Effects of Altitude on Menopause

How Living and Playing in Colorado’s Mountains Affects Your Hormones, Energy, and Health

If you live in Colorado, chances are you love being outdoors. Whether that’s hiking, skiing, climbing, or simply breathing in that clear mountain air. The thin air, bright sun, and active lifestyle are part of what make life here so special. But if you’re in perimenopause or menopause, you may have noticed that your body reacts a bit differently at altitude. Maybe your energy drops faster on hikes, your sleep is more restless in the mountains, or you’re wondering whether hormone changes affect how you adjust to thinner air.

The good news: according to recent studies, menopause itself doesn’t make altitude harder on your body. In fact, most healthy, active women in midlife handle the high country beautifully. This is true especially with a little planning, hydration, and the right hormone support.

Let’s look at what science knows about altitude and menopause, what questions still remain, and how you can keep exploring the outdoors comfortably through every season of life.

Understanding Altitude and Your Body

What “Altitude” Really Means

In simple terms, altitude refers to how high you are above sea level. Colorado sits higher than most of the country, with Denver at about 5,280 feet (“The Mile High City”) and popular mountain towns like Breckenridge, Telluride, and Aspen ranging between 8,000 and 10,000 feet.

At these elevations, the air is thinner, meaning there’s less oxygen in each breath. This mild oxygen shortage is called hypoxia, and it makes your heart and lungs work a bit harder. The body responds by breathing faster, producing more red blood cells, and shifting energy use to adapt.

Common Effects of Altitude

Most people, regardless of age or sex, notice some short-term changes when they go up high:

• Slight fatigue or lightheadedness
  
  
• Shortness of breath with exertion
  
  
• Trouble sleeping the first night or two
  
  
• Dehydration or dry mouth
  
  
• A faster heart rate

For most, these effects ease after a few days. But if you’re already adjusting to menopause, altitude can feel like one more variable your body is juggling.

Menopause and the Body’s Response to Altitude

Menopause changes the way your body regulates temperature, circulation, and sleep. These are all functions influenced by oxygen levels and blood flow.

• Estrogen decline can make blood vessels less flexible, sometimes increasing heart rate or causing hot flashes.
  
  
• Progesterone changes can alter breathing patterns and sleep quality.
  
  
• Sleep disturbances are common, and thin air can make them worse by lowering nighttime oxygen levels.
  
  
• Mood changes and fatigue overlap with mild altitude effects, making it tricky to tell which is which.

So, does this mean menopause makes high altitude more difficult? The latest science says no, at least not in terms of medical risk.

What the Research Shows

Two major studies published in 2024 finally began answering this question.

1. The UIAA Medical Commission Scoping Review

A group of international researchers reviewed over 7,000 studies to see how menopause and high altitude interact. Only 11 relevant studies were found, showing how little this topic has been studied, but the results were reassuring:

• Menopause does not increase the risk of acute mountain sickness (AMS), the temporary illness some people experience at high altitude (symptoms include headache, nausea, and fatigue).
  
  
• Physically fit postmenopausal women adapt to low oxygen as well as younger women.
  
  
• The body’s cardiovascular and oxygenation responses are not significantly affected by menopausal status.
  
  
• One consistent finding: urinary tract infections (UTIs) are slightly more common during mountain travel, possibly due to dehydration, limited bathroom access, and changes in vaginal flora after menopause.

In short, the researchers concluded that menopause has minimal effect on the physiological response to altitude. Your ability to acclimatize is still strong, and your adventurous spirit can stay that way too.

2. Women at Altitude

In another landmark study, researchers followed 1,161 female trekkers traveling in Nepal at elevations between 11,500 and 16,000 feet. The group included premenopausal and postmenopausal women, with some using hormonal contraception or hormone replacement therapy (HRT).

Their findings:

• The rate of acute mountain sickness was about the same across all hormonal groups, around 25–30%.
  
  
• Menopause status didn’t affect risk, and neither did using HRT.
  
  
• Women taking hormonal contraception or progesterone therapy were no more or less likely to experience altitude sickness.

The study concluded that hormonal status is not a risk factor for altitude-related illness. This is good news for women in Colorado who love mountain adventures.

What This Means for Colorado Women

If you’re a woman in your 40s, 50s, or 60s who loves hiking or skiing, these findings should feel encouraging. You can keep doing what you love without factoring in your menopause status. However, knowing what to expect can help you manage symptoms better and stay comfortable.

How to Tell the Difference: Altitude Fatigue vs. Menopause Fatigue

Recognizing which type of fatigue you’re feeling helps you decide whether to rest, hydrate, or discuss symptoms with your healthcare provider.

Altitude and Common Menopause Symptoms

1. Sleep Changes

Both altitude and menopause can disturb sleep. At higher elevations, oxygen dips may cause brief awakenings or vivid dreams. Add night sweats or hot flashes, and rest can feel elusive.
What helps: Avoid alcohol at night, stay hydrated, use cooling bedding, and consider discussing progesterone therapy to stabilize sleep patterns.

2. Mood and Energy

Low oxygen can temporarily alter serotonin levels, the same brain chemical affected by estrogen changes. This can heighten mood swings or anxiety.
What helps: Exercise outdoors during daylight, maintain steady hydration, and practice gentle breathing before bed. If mood changes persist, talk with your provider about whether adjusting HRT could help.

3. Bone and Muscle Health

Altitude itself doesn’t cause bone loss, but staying active is key to maintaining strength. Regular hiking and resistance exercise protect against osteoporosis, which becomes more likely after menopause.
What helps: Combine activity with adequate calcium, vitamin D, and, if appropriate, hormone replacement therapy for strong bones and energy support.

4. Vaginal Health and UTIs

The UIAA review found increased UTI risk for postmenopausal women at altitude. Dry air, reduced estrogen, and dehydration all contribute. 

What helps:

• Drink water regularly, even if you’re not thirsty.
• Don’t delay bathroom breaks on hikes.
• Ask your provider about vaginal estrogen cream or tablets, which restore healthy pH and prevent infections.

5. Skin and Hair

Dryness is one of the most noticeable altitude effects and menopause amplifies it.
What helps: Use gentle cleansers, moisturize twice daily, and wear broad-spectrum sunscreen. Hydration and balanced estrogen levels improve skin texture and resilience.

Hormone Replacement Therapy (HRT) and Altitude

Some women worry that taking hormones might affect how their body responds to altitude. The Gardner et al. study directly addressed this, and found no increased risk of mountain sickness among HRT users.

Why That Matters

Estrogen and progesterone influence body temperature, vascular tone, and mood, all systems that help you adapt to environmental stress. While research is limited, using HRT under medical guidance appears safe for women who live or recreate at high elevation.

If you’re on HRT:

• Continue your regular doses when traveling or spending time in the mountains.
• Support your therapy with good hydration, nutrition, and rest.
• Keep your follow-ups with your healthcare provider to adjust doses as needed.

Questions to Ask Your Provider About HRT and Altitude

1. Does altitude affect how I metabolize my hormone prescription?
2. Should I adjust my dose if I’m spending extended time above 8,000 feet?
3. What are early signs that dehydration or altitude may be influencing my symptoms?

Practical Tips for Staying Active and Comfortable at Altitude

You don’t have to change your lifestyle,  just tune into your body’s signals.

1. Hydrate Well and Early
   Start increasing fluids a day before heading to higher elevation. Herbal teas, electrolyte drinks, and water-rich foods (like fruit) help prevent dehydration.
2. Pace Your Acclimatization
   If you’re traveling from lower elevations to high-altitude areas, spend one night at mid-elevation (around 6,000–7,000 feet) first.
3. Eat to Fuel Oxygen Use
   Iron, B vitamins, and lean protein support oxygen transport and energy.
4. Protect Your Sleep
   Limit caffeine after noon, avoid alcohol before bed, and use a sleep mask or earplugs in mountain cabins.
5. Prevent UTIs
   Stay hydrated, urinate regularly, and consider vaginal estrogen if dryness is an issue.
6. Know When to Seek Help
   If you experience persistent headache, confusion, or shortness of breath, rest and descend to a lower elevation. Contact your provider if symptoms don’t resolve.

Living Your Best Life

Menopause is not the end of your adventures, it’s just a new phase of them. The research shows your body remains strong, adaptable, and fully capable of thriving at altitude. With balanced hormones, good hydration, and mindful care, you can continue exploring Colorado’s peaks, trails, and open skies with confidence.

Your body is resilient and responsive to treatment,  and hormone replacement therapy remains one of the most effective tools for supporting energy, mood, bone health, and overall well-being during this stage of life. Talk with a trusted healthcare provider about how it can help you stay strong and vibrant, wherever the trail leads.

References

1. Gardner, L., Keyes, L. E., Phillips, C., Small, E., Adhikari, T., Barott, N., Zafren, K., Maharjan, R., & Marvel, J. (2024). Women at altitude: Menstrual-cycle phase, menopause, and exogenous progesterone are not associated with acute mountain sickness. High Altitude Medicine & Biology, Advance online publication. https://pubmed.ncbi.nlm.nih.gov/38516987/ 

2. Mateikaitė-Pipirienė, K., Jean, D., Paal, P., Horakova, L., Kriemler, S., Rosier, A. J., Andjelkovic, M., Beidleman, B. A., Derstine, M., Pichler Hefti, J., Hillebrandt, D., & Keyes, L. E. (2024). Menopause and high altitude: A scoping review—UIAA Medical Commission recommendations. High Altitude Medicine & Biology, 25(1), 1–8. https://pubmed.ncbi.nlm.nih.gov/37922458/