Get stronger & better: hormonal changes for women in their middle years & beyond

Get stronger & better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Apr 28, 2023 | Carolyn Surgent, DPT

Get stronger & better: hormonal changes for women in their middle years & beyond

Get Stronger & Better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While they will likely hear about hot flashes or possible changes in body composition or sleep, they might not have all the information they need to help prepare for and normalize this important transition. Given the limited education most healthcare providers receive on these topics, it’s no wonder women are underinformed. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Perimenopause & Menopause Defined

First, remember that while perimenopause & menopause may unfold a little differently for everyone, it’s a normal biological process. Specifically, perimenopause refers to the years leading up to menopause, beginning as early as 35 with changes in menstrual cycle and hormones. Menopause is marked by a full year without a period, but women will experience the effects of tapering hormones for some time to follow. If average life expectancy for women in the United States hovers in the early 80s, you can expect to live 40% of your life in the post-menopausal stage.

Common Symptoms

While the list of symptoms associated with menopause can be overwhelming, there’s plenty to do to feel and perform your best. A partial list includes: hot flashes, changes in body composition or weight gain, vaginal dryness and/or pain, fatigue, joint and/or muscle pain, brain fog, mood changes, irritability or anxiety, sleep disruptions or sleeplessness, and heart palpitations.

What you can do

First and foremost, get educated and find professionals to help optimize your health & performance. In short: hit play, not pause!

  • Stay active – There’s a great deal of research supporting the benefits of staying active through the lifespan. Specifically, activity can help limit risk of cardiovascular disease, support stable blood glucose levels and protect against sarcopenia (muscle loss) and decreased oxygen consumption (VO2max) typically associated with normal aging.
  • Strength Train – Research shows that lean mass declines as fat mass increases in the five years leading up to menopause and five years post menopause. Women may notice the changes in their body composition and weight with alarm and double down on cardio or light resistance training out of concern for “bulking up.” On the contrary, strength training is the best plan for limiting these changes and holding on to muscle essential to feeling good, performing well and living better. Did you know that having more muscle mass is correlated with living longer? Moreover, strength training can provide stimulation for ligaments and other soft tissues that may be impacted by lower levels of estrogen.
  • Keep tabs on stability, mobility & core strengthening – While the need to stay strong through the middle years is incontrovertible, good stability, mobility and a strong core will provide the foundation for any strength training program and overall better function. A stable body can move quickly and accommodate the demands of a changing environment. Having good mobility can insure you can move in ways you want with less risk for injury or imbalance.
  • Improve/maintain pelvic floor function – Hormonal changes and shifting core strength can impact the tone and function of your pelvic floor musculature, increasing risk for incontinence and pain during sex. Discussion of symptoms with a trained provider along with assessment and appropriate treatment can improve function and quality of life.
  • Pay attention to sleep & recovery – Women who are already active may notice some lag in their performance or motivation to exercise consistently at the same intensity through perimenopause and menopause. Simply put, adjusting the types and frequency of key workouts through the week and allowing appropriate recovery becomes more important. Defending your sleep with use of good sleep habits and hygiene may mitigate the effects of hormones on getting quality rest.
  • Defend bone density – Did you know that, according to the National Institute of Health, nearly one in two women over the age of 50 will sustain a bone fracture? And did you know that despite participating in protective weight bearing and higher impact activities, women might still see a decline in bone density for the first five years after menopause? Strength training, weight bearing activities and even plyometrics (as appropriate) should be an important consideration in choosing activities to keep vital in your middle years and beyond.
  • Optimize nutrition & hydration – While many women may turn to calorie restriction or intermittent fasting in an attempt to control weight and body composition changes, these may not work. Ensuring appropriate energy availability to support daily activity, maintain thyroid function and protect overall metabolic health is essential. A licensed nutritionist can help guide the way.
    Review your blood panel with a healthcare provider – Your bloodwork can provide essential information about your health through perimenopause and menopause. Reviewing your lipid profile can provide a window into your cardiovascular health; blood glucose levels can indicate your metabolic health and inflammatory markers can indicate levels of systemic inflammation impacting how you feel and function.
  • Understand common interventions including hormone replacement therapy (HRT) – A great deal of research has been done debunking the findings of the Women’s Health Initiative study in the early 1990s, which overstated the risks of hormone replacement therapy in healthy women. Your healthcare provider can provide more information about the possible benefits of HRT.

Takeaway Message

Getting educated and finding the right support can help you function, perform and feel better in perimenopause, menopause and beyond. From trainers, physical therapists, pelvic floor specialists, performance coaches to nutritionists, the professionals at Performance can help.


Body composition and cardiometabolic health across the menopause transition (

Figure - PMC (

Changes in body composition and weight during the menopause transition - PubMed (

Muscle mass index as a predictor of longevity in older adults - PubMed (

Next Level: Your Guide to Kicking Ass, Feeling Great & Crushing Goals Through Menopause & Beyond by Stacy Sims with Selene Yeager

Carolyn Surgent

Carolyn Surgent,

Carolyn Surgent, PT, DPT, FDN, is a physical therapist and certified dry needling specialist based in Greenwich. She is a mover by nature and loves to explore how the body works and moves.

Meet Carolyn