It could be perimenopause, the period before the cessation of your menstruation, says nurse practitioner Daniela Ezratty, MSN, ACNP-BC, of Ezratty Integrative Aesthetics in Atlanta, where she treats many women of perimenopausal age. Usually, this starts somewhere around age 40, but it can come as early as 35 for some. “Perimenopause is when there’s a drop in estrogen and progesterone, but you’re still getting your period,” she says. Once you’ve stopped having a period for a full year, then you’ve officially entered menopause.
- Daniela Ezratty, MSN, ACNP-BC, nurse practitioner and founder of Ezratty Integrative Aesthetics
- Janet Huehls, MS, clinical exercise physiologist and founder of Exercising Well
The changes in your body that come along with perimenopause can be frustrating, and you might be tempted to counteract the symptoms with exercise. But what’s happening on a biological level can’t be controlled by defaulting to the same workouts you might have done in your 20s or early 30s.
“In perimenopause and menopause, we lose muscle mass twice as fast as any other time in our life,” says Janet Huehls, a clinical exercise physiologist in Paxton, Massachusetts. “It doesn’t show up on the scale, or in the way that we are moving right away. It’s happening behind the scenes.” But you might feel not as strong as you once did or maybe your body just seems a little more unsteady. Understandably, this can lead to a lot of worry and stress, says Huehls.
Fortunately, there are ways to use working out to your advantage, if you take the right approach.
Reset your expectations
The late 30s and early 40s are a time when a lot is often going on in your personal life, points out Huehls. You might be caring for small children, helping aging parents, or reaching the peak of a career. It can be extremely stressful to balance it all as your body changes.
It might seem intuitive to try to exercise through this transitional phase to help with mental clarity and health. But before you jumpstart a new fitness routine, you’ll want to reset your expectations.
One trap Huehls often sees is that it’s easy to get caught up in the pervasive athletic mindset, which she acknowledges is very appealing. “We think that If I push harder, I’ll go faster, I’ll get better results because that works in other areas of life,” she says. But it doesn’t apply here. “You’ve got all these demands on your time, and the mindset of ‘more is better’ is stressful. The stress state is a real problem,” Huehls says.
Stress can raise cortisol levels, which can impact estrogen and progesterone. “The symptoms of hormonal changes during perimenopause are stress-producing. It can be a vicious cycle,” she says. Instead of working out harder, which can keep increasing those stress levels, Huehls suggests listening to your body: “Give your body what it needs now to function and feel better.”
Huehls says perimenopause is an important inflection point, offering an opportunity to step back and ask how you can work out smarter. “Perimenopause is the right time to say, ‘Hold on, I need a reset. What do I need right now? What do I need going forward? And how can I make this not stressful?” she says.
While everyone needs to be mindful of their stress state—Huehls points out that chronic stress is linked to all our major health concerns—this is especially true in perimenopause when hormones are out of whack and our bodies can’t recover the way they used to. “In the physiologic state of stress, energy goes into fighting, fleeing, or freezing, which means less energy into healing, growth, and learning needed to thrive,” she says.
Rely on functional strength training
The best exercise to do in perimenopause is functional strength training with heavy weights—moves that will help you perform everyday activities better. “As we age, we need good functional strength exercises that are challenging muscles to build up those muscle fibers,” says Huehls.
If we stick to low-intensity cardio and light weights because we’re scared of “bulking up,” then we’re only using a small portion of muscle fibers. “The ones you’re not using go into hibernation, and there’s the muscle loss,” she says. But she is quick to point out that phrase is somewhat of a misnomer. “There’s muscle fiber still there, and I think that’s a really important point of hope,” she says. “Those muscles can be reactivated.”
Huehls says to focus on functional exercises that go through the basic movement patterns of everyday life: pushing forward, pulling back, lifting overhead, pulling down. Do some exercises with both legs on the ground, and some with one leg on the ground. And build towards a challenging second and third set to make sure you’re gaining strength.
"Give your body what it needs now to function and feel better." —Janet Huehls, MS
If you can combine strength training, stamina training, and mobility work into one exercise or workout, then you’re golden, says Huehls. “The key is balance and not straining your body.”
Change your mindset on cardio
Huehls says that cardiovascular exercise should have a goal of improving and maintaining stamina, and shouldn’t be based solely on heart rate. “Lasting energy is something we need in this phase of our life,” she says. “The proper cardio can make the heart muscle stronger, but it can also make the whole system more efficient at creating lasting energy.”
What that cardio looks like for you depends on your body and preferences, but it’s likely that super high-intensity workouts are contributing to stress rather than counteracting it. Ezratty says that workouts like HIIT exercises or boot camp classes can stress out the body during perimenopause: “Your cortisol levels are rising, you’re increasing inflammation, and you’re increasing hunger drive,” all of which will be counteractive if your goal is to get stronger or maintain your weight. While this is true even for younger women, Ezratty points out that those in their 20s and 30s have more tolerance because they have more optimal hormone levels. “It’s the decrease in our hormones that makes the cortisol so nasty for us in perimenopause into menopause,” she says.
Instead, cardio that doesn’t stress you out and includes a mindfulness element and joy can be more effective. “Perimenopause is entering a stage of chaos, and mindfulness is a perfect pair with exercise, rather than trying to distract yourself with exercise,” says Huehls. She suggests combining something you enjoy, like talking to a friend or listening to a podcast, with your stamina training.
As for what not to do, Huehls is very clear: Avoid anything that feels stressful. “Whether it’s stressful because you don’t have time to do it, you’re worried about injury or it just doesn’t feel good—don’t do it. Anything you do for your health that puts you in a stress state is not helping you in the end and can contribute to perimenopausal symptoms,” she says. “When we stop thinking about it as a workout that has to be hard and stressful, we can use exercise as the way to tell our cells we want to be well.”
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