Balancing endurance exercise with hormonal health

As a longtime distance runner that also happens to have PCOS, balancing endurance sports alongside my hormones is something that’s particularly close to my heart. I’m sharing my own story and what works for me not as advice (I’m not a doctor, remember that!), but as an example of how important personalization and experimenting are for all of us in our hormonal health journeys.

With that, let’s begin!

Why running?

I’ve been a runner for over 10 years. I begrudgingly started in high school when I joined the cross country team per suggestion (read: demand) of my father, who mandated I participate in at least one sport per year. I lack all hand-eye coordination, so running in a straight line it was.

It took me 3 years to warm up to the sport. But during my senior year as college application deadlines drew near and other real-life pressures mounted , I found myself not just enjoying the activity in a way I had not before, but yearning for it during rest days and seasons. By the time I went away to college, running was a favorite pastime, and it filled the role of my everything-outlet. Whether I needed to decompress, reflect, cry, brainstorm, or just get some much-desired alone time, running was there. Beyond that, I became a successful (as I like to coin it) “competitive mediocre road racer” as I turned to half and full marathons once no longer bound by the high school XC and track circuit.

Today I’m still a runner, albeit a different one than I was in college. I commute nearly 3 hours round trip to work each day, which can put a wrench in working out, and prior to my current role I was a consultant on the road for 80% of my life. This has meant fewer PRs, more injuries, and refreshed expectations of my once lofty endurance goals.

Still, running remains one of the most important parts of my life, primarily for the forced reflection and self-evaluation time it allows. I can only hope I’ll be lucky enough to continue running for the rest of my life, because without this ritual, everything becomes a bit more daunting and overwhelming, and I am more inclined to live life in autopilot.

The catch

Ah, there’s always one of these.

If you’re a hormonal health nerd too, chances are you’ve picked up that endurance sports like long distance running are not recommended for women with PCOS like myself, or those struggling with undiagnosed hormonal health symptoms like acne, hair loss, and fatigue.

The reason?

Moderate intensity endurance activities have a real knack for putting your body under stress. Studies show that endurance athletes are at risk for significantly higher long-term cortisol exposure, as our bodies pump this stress hormone out more intensely once our muscles are out of their glycogen stores. This typically happens after roughly 60 minutes of moderate exercise - a duration which many runners, swimmers, and bikers hit quite frequently.

We’ve talked about the impact cortisol has on our hormonal health over on Instagram before. Essentially, cortisol helps control our blood sugar, regulate our metabolism, reduce inflammation, and more. It plays an integral part in our hormonal health, but too much of it can suppress ovulation (the reasoning behind this: our bodies are smart, and don’t want to get pregnant if we are in a high-stress environment) while exasperating the hormonal imbalance symptoms that accompany this.

Endurance sports can also impact men’s hormonal health: take Ryan Hall, who struggled with low testosterone due to overtraining. Testosterone is important for bone health (similar to estrogen for women), strength and energy, and red blood cell count, all of which are important not just for successful endurance sport-ing but also living a pleasant and productive life.

Armed with this knowledge, we have a decision: forgo endurance exercise in lieu of something that’s more hormonal balance-friendly, or continue in a way that works for us.

Managing prolonged cardio & PCOS

In case it isn’t obvious, faced with the above decision, I chose the latter.

Over the course of a few years of paying wildly close attention to my body and how it responds to exercise, I’ve learned how to make running fit within my lifestyle in a way that works for me. A lot of factors contribute to hormonal imbalances, stress being a huge catalyst, and for me, nothing helps me unpack my minute and significant anxieties in the same way that going on a long, solo run. For that reason alone, making running work for me was worth it.

Here are a few helpful tips that have helped me:

• Eat enough and weigh enough. If I had to estimate how many calories I eat each day, I’d put that number at least 3,000 depending on how much I’m running (which generally ranges between 25 and 40 miles per week). That is a good deal more than the (in my opinion, ill-advised) “recommended” caloric intake, but I’d say 70% - 90% of said diet is comprised of fairly nutrient and energy-dense foods (e.g., snacking on spoonfuls of peanut butter instead of potato chips). While the saying you can’t outrun a bad diet is certainly true - and as a society we tend to overestimate how much energy we expend while working out - research shows that endurance and high impact sports like running can cause hypothalamic amenorrhea (period loss) if we are not replenishing our body properly. For this reason, sheer energy input (i.e., calories) is really, really, important. Weight plays into this as well. When I’m running a lot, I’ve found I actually need to gain around 5 pounds to keep my cycles normal. This may be counter-intuitive for running diehards who are compulsive about maintaining their goal race weight. But for me, those 5 vanity pounds are well-worth being able to train hard for a goal race without worrying about period loss and subsequent bone density issues.
• Carbs are my BFF, especially in the first two weeks of my cycle. This food group gets a really bad rep in the world of hormonal health. There’s some truth to that: if you’re making refined grains and processed sugar a major part of your diet, you probably won’t feel so hot. Particularly if you have insulin-resistant PCOS. But! Did you know that you need carbs to ovulate? Moreover, did you know that your body isn’t able to recover as quickly without carbs post-workout? For us endurance athletes, carbs are a must, especially immediately before and after workouts as well as during the follicular phase of our cycle. I personally feel my best when my carbs are coming from starchy vegetables like potatoes, but fruit, whole grains, and even refined carbs (gasp! These can be great fuel immediately pre and post-run, because your muscles more readily gobble up the simple sugars, thus slowing your body’s cortisol response to glycogen-depleted muscles) will all get the job done if you’re hitting the pavement for 1+ hours at a time.
• Whoops, I have 2 BFFs. Don’t want to make fats jealous! Fats are integral to proper hormone functioning. For those who are more active, their importance intensifies. For me personally, we are talking 1+ jar of peanut butter or tahini per week, several servings of nuts at work daily, and being liberal with oil and butter while cooking. When I skimp in this area and am continuing on with my normal running routine, I notice a marked increase in skin dryness, acne, brain fog, and poor sleep. Beyond their direct health benefits, fats are also great at adding dense energy to your diet (remember #1 above!) to make sure that your body has enough fuel to work with to ovulate and keep your endocrine system running smoothly.
• Keep tabs on other stressors in your life. While exercise is hopefully a good stressor, it can certainly be a bad stressor when you are not giving your body enough time to recover. And, non-exercise stressors can impede your athletic recovery ability. It’s all connected! For me, “other stressors” translates to lack of sleep, working long hours at my job, and over-committing socially. I generally find that if I’m not doing a good job with 2 of 3 of these items (e.g., I’ve only been sleeping 6 hours per night and have been going out several nights per week), I am at a way higher likelihood of running injury as well as disrupting my menstrual cycle, and should dial back in running until the rest of my life is a tad less overwhelming. Both of these are indicators that I’m overdoing it, which leads me to my next point…
• Monitor your cycles and symptoms. I’ve been religiously tracking my period ever since I was diagnosed with PCOS in college. For the past 5 years, over 80% of my cycles have been in their normal 28-30 day range. My “off” periods (punny!) have only happened during my move from New York to San Francisco (to be expected, to some extent) and when I’ve too quickly ramped up my running mileage. I pay attention to more than just my period, though. For me, my skin and energy levels are tell-all indicators of how my hormones are doing. If I’ve been dealing with recurrent breakouts or unexplained tiredness for more than a week or two, that means that an irregular period is likely just around the corner if I don’t make a swift change. It’s usually easier to right the ship before my period gets wonky, so for me, these are two things I’m particularly sensitive about.
• Be realistic. I’ll never be an Olympic runner, and I don’t push my body like I am. Could I run 80 mile weeks if all the above factors are being addressed? Sure, maybe. But for me, respecting my own physical limits (no more than 40 miles per week with 2 rest days from cardio) makes it a whole lot easier to maintain hormonal balance. These parameters vary person by person: perhaps you are able to be a semi-pro runner while also managing PCOS, or maybe you find that your body starts to rebel once you surpass just 15 miles per week. Whatever those limits are, it’s important to accept where your body is at any given time and understand that if you push those limits, some disruption could occur.

If you’re an endurance junkie like me and are experiencing hormonal imbalance symptoms or irregular cycles, it is definitely worth taking some time off to let your body rest and adjust. Particularly if you are trying to start a family and having trouble conceiving, limiting extended cardio for the near-term may be what’s best for you. It all depends on your baseline, existing priorities, and future goals; our bodies are all unique, and just because someone works for one person doesn’t mean it will work for the next.  

Above all though, you should find a provider to help you manage your hormonal health, and ideally, one that is respectful of things you want to keep in your routine vs. those you are open to altering or eliminating altogether. With that kind of support, finding a balance between managing a hormonal imbalance along with exercising your love for endurance sports (my second pun in one blog post - we’re on fire today!)  becomes much more achievable.

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