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Menopause, Fitness, and Health: What You Need To Know

We all know about menopausal hot flashes. We also know that “women of a certain age” tend to carry more fat around their abdominal area.

But what about some other changes not talked about as much? Mood swings, problems with sleep, muscle aches, thinning hair, fatigue. And, what about bladder leakage? Yikes!

Have you also maybe noticed that what worked for you in your 20s and 30s with diet and fitness is suddenly not working so well anymore?

We’re going to go over what menopause is, and why the decline of estrogen causes so many changes in our bodies. We tend to think of estrogen as just a reproductive hormone, but it’s really involved in so many different processes in a woman’s body.

It’s because of changes in these processes that menopause has such a noticeable effect on our fitness, and the way our body looks and feels.

What is menopause?

Woman standing thinking, with white question marks behind her
There’s more to it than you might think!

Technically, there are 3 stages of menopause: perimenopause, menopause, and post-menopause.


When does it start?

Perimenopause is the time leading up to the cessation of menstruation. It usually starts sometime in a woman’s mid-40s, but it can be earlier or later. On average, it lasts between 4 to 6 years. But for some women, it might last only a year, or as long as up to 10 years.

The average ages and time spans are just that: averages. Though every woman will experience perimenopause, we are all individuals with our own unique physiology.

There are also some women who don’t experience perimenopause in a gradual way. Illness or cancer treatment can cause the ovaries to stop working very abruptly. Surgical removal of the ovaries will also cause a woman to go into immediate menopause, regardless of her age.

Menstrual changes

During the natural perimenopause process, estrogen and progesterone begin to fluctuate and decline, causing a slowdown of egg production in the ovaries. Ovulation doesn’t occur as often; pregnancy may be more difficult, but it is still possible.

Women will notice their menstrual cycles becoming irregular, with either more or less time between periods than usual. Sometimes there can be several months between cycles. The blood flow may also become heavier or lighter. The flow can even switch from light to heavy, from month to month.

Another change many women experience is shorter or longer menstrual periods. Sometimes the flow might last for 10 or more days, instead of the typical 5 to 7 days you may be used to. Or, you might only spot for 2 or 3 days.

Other symptoms

Woman Having a Headache While Working at a Desk Surrounded by Green Plants

Not all women will experience symptoms during perimenopause, other than changes in their menstrual cycle. But many will notice some, or all, of these other changes caused by hormonal shifts:

  • hot flashes
  • mood swings
  • low sex drive (libido)
  • headaches
  • insomnia (trouble sleeping)
  • breast tenderness
  • muscle and joint soreness/stiffness
  • weight gain (especially abdominal)
  • vaginal dryness and/or pain
  • fatigue
  • forgetfulness/trouble concentrating
  • urinary bladder leakage
  • itchy and/or dry skin
  • thinning hair (falling out)

What’s the difference between menopause & post-menopause?

Many women mistakenly say they’re “in menopause” when they’re actually in perimenopause, those (sometimes many) years leading up to menopause.

The truth is that as long as a woman is still having menstrual periods, she is not yet actually in menopause. She may not ovulate every month anymore, but there is still a chance she could become pregnant.

As we learned, during perimenopause when estrogen and progesterone are still fluctuating, a woman may still have periods, although they may be very irregular (with sometimes a few months in between).

Okay, so when does menopause actually start?

According to medical professionals, after a woman has gone for 12 full months without a period at all, she is considered to be officially in menopause.

Menopause is just a point in time that marks the complete cessation of the menstrual period, and the end of fertility. Post-menopause means all the years in a woman’s life after her menstrual cycle ceases.

So, the phrases “in menopause” and “post-menopause” mean essentially the same thing.

Body changes in menopause

Brown colored apple and pear sitting ontop of a tree stump with a yellow flower
Body shapes: “apple” vs. “pear”

Men and women both experience the physiological changes of aging. Even very active and fit people of both sexes will notice a decline in strength and endurance. Also notable are changes in body composition, due to fat redistribution and loss of lean body mass (muscle tissue).

Women in perimenopause and menopause have unique changes to bodily processes due to low estrogen, progesterone, and other key hormones. This just adds fuel to the fire of the already existing challenges of aging in general.

Fat redistribution and body recomposition

Due to testosterone, men have a tendency to store fat more in the abdominal area (“apple” shape) than in other parts of the body.

However, before menopause most women, because of the hormones estrogen and progesterone, typically carry fat more in the hips and thighs (“pear” shape).

There are of course exceptions, but these are the general differences in adipose tissue (fat) distribution between men and women.

As estrogen declines, many women will find it much easier to gain weight, and more difficult to lose it than when they were younger. This seems to happen even when their diet and activity levels haven’t changed. This can be very frustrating!

Even more maddening, perhaps, is the phenomenon of the waist becoming larger and more fat accumulating in the abdominal area, even if body weight and BMI remain the same (becoming more “apple-shaped”).

How is this possible?

If you’re the nerdy type, here is a study from 2021 by Ko, H., & Jung, Y. titled “Energy Metabolism Changes and Dysregulated Lipid Metabolism in Postmenopausal Women”. It explains in scientific detail the very intricate chain reaction between hormones that occurs in menopause, resulting in body recomposition.

Here’s a summary of the main points of that study:

  1. The loss of estrogen and an increase in androgen hormones (especially testosterone) contribute to an overall decrease in lean muscle mass and an increase in adipose tissue (fat). This is because interactions between other important hormones are affected by the change in estrogen and androgen, resulting in a lowered BMR (basal metabolic rate). This recomposition causes a change in body shape. Lowered BMR also causes the body to burn fewer calories even during physical activity.
  2. An increase in abdominal fat (visceral: fat that wraps around the internal organs). We don’t like how it looks, but more concerning is that it is more dangerous to our health than fat just under the skin (subcutaneous). Because visceral fat produces excessive FFAs (free fatty acids), they aren’t properly metabolized (used as energy). This means that not only is fat more easily accumulated in the abdomen, but it is also more difficult to get rid of than fat in other parts of the body.
  3. Excessive abdominal fat can trigger insulin resistance. Read here to see how insulin resistance can turn into prediabetes.

Higher cortisol levels

Blue arrow pointing up on a graph
As estrogen decreases, cortisol can increase

Another hormone to consider for its impact on women in all stages of menopause is cortisol. Cortisol is called a “stress hormone” because it is a key player in keeping the body prepared for quick action, along with adrenaline.

Besides that, cortisol has many other functions and affects almost every system in the body. These include regulating the sleep/wake cycle, blood sugar levels, and blood pressure. It’s also involved in energy metabolism within the cells.

The problem is that during menopause, low estrogen levels can cause an increase in cortisol. This in effect puts the body under a constant state of biological stress, even if you may not be experiencing much stress at all in your life.

Read here and also here for more information about why cortisol levels might increase in menopause.

Why is high cortisol a problem?

During all stages of menopause, a woman’s body is already going through a lot of physiological changes due to the loss of estrogen. Throwing in higher cortisol levels on top of it can add even more unpleasant effects and symptoms!

These are some of the symptoms of high cortisol, and the ways it can affect the body:

  • high blood pressure
  • increased blood sugar
  • weight gain (especially belly)
  • sleep disturbances
  • fatigue
  • aches/pains
  • muscle weakness
  • increased inflammation
  • insulin resistance
  • compromised thyroid function (even with “normal” test results)

As you can see, a lot of the effects of high cortisol are the same as for low estrogen. This can add up to quite a “double whammy” of menopause symptoms!

How does menopause affect fitness?

Woman in a Blue Tank Top Running Outside
Has your athletic performance changed?

We’ve discussed how hormonal changes in menopause can affect the way our body looks. Lean muscle tends to decrease, while fatty tissue (adipose) percentage increases. More fat accumulates around our middle, instead of mostly in our hips and thighs.

Even if we’ve been very fit and active our whole adult life, after menopause things start to change. Our body doesn’t look the same as it used to, and often it doesn’t feel the same either.

If you’ve read everything up to this point, you have a better understanding of the changes your body goes through during menopause. It’s easier now to see why we don’t look and feel the way we used to.

It doesn’t mean you’re not fit! On top of hormone-related changes, lung capacity and maximum heart rate naturally decrease with age.

Athletic performance

In addition to your body looking and feeling different, you might have also noticed a change in your athletic performance. You might get out of breath at lower levels of exertion than before, and your muscles might max out at lower weights and reps than in younger days.

Age-related changes

The normal aging process is responsible for some of these fitness changes.

As we get older, lung capacity and heart function naturally decline. These particular changes aren’t really related to menopause per se, but rather to the normal effects of aging (in both men and women). It is important to consider these changes, and how they could impact your fitness in the menopause years.

When it comes to the heart, one of the biggest factors is that the maximum heart rate (MHR) decreases with age.

It doesn’t mean you’re not fit! It is caused mainly by 2 things:

  1. A decrease in intrinsic heart rate, that is controlled by a cluster of cells within the heart called the SA node (the heart’s own electrical pacemaker). These cells begin to break down and lose their efficiency over time.
  2. The heart becomes less sensitive to adrenaline (also called epinephrine), which is secreted during exercise.

Taking into account the natural age-related decrease in cardiorespiratory function, it makes sense why in menopause we might feel more out of breath and tire more easily while exercising.

Hormone-related changes

In addition to the age-related changes in our physiology discussed above, the disruption of hormones throughout the menopause process can also have an effect on our fitness.

We previously talked about the symptoms of menopause. Let’s take a look now at how these hormonal shifts can affect how we feel, and how we perform, during our workouts.

Decreased estrogen
  • Disturbed sleep causes daytime energy slumps
  • Insomnia doesn’t allow for recovery and proper muscle repair
  • Fatigue
  • Muscle and joint soreness/stiffness
  • Loss of muscle mass and strength
  • Bladder control issues (leakage)
Increased cortisol
  • Fatigue
  • Muscle and joint pain
  • Loss of muscle mass and strength
  • Interferes with the sleep/wake cycle
  • Inflammation of cells, organs, and body systems
Decreased testosterone
  • Fatigue
  • Muscle weakness

No wonder we feel different!

Estrogen, cortisol, and testosterone deficiency/excess can cause overall fatigue, loss of muscle mass and strength, as well as muscle and joint pain. Add these to the age-related changes (decreases in lung and heart capacity), and it’s no wonder that our workouts are affected, and our athletic performance might not be what it once was.

Urine leakage is also something that many women in menopause experience (myself included!). It can definitely affect our workouts and we might need to modify some exercises to accommodate this issue.

If you’re in perimenopause, or well into post-menopause, most likely you have noticed some of these changes in the way you feel during your workouts. I know I have!

My experience

Throughout perimenopause, my energy and strength weren’t very impacted by hormone fluctuations. I still had pretty much the same energy and strength in my 40s as I did in my 30s, and I was able to keep up with my intense workouts as I always had.

One thing I did have problems with in perimenopause, though, was bladder leakage. Around age 35, I started having to go to the bathroom more often, because it became difficult to hold my urine. As soon as I felt “the urge” to go, I needed to find a bathroom fast! This then progressed to include stress incontinence.

Needless to say, the bladder leakage situation had an impact on my fitness, as well as my life overall.

About a year into my “official menopause” which began at age 56, I noticed I was more tired than usual, and my regular workouts seemed harder than they used to be. My heart rate increased more quickly, and I got out of breath more easily, with less exertion. And I started having aches and pains in my muscles and joints that I never had before.

Fitness and nutrition strategies for menopause

Lower half of woman, wearing dark leggings and running on a road with grass, trees, and blue sky in the background
New strategies for a new season of life

If you’re like me, you might be realizing that the way you exercised and fueled yourself in the past is no longer serving you. I’ve been an avid fitness person and eating healthy for about 35 years. It’s always worked just fine for me! But after menopause and now 60 years old, my physiology is different, and now I understand why.

Stacy Sims PhD is an exercise physiologist, nutrition expert, and researcher specializing in women’s training and recovery. In an article in Outside Magazine, she discusses how to “outsmart estrogen depletion”.

Her basic recommendations:

  • Lift heavy
  • Do HIIT (high-intensity interval training)
  • Increase protein intake
  • Less volume/more intensity in workouts
  • Longer recovery

So now, let’s elaborate on these:

Strength training

A Close Up of a Muscular Woman Exercising with a Dumbbell at the Gym


To prevent the loss of lean muscle mass and bone that occurs in menopause, it is important to prioritize strength training. Remember, though, that in order to build muscle, you have to push the muscles beyond what they are used to doing.


This is where Dr. Sims’ recommendation to lift heavy comes in. If you’re only lifting lighter weights that don’t challenge the muscles, those muscles aren’t going to adapt and grow. She also mentions doing less volume/more intensity, which also applies here.

For example, let’s say you’re doing biceps curls with dumbbells. If you’re only using light weights, you might be able to do 20 curls before your biceps are tired. This is “high volume, less intensity”. It’s not very effective for building muscle.

But, if you use a much heavier weight, and you’re only able to do 8 to 10 reps in a set, this is what is meant by “less volume with more intensity”. The heavier weight is more intense, but you can’t do as many (less volume) This is a good thing, and what you want to shoot for!

Of course, when it comes to fitness, safety is #1! Read here for some safety tips to keep in mind before attempting to lift heavy weights.


Bottom half of a woman wearing blue leggings and sneakers running up stairs


While strength training is the most effective way to build muscle, training your cardiovascular system is also a vital part of fitness. It’s necessary for keeping the heart and lungs strong and healthy, and also for maintaining a properly functioning metabolism, leading to fat loss.

Dr. Sims explains that estrogen stimulates the body to utilize protein to build muscle and burn fat. But when estrogen goes away in menopause, we have to find another way to accomplish that. She advocates more HIIT workouts than steady-state cardio in menopause for that reason.


There’s been a lot of talk lately on the effectiveness of shorter, HIIT cardio training workouts vs. longer, lower-intensity endurance sessions (also called LISS, “lower intensity steady state” training). See my blog post here that explains the difference between these.

HIIT training has been shown to be very effective for burning fat and stoking the metabolism, and also for conditioning the heart and lungs. This goes for people of all ages, including women in menopause.

A study in 2019 compared HIIT cardio training with moderate-intensity cardio in older men and women rehabbing from a heart attack. The group that did HIIT workouts lost more overall body fat, gained more lean muscle mass, and lost more abdominal fat than the group that did lower-intensity workouts.

Besides the health benefits of HIIT training, it’s very appealing because you can achieve all the benefits in a shorter duration of time, and it includes rest periods between intervals.

Shorter workouts, with rest included. What’s not to like about that?!

How much/how often to exercise?

Expert recommendations

Experts agree that exercise is good for everyone, and that includes women in menopause. General recommendations are for a minimum of 2 1/2 hours of exercise per week, and to reap even more benefits, 5 hours or more per week is ideal.

See a blog post I wrote where I go into more detail on this.

Don’t overdo cardio

When it comes to all of the benefits associated with HIIT, there is one caveat: be careful not to overdo it. More is not better! While HIIT is effective at breaking down fat, it also breaks down muscle (as does too much of any type of cardio). This is not what we want, especially in menopause!

In order to reap the fat-burning benefits while preserving muscle mass, it’s best to limit HIIT sessions to 2 or 3 times a week. Remember also that HIIT burns more calories in a shorter period of time than lower-intensity cardio, so super-long sessions aren’t necessary (or desirable). 20 or 30 minutes is plenty for a HIIT workout!

The importance of recovery

Woman in Blue Tank Top and Shorts Lying Back and Sleeping on a Hammock

As Dr. Stacy Sims mentioned, women in menopause need more recovery time from workouts. Earlier in this blog post, we discussed the hormonal changes that can affect how our body systems work.

Cortisol is often already elevated, and overtraining without adequate rest and recovery can cause the adrenals to produce even more cortisol. This puts the body under more stress, which leads to fatigue, disturbed sleep, loss of muscle tissue, and an increase in body fat (especially belly fat).

So, while it might be tempting to go all-out on workouts to try to accelerate weight loss, this tactic could backfire, with exactly the opposite effect.

Here are some recovery tips to keep in mind:

  • Get enough sleep
  • Allow 48 hours between strength workouts; or, target different muscle groups on alternate days
  • Don’t overdo exercise, especially cardio
  • Stay properly hydrated
  • Make stretching and mobility exercises a regular part of your routine
  • Listen to your body: If you’re tired, rest!

Prioritize protein

As estrogen declines in menopause, the body becomes less effective at metabolizing carbohydrates. This causes insulin to surge, and blood sugars to rise. When this happens on a regular basis, it can lead to metabolic disorders like insulin resistance or diabetes.

Carbs aren’t necessarily the “bad guy” in menopause, but we need to become more aware of the types of carbs, and also the amounts, we are consuming. We might not be eating lots of processed carbs, but even complex carbs like whole grains and beans can be a problem if consumed in excess.

It’s really not necessary to completely cut out carbs and go full-on keto or paleo (unless advised to do so by your health care provider). But because carbs aren’t as easily metabolized anymore, it’s a good idea to let protein take center stage at every meal, along with healthy fats.


It can be frustrating when you’re working out and eating healthy like you’ve always done, but you’re not getting the same results. Maybe you’ve also experienced a change in your athletic performance. Believe me, I too have experienced this frustration!

But by understanding the processes going on behind the scenes, we can have a better idea of why these things are happening. Being more informed enables us to work with our body in menopause, instead of against it.

I’ve been implementing these changes in my own fitness and nutrition. I’m lifting heavier weights and doing shorter, but more intense cardio sessions (HIIT). By getting enough sleep and rest, and also prioritizing protein in my diet, I’m ensuring that my body gets the recovery and fuel it needs to keep building muscle, and burning belly fat.

Menopause can be a challenging time of life. But with a few changes to our daily routine, we can continue to enjoy being healthy and fit for many more years to come!

Please feel free to ask questions or leave a comment below.

What kind of challenges have you encountered as you navigate the menopause transition? Have you adopted a new strategy for your fitness and nutrition? If so, please share what has/hasn’t worked for you.

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