Trail Notes | Female Athlete Health

it is not just the kms

Oestrogen And

Your Joints.

If your knees and hips feel stiffer in your forties than they used to, and you have quietly blamed the years of running, there is a piece of the story you have probably never been told. Your hormones are part of this.

Many of us reach perimenopause and start to notice new joint signals. Knees that ache longer in the morning. Hips that take an extra kilometre to loosen. Recovery in the joints that feels slower than it did a few years ago. The easy assumption is that the mileage has finally caught up with us.

The research now tells a more precise story. A large part of what you are feeling is hormonal, not mechanical, and that distinction changes how you train through this window.

Trail Note  ·  01

The pattern clinicians have seen for years

It has long been observed that women develop knee osteoarthritis at higher rates than men after the age of 50, and that the rise lines up closely with the menopausal transition. The pattern was clear. The mechanism behind it was not.

For a long time this left us with unsatisfying advice. Joints were treated as a wear-and-tear problem, and the recommendation was often simply to do less. For an athlete who has built a life around movement, that advice never sat right, and it turns out it was incomplete.

Trail Note  ·  02

What the new research actually showed

In 2025, a landmark study in Nature Aging gave us the clearest evidence yet that the loss of oestrogen and progesterone at menopause is directly causing cartilage to break down, not just happening at the same time.

Working in a menopause model, the researchers showed that the hormonal drop accelerated cartilage ageing, drove the breakdown of the tissue's supporting structure, and produced measurable degeneration compared to controls. When they restored those same hormones, the cartilage was protected. Human cartilage cells from post-menopausal donors behaved better when oestrogen and progesterone were added back, ageing more slowly and rebuilding more actively.

In plain terms: oestrogen and progesterone are protective for your joints, and their decline removes a defence your cartilage has relied on for decades.

Trail Note  ·  03

Why this matters for the trail athlete

The core cohort of trail and ultra running sits right inside this hormonal transition. If you are somewhere in the 40 to 55 range, you are navigating a steady decline in oestrogen and progesterone at the same time as you are asking a lot of your body on the trails.

This is why the perimenopause window deserves proactive joint care rather than quiet worry. An athlete who has trained for years without a single joint complaint may suddenly notice changes, and assume she has done something wrong. She has not. The ground has shifted underneath her, and the response is to adjust the plan, not to stop.

Trail Note  ·  04

What you can actually do

The hormonal shift is not fully in your hands, but the way you support your joints through it very much is. The research is consistent that non-pharmacological strategies, especially strength work and sensible load management, remain first-line for joint health in this window.

Trail Note  ·  05

The reframe

Understanding the oestrogen piece does something quietly powerful. It takes the joint changes of perimenopause out of the realm of guilt and self-blame, and puts them into the realm of things you can prepare for.

You are not paying a debt for the years you have run. You are moving through a hormonal transition that asks for a smarter, stronger, more attentive approach to the joints that carry you. The aim is not to run less. It is to keep running, well, for decades.

strong joints are built, not just inherited

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