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The hot flush that stole a world title: special report on sport and the menopause

Professor Fiona Wilson, a physiotherapist and specialist in sports medicine, represented South Africa in rowing and remembers experiencing severe palpitations when she was going through the perimenopause, the time during which a woman's body makes the natural transition to menopause.  

"If you are an athlete pre-menopause and you get palpitations, that is a sign your heart isn't coping with the training, but even I had to Google information about palpitations and the perimenopause," she says. 

"I remember being at a sports medicine conference and getting very bad palpitations and I was looking around me and I saw a cardiologist and I thought if I have a cardiac arrest, there will be someone to help me!

"But it is only when I began to look it up myself that I realised it was a symptom of menopause. Joint pain was another big symptom for me. A lot of the women I row with thought their joint pain was to do with old age and I had to say 'that is not normal, you should not be having old age joint pain when you are in your mid-40s'."

Wilson was able to manage her menopause through the use of hormone replacement therapy [HRT] but she believes there is still reticence around admitting the use of HRT both in sport and in the general population. 

"I think people just don’t talk about HRT in general because it is admitting 'I am a menopausal woman'," she says. "People do judge you on your age. It is taboo for all women and it seems to be even worse for athletes as the attitude is put your head down and get on with it."

Until then, many sportswomen simply have to work out a way to minimise the disruption the menopause can cause. Some, such as the Olympic eventer Mary King, even find a way of making it work to their advantage. 

King, now 60, had her best Olympic success during and after her menopause, winning team silvers in the 2004 and 2012 Games, and a bronze in Beijing. 

"I had those hot flushes but in winter, when it was bitterly cold and I had numb fingers and toes, that was just lovely! I warmed up for a little while and then it went away.

"I am sure menopause affects people in different ways and I was very lucky I had mild symptoms but there is certainly life after menopause. It was bliss not having your period any more - it was much easier not having to faff around with any of that."

King acknowledges that eventing may be a special case, given it is a sport where age rarely counts against a competitor - and women and men compete on an equal footing.

"I remember galloping around London having won a silver medal thinking I was so lucky but the headlines the following day were about the swimmer Rebecca Adlington who didn't win gold as expected, she won bronze," she recalls. "The headlines were, 'At the age of 23 I am too old for my sport'. I just thought thank goodness I am not a swimmer!"

For younger women, even those who do not play sport professionally, the impact can be far more corrosive. Zoe Hardman, the Heart FM radio presenter who has built a strong Instagram following around health and fitness, went through the menopause early, at 37. 

By then she had already had two children, but the changes in her body - and the impact they had on her mental health - were still devastating. 

"I developed early menopause symptoms: night sweats, brain fog, dryness, you name it, I got it," she says. "I felt like I was being hammered from all directions.

"My crying was absolutely hideous, I would cry all day, every day and for days on end. The depression was horrendous. It was terrifying. I had the darkest thoughts in my head."

For Hardman, sport and training was a key supplement to her HRT treatment, even if this brought its own problems. 

"The sweats were coming during the day, too, and I have always been quite a sweaty person when I train. Having these menopause symptoms I would be just dripping and dripping and I remember my husband suggesting I should take a shower in the middle of the work-out. 

"It wouldn’t just happen when I was training, it would happen when I was in Tesco or on the school run."

Hardman, 38, is urging women who think they might be going through the menopause to seek medical attention regardless of whether they want to manage their symptoms with HRT or naturally. 

"I just want everyone to have the confidence to go to their GP if they are experiencing any symptoms and demand blood tests. If you think you are going through menopause, early menopause and you need extra care, do not get fobbed off. 

"I was lucky I had an amazing GP who listened to me because of my family history [Hardman’s grandmother, mother and sister all had early menopause] but I have spoken to so many women who have gone to their GP and are turned away and told they are anxious or tired.

"There are thousands of women living through this, it cannot carry on and no matter what route you want to go down – just make sure you get the answers that you want."

Wilson admits that there currently "isn’t enough research" into the effects of the menopause on athletes. That is slowly changing, but until then many women will look to the likes of Hedman, King and Hardman for proof that the menopause does not have to curtail professional ambitions.

"The menopause shouldn’t stop you from doing what you want," Hedman says. "It affects everyone differently but I am one of those people who doesn't allow myself to be put down by something. I have fought all my life and, as a competitor, I won' let someone get on top of me or interrupt me. 

"I know my body and I go with it. I just love the game I play. If I do well, then brilliant; if I don't do so well, it won't knock me down and I won't cry about it because to me life is short and I want to grasp everything I can. I want to make my mark and won't let the menopause stop me."

Frimley Green, 2014, and the final of the BDO Darts World Championship. Deta Hedman is just moments away from the crowning glory of her career - two sets up on Lisa Ashton, and throwing for the title. 

Hedman has been the picture of ice-cool concentration all night but as she steps up to the oche, something seems different. She looks distracted, sweaty and uncomfortable. Her throws are off, and she loses the leg, then quickly the set. Shortly after, she is shaking Ashton's hand, congratulating her on a remarkable 3-2 comeback victory.

What happened? Was it the pressure of the situation? Was Ashton simply that much better a player? No. Hedman was having a debilitating hot flush - like so many millions of women around the world, wrestling with the menopause.

Hedman was 55 in 2014, but had started experiencing menopausal symptoms several years before that, so she knew what was about to hit her that night in Surrey. 

"The whole week I was having hot flushes before I played and I thought 'thank God for that' - I just didn’t want to have them when I was on the oche," she recalls. 

"In the final, I could feel it coming on. I played through it but I have never had a hot flush so bad, I was an absolute mess. With the tension that is why it was so horrendous. I should have asked to go to the toilet but at the time I was winning and I thought 'you can do this'. But my head and everything just went."

Losing a world title to the menopause is a cruel twist, seven years on and it is a defeat that still haunts her. "I was absolutely devastated afterwards," she says. "I lost in the end because, by the time I came around and was trying to fight what was happening and stay focused, Lisa picked up momentum. My fightback was a little too late.

"Even now because of that experience I always hope that I have my hot flush before I get on the oche because it just throws me off my stride."

Menopause is something almost every woman experiences but it is rarely spoken about in professional sport. Partly this is because by the time most athletes start to get symptoms they will be at the tail-end of their careers or retired; in sports such as darts, golf and equestrianism, however, where women can compete for longer, it can have a devastating impact.

Hot flushes are one of the classic symptoms of menopause, but there are myriad others which can impact on sporting performance - from joint pain to palpitations, low moods and 'brain fog'.

'My mood changes'

"There have been times when I was looking at the board and I have gone for a different shot than I was planning and I would think 'why did you just do that?'" Hedman says. "I know when it is coming and my concentration goes all over the place.

"I get very irritable, sometimes I couldn't be arsed being around people at times. I just want to sit on my own and say: 'Leave me alone, let me stay in my own little world'. I do feel that my mood changes. One minute I am the life and soul of the party and next I just don't want to be there."

Hedman takes a cheerfully philosophical approach to her menopause - "Having lived your life, you know how to control yourself when the menopause symptoms happen," she suggests - and says that, in darts, the subject is actually freely discussed. 

In many other sports, however, it remains something of a taboo topic - or at least misunderstood in how it can impair performance. This partly stems from the wild disparity in symptoms that women can experience, which can surprise even experts in the field.