Exercise helps with most things: mood, bone density, heart health and more. It is a recommended means of managing common symptoms of menopause, too.

But a new study suggests even elite athletes might struggle to keep exercising in the face of some of the most common side effects of this change of life.

Researchers looked at 187 female athletes of several cardio-intensive sports: runners, swimmers, cyclists and triathletes. Every participant was between the ages of 40 to 60 years old. As the term “athlete” might imply, these were no couch potatoes: Each of the women surveyed exercised at least three days a week, sweating for a minimum of three hours a week.

They completed a scale that described different menopause symptoms, reporting how these affected their ability to perform during training and actual performance in the sport.

Most — 88% — reported difficulty sleeping, with physical and mental fatigue a close second at 83%. These were some of the most common menopause symptoms associated with negative effects on sports performance, along with muscle aches and pains and weight gain.

Notably, study authors say the severity and prevalence of these symptoms mimics those seen in the general population (also known as those of us sweating for less than three hours a week, and certainly not at elite levels). They recommend providers address symptoms not only for quality of life, but also for health — so patients can keep exercising with less discomfort.

And, while we might not all be triathletes, it’s nice to know hot flashes don’t discriminate.