Menopause
“Lift heavy” — yes.
“Do HIIT three times a week” — not necessarily.
After surgical menopause, your nervous system and recovery capacity are completely different. Too much high-intensity work can elevate cortisol, interrupt sleep, and cause fatigue to spiral. HIIT and SIT are important components to training but you don't have to give up distance entirely.
You can absolutely maintain endurance and performance — it just needs a smarter framework:
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Strength training 2–3 times weekly with progressive overload.
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One controlled intensity session a week — not five “go hard” workouts.
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True low-intensity aerobic sessions to rebuild capacity.
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Prioritizing rest and fueling like they’re part of your training plan.
The magic lies in polarization — knowing when to push and when to pull back.
Progressive Overload, Polarization, and Periodization
These three principles are the backbone of how I coach athletes in menopause — surgical or otherwise.
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Progressive overload ensures you’re adapting, not just maintaining.
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Polarization keeps intensity intentional — high enough to spark change, low enough to sustain it.
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Periodization aligns your training with your physiology, giving your body the recovery windows it actually needs.
Bone density declines faster after ovary removal, which makes heavy, compound lifts even more essential — not for aesthetics, but for protecting the frame that carries you through life.
Endurance athletes don’t need to scale back their goals — they need to scale up their strategy. You can still chase PRs, conquer long runs, and toe start lines. You just have to train like someone who’s rebuilding from the inside out.
Fueling Through the Shift
The biggest complaint I hear from women in menopause — natural or surgical — is weight gain.
It’s real, it’s frustrating, and it’s often misunderstood.
Estrogen isn’t just a reproductive hormone; it’s metabolic. When it drops, insulin sensitivity shifts, muscle protein synthesis declines, and energy expenditure subtly changes.
For women in surgical menopause, this happens fast.
The fix isn’t restriction — it’s recalibration.
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Slightly increase daily protein (aim for 1.8–2.2 g/kg/day).
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Distribute it evenly across meals to support recovery and satiety.
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Fuel runs intentionally — don’t fast, don’t under-eat pre- or post-workout.
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Keep carbohydrates in play to support performance and hormone metabolism.
Small tweaks. Big difference. You can feel comfortable in your body and perform at a high level — they’re not mutually exclusive.
If You’re in Surgical Menopause, Start Here
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Personalize your hormone therapy — estrogen, progesterone, and possibly testosterone.
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Rebuild strength with progressive overload 2–3x/week.
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Polarize your training: keep hard days hard, easy days easy.
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Reassess fueling — prioritize protein, carbs, and hydration.
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Get a DXA scan for bone health.
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Address tendon and joint health proactively. My Tendon Health + Rehab Guide walks you through exactly how to load, rebuild, and bulletproof your tissues.
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Work with a pelvic floor specialist before returning to higher-impact training.
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Give yourself time and compassion to grieve and re-identify as an athlete.
And if your provider dismisses your symptoms or says you’re “too young for HRT,” find another provider. Surgical menopause requires replacement, not tolerance.
The Bigger Picture: Quality of Life Is the Metric
Menopause isn’t a finish line — it’s a phase.
And surgical menopause is a crash course in adaptation.
You deserve care, strategy, and support that reflect your reality — not generic advice written for someone else’s timeline.
So no, you don’t have to HIIT your way through menopause.
You don’t have to stop MHT at 51.
And you don’t have to accept “slowing down” as inevitable.
What you can do is rebuild intentionally — with hormone support, smart training, and fueling that fits who you are now.
That’s what performance looks like in this next chapter.
Not fighting your physiology, but learning to partner with it.
Your Next Step
If this resonated, I’ve built an entire ecosystem around helping athletes move through this season with strength and confidence.
Explore my training plans, guides, and resources designed for menopausal and masters athletes here:
👉 hustle.run.thrive. Shopify Store
Because your best miles don’t end when your hormones do — they just start to mean more.
Author’s Note
I didn’t set out to become a menopause coach. I was an athlete navigating endometriosis and multiple surgeries when “temporary menopause” became part of my treatment plan. By 38, a full hysterectomy and surgical menopause ended that chapter abruptly.
At the time, there weren’t resources for younger, active women like me — women who wanted to stay strong, race, and feel connected to their bodies again. Most of what I found was focused on midlife, weight loss, and symptom management. None of it spoke to performance, strength, or resilience.
So I built what I couldn’t find.
Now, through hustle.run.thrive., I coach athletes of all ages — but my mission is to make sure masters and menopausal athletes never feel like they’ve aged out of possibility.
Menopause isn’t the end of your story. It’s the rewrite.
About the Author
Becky Croft is a certified RRCA Running Coach, Girls Gone Strong Menopause Strength Coach, and Chi Running Instructor. She specializes in coaching masters and menopausal athletes who want to perform, not just participate.
Through her platform Hustle.Run.Thrive., Becky helps athletes bridge the gap between science and lived experience — blending progressive training, mindset work, and strength-based performance to help women stay strong, healthy, and joyful through every stage of life.
When she’s not coaching or writing, Becky leads her local running community, mentors other coaches, and keeps disrupting the narrative that “menopause means slowing down.”
Follow her work, shop her guides, or join her coaching roster at hustle.run.thrive..