How Perimenopause changed my workouts

Are you a female between the ages of 35 and 55?

What about a female over the age of 55?

If so, or if you know one, read on!

Any movement is better than no movement. So, if you haven't been exercising and would like to, just start moving however it feels good to you. But, unfortunately, the way we move at different ages can make a big difference in our health.

My advice to females:

Kids to late 30s: Do whatever makes you happy! Movement is key. Sports, play, running, you name it.

Late 30s to 50: If your body continues to feel good with how you are moving - keep it up! BUT, make sure to add in some heavier weight lifting to the mix. If your body is not responding to your typical workouts, read on!

50s and above: Keep moving! But make sure to add in specifics for bone health (10 min of impact activity at least 3x/week), as well as heavier weight lifting.

Perimenopause basically describes the time period where our hormones start to change, in particular, both estrogen and progesterone (along with quite a few others), leading up to one event which we have termed "Menopause." It's kind of an odd term, as it is defined by 1 day, when really this is a process that continues to evolve. Menopause is characterized by 12 straight months without a menstrual cycle. On that day, you all of a sudden become "post-menopausal." I think we are starting to do a better job of educating people that the years leading up to this event, as well as the years following are just as important as "that day." And how we treat our bodies are equally important during these times.

During Perimenopause, as our Estrogen receptors start to decline, it affects nearly all our organs, but some of the most common complaints include:

• Brain Fog

• Vasomotor changes (hot flashes, night sweats, etc)

• Tendon and joint pain

• Weight gain - and in particular, visceral, or stomach fat accumulation

• Cardiovascular changes

• Vaginal changes

• Bone loss

• Muscle loss

• Mental health challenges (well, no kidding with all the above issues!)

This blog is not about Hormone Replacement Therapy (HRT), as that is outside the scope of my practice, but I do want to make it very clear - just as we treat other disease processes and changes in our bodies, we can treat this as well. HRT is not for everyone, nor does everyone need it. There are many ways to treat all of the above conservatively, but the only thing that actually replaces the loss of these hormones is HRT. If you are experiencing ANY of the above symptoms, or really any other new symptoms and fall into that age category, I strongly encourage you to have a conversation with your health care provider. If they are not willing to discuss HRT with you, please get a second option! That said, we will be focusing on the conservative measures you can take, and in particular, exercise!

Everyone’s experience is different, but for me, things started to shift in my early 40s. I began to notice that my typical go-to strategies for dropping a few pounds were no longer working. In the past, I could slightly reduce my calorie intake, add a few longer runs or bike rides, and the weight would come off. But suddenly, that approach stopped working. In fact, it seemed like the opposite was happening—I was gaining weight despite doing more long, steady cardio.

Naturally, I assumed I must be eating more. So I cut back. Still nothing changed.

Around that same time, I also started noticing more aches and pains. Now, I know that’s not unusual with aging and isn’t unique to middle-aged women. But as a physical therapist, I’m used to treating these issues, and what was incredibly frustrating was that these injuries were not responding to the usual treatments that typically work for both my patients and myself. By my mid-40s, I developed an excruciating case of plantar fasciitis. It didn’t respond to the treatments I normally use with patients, and it didn’t improve with rest. It was just…there. Constantly.

On top of that, I have a strong family history of Alzheimer’s disease, and around this time I started to worry that something more serious might be happening. I struggled to remember simple, everyday words. My word recall was terrible, and brain fog was interfering with both my work and social life. Add night sweats and poor sleep to the mix, and I was a mess.

At that point, I decided to start learning everything I could about perimenopause, post-menopause, and exercise during this stage of life. I took every continuing education course I could find on the topic. I spent nights (since I wasn’t sleeping anyway), weekends, and every spare moment researching.

As I learned more, I began shifting my exercise routine.

Gradually, most of my symptoms improved—everything except that stubborn plantar fasciitis.

I replaced my longer, steady cardio sessions with more interval-based workouts, eventually transitioning to SIT (Sprint Interval Training) bike sessions. I reduced my cardio from five days per week to about two, but increased my strength training to four or five days per week. I also increased the weight and overall load I was lifting.

When I could tolerate it, I tried to walk more (though the plantar fasciitis often got in the way). I also prioritized yoga and stretching, not only to help my aging body move better, but also to help calm my nervous system.

Over time, my sleep improved. My brain fog wasn’t completely gone, but it was significantly better. My mood improved, and after watching the scale slowly climb for months, I finally began to lose a few pounds again.

Eventually, I also started HRT, and many of these improvements became even more noticeable. And that stubborn plantar fasciitis? It finally went away! At least until recently, when I started adding more plyometric exercises back into my routine. It’s always a journey.

There’s no such thing as a “perfect” exercise routine for an entire group of people. Everyone is unique, and your exercise routine should reflect that. However, there are several key principles we can focus on, not only to reduce some of the symptoms discussed above, but also to help prevent conditions such as cardiovascular disease and osteoporosis.

The challenge with these conditions is that they often develop silently. You may not experience symptoms until they become a much bigger problem—and let me tell you, they are far more difficult to treat once they reach that point.

The suggestions below focus on minimizing these risks, particularly as estrogen levels decline and our risk for these conditions increases.

Benefits of exercise with menopause

• Exercise can help reduce hot flashes and other side effects of menopause, decreases

risk of osteoporosis, cardiovascular disease, sleep disturbances, improves mood and

quality of life, helps with changes in body composition, can help with mental clarity,

and improves strength, power and balance as this naturally declines, and can even

help regain bone loss.

• 4 big ones we will focus on are muscle loss, mental health, cardiovascular disease,

and bone health.

1. SARCOPENIA:

The term sarcopenia refers to the loss of skeletal muscle mass and strength that

generally occurs during aging (from the age of 50); in individuals aged 60–70, a

prevalence of about 5–13% has been estimated, which increases to 11–50%

after the age of 80.

The interventions that have proved most effective in reducing the severity and

preventing the worsening of sarcopenia include physical exercise, especially

resistance, and the administration of dietary supplements in association with a

targeted diet. Among the various nutrients, high biological value proteins and

leucine are of particular interest for their demonstrated effects on the health of

skeletal muscle (4). The intake of food containing protein during meals stimulates

muscle protein synthesis, with a peak about 2–3 h after ingestion (5). The

international guidelines recommended that a leucine intake of 3 g at three main

meals together with 25–30 g of protein is the goal to be achieved to counteract

loss of lean mass in elderly (8).

Resistance training can be helpful to control insulin levels, decrease cholesterol,

and thus, weight loss as well as improved strength and function!

2. MENTAL HEALTH:

The hormone changes during perimenopause happen because we start to have

a critical egg supply (you are born with all your eggs and they start to run out).

This sends a message that we need more hormones to get the egg to drop, so

then we get a high surge of estradiol, FSH (follicle stimulating hormone), and it

causes hormone chaos. Your brain is asking for more, then you get too much,

and then crash low again. It’s up and down and all over the place. So it is very

common to feel EVERYTHING, especially irritated. Some forms of exercise (high

intensity, as well as heavy lifting) can help to regulate these hormone changes a

little better.

• Sleep changes also affect our mental health: 40-56% post menopause women have

sleep issues, 46% aged 40-54 yo, and 48% aged 55-65

• Common reasons are: restless leg syndrome, sleep apnea, insomnia

• Why does this happen?• Decrease estrogen: decreased uptake and production of mg-muscle cramps, hot flashes

• Decreased progesterone: decreased ability to fall asleep and to stay asleep

• What can we do?

• Insomnia treatment: Cognitive behavioral therapy, sleep hygiene, high intensity

exercise, yoga, as well as limited evidence: acupuncture, diet, herbs

• Hormone therapy, low dose selective serotonin, serotonin/norepinephrine

reuptake inhibitors, and gabapentin in peri

• Dark chocolate helpful for reduction of depression and cortisol. Milk chocolate

and addition of milk with chocolate decreases benefits - boo!

3. CARDIOVASCULAR DISEASE AND HEALTH:

-Woman have 2-4x risk of cardiac event post menopause mainly because

estrogen is cardio-protective

-Cardiovascular dis (CVD) is leading cause of death in women in US. More

deaths from CVD in women than all forms of cancer combined.

-Cardiac rehab reduces 12-25% mortality in women (Works much better for

women than men-so exercise is even more important for women)

-SIT and HIIT versus moderate intensity training are far superior.

No difference in fat distribution and lipid serum between longer duration

exercise and SIT training, but accomplished in less time with higher intensity

training and greater loss of abdominal and visceral fat

What is SIT?

• SIT stands for Sprint Interval Training. Many have heard of HIIT, which

stands for High Intensity Interval Training. Both are more beneficial during this

time than moderate intensity exercise, but research has shown SIT to be

superior in helping with insulin sensitivity, cardiovascular health, as well as

weight loss/prevention of weight gain, especially through the abdominal area.

• HIIT typically is performed at 30-80% effort at a longer duration of 30-45 min. The

rest periods are shorter, in the effort to keep the heart rate elevated the whole

workout. The effort level is usually around a 6-8/10 range.

• SIT is a true 10/10 effort range. The goal is 100% max effort, with shorter bouts

of 5-30 sec, with longer recoveries of 2-4 minutes. You probably are not

exercising more than 20 minutes or so.

• Fat loss : An analysis of 75 studies comparing steady state cardio, HIIT, and

SIT found that sprint interval training SIT decreased body fat percentage

91.83% more than steady state cardio and 39.95% more than HIIT. (https://

runrepeat.com/sprint-interval-training)

• Time efficient: It’s not always easy to get the workout in. The great thing about

SIT is it’s fast! When analyzing SIT vs HIIT, it was found that those who did SIT

exercised for 60.84% less time than HIIT and 71.17% less than steady state

cardio, but reaped the same benefits. Which means, you get even better

results in a shorter time.• Inexpensive: You can do this anywhere. Other options if you can’t run are the

pool, bike, elliptical

• Build muscle and endurance: Sprinting works some of the same fast twitch

muscle fiber types as heavy lifting. This develops power and speed. (https://

www.ncbi.nlm.nih.gov/pmc/articles/PMC5839711/)

4. BONE HEALTH:

Osteoporosis: Imbalance between bone resorption and bone formation.

Metabolism of hormones and mechanical stressors play a role, Causes low bone

mass and micro-architectural deterioration (reduced density)

• 90% of women bone mass achieved by 16-18 yo

• 60-80% genetically determined

• 50% of Americans over 50, at risk for osteoporotic fracture

• 10-12% bone loss during transition to menopause secondary to estrogen decrease,

then rapid loss 1 year prior, and then .5-1.5% each year following

• DEXA scan to determine (-2.5 or below) - recommended for over 65, but really, if

you have a light frame, or other pre-determined issues consider speaking to your

physician to perform earlier:

• Soda, alcohol >3/day, tobacco, sedentary lifestyle, heavy metals-lead exposure,

endurance training that causes amenorrhea, vit D deficient, poor nutrition

• Calcium paired with Via D when possible, do not exceed 500-600mg/day - overdose

can lead to kidney stones and some studies show cardiovascular disease, and not

all at once.

The take away...if you are a female entering into Perimenopause, or beyond, make sure to add strength training into the mix. If possible, slowly increase that to heavier, larger compound lifts. Consider transitioning steady cardio to more interval-based training, and eventually, to SIT. And try and incorporate impact activity for bone health at least 3x/week. If you want more guidance on any of this, reach out! I am happy to work with you one-on-one, coaching, or even remote coaching.

~Alicia, your PT and Wellness Coach