The Invisible Weight
A lot of people will never understand what it feels like to wake up already tired, to lace up for a run and feel like your legs are made of lead, or to touch your own skin and wince. And if you try to explain it? You risk being dismissed, told it's "just stress" or "part of getting older."
Now add menopause into the mix. A hormonal upheaval that affects every system in the body—sleep, cognition, metabolism, pain sensitivity. For many women, especially those who experience early menopause or go without hormone replacement therapy (HRT), it's not just a rough patch. It's a complete shift in how their bodies function.
So what happens when pain becomes chronic? When the fatigue won’t lift? For some, the answer is fibromyalgia—a condition still often misunderstood, minimized, or mislabeled.
What Is Fibromyalgia, Really?
Fibromyalgia is a chronic condition marked by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive dysfunction (often called "fibro fog"), and increased sensitivity to touch. It falls under the category of central sensitization disorders, meaning the nervous system becomes hypersensitive and overreacts to stimuli that wouldn’t normally cause pain.
It’s not rare, either. An estimated 80 to 90 percent of fibromyalgia patients are women, most of whom are between the ages of 40 and 60. Sounds familiar, right?
Hormones and the Pain Connection
Estrogen plays a significant role in modulating pain. It influences neurotransmitters like serotonin and dopamine, helps regulate inflammation, and supports quality sleep. When estrogen drops in perimenopause and menopause, women often report a rise in aches, joint stiffness, and general pain.
This doesn’t mean menopause causes fibromyalgia, but it can absolutely worsen symptoms or even unmask an underlying issue. Early menopause, especially without the protective buffer of HRT, may leave the nervous system more vulnerable to the kind of overactivation seen in fibromyalgia.
Shared Symptoms, Missed Diagnoses
Here’s where it gets really tricky: the overlap in symptoms between menopause and fibromyalgia is massive. Brain fog? Check. Sleep disruption? Check. Fatigue, mood changes, digestive issues, widespread discomfort? Check, check, check.
Many women get stuck in a cycle of referrals: from primary care to rheumatology to psych. They're told to lose weight, reduce stress, try yoga, or just "wait it out."
When the Athlete Identity Gets in the Way
Athletes—especially endurance athletes—tend to normalize discomfort. Pain becomes background noise. So when the body starts sending louder distress signals, it’s easy to dismiss or push through it. But fibromyalgia doesn’t respond well to grit. It needs restoration, regulation, and a nervous system that's no longer under siege.
This is where traditional coaching can fail. If someone is "non-compliant" with a plan, the answer isn’t always discipline. Sometimes it’s deeper.
HRT: A Potential (But Not Universal) Support
For those in early menopause or who experience significant symptom disruption, HRT may be a helpful intervention. Some research suggests that restoring estrogen levels can improve pain tolerance and sleep quality, both of which are central to managing fibromyalgia. But HRT isn’t a cure-all. It’s one piece of a much bigger puzzle.
Other tools that may help:
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Strength training with appropriate load and recovery
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Gentle movement like walking or mobility work
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Sleep hygiene and circadian rhythm support
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Nervous system regulation practices (e.g., breathwork, therapy, pacing)
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Nutritional strategies to reduce inflammation and support energy levels
What Coaches and Practitioners Need to Remember
Coaching someone with fibromyalgia (and/or menopause) isn’t about lowering expectations. It’s about understanding that adaptation might look different, and that progress is non-linear.
That means:
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Replacing "no excuses" with "what's your body telling you today?"
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Building programs with flexibility, not punishment
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Tracking wins outside of time and pace
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Encouraging curiosity, not shame
Reframing the Comeback
Starting over doesn't mean you failed. Sometimes it means you're listening.
For an athlete with fibromyalgia, especially in the context of menopause, a "comeback" isn't about pushing through pain—it's about partnering with your body again. It might mean running slower, training less frequently, or redefining what success looks like.
And it also might mean your next start line is your most meaningful one yet.
If your body is whispering, don’t wait for it to scream. Whether you're a coach, a teammate, or the person inside that body—make space for the hard truths. Healing is never linear, but it is possible. And it starts with being believed.
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