Personal, Family & Health Awareness17 min read

Perimenopause, Phase by Phase: What Changes and What Actually Helps

By Shiva Malhotra

Barefoot Protocol

Evidence-based health, movement & longevity

Published: 12 August 2026, 10:20 AM AEST

Last updated: 12 August 2026, 10:20 AM AEST

Quick answer

In perimenopause, falling oestrogen ends roughly four decades of automatic protection. Muscle loss accelerates, bone thins fastest in the window from about twelve months before your last period until two or three years past it, fat relocates from hips to abdomen, and sleep, mood and temperature control turn unreliable. Progressive strength training and enough protein push back hardest on the physical changes.

The part nobody tells you at the start

A disclosure first, because you’re owed it up front. I’m male. This is not my lived experience and I won’t dress it up as one. So I’ve drawn a hard boundary through this article: everything medical gets signposted to your doctor, every time, without hedging. What sits squarely inside my competence is helping adults over 30 build strength — and strength happens to be one of the very few things that measurably changes this picture. Most women are never told that, and they are rightly annoyed when they find out.

One frame does most of the work here.

Think of it as unpaid maintenance. For roughly forty years a set of jobs got done on your body without anyone invoicing you or even mentioning them: skeleton kept dense, muscle kept on the payroll, fat filed away to hips and thighs rather than the abdomen, heart and sleep and internal thermostat all quietly serviced. Oestrogen underwrote a large share of that arrangement.

Perimenopause is when the arrangement lapses. Nothing steps in to replace it. The maintenance still has to happen, and from this point on it happens deliberately or it doesn’t happen at all. That lands badly for about ten seconds and then stops being bad news, because maintenance you can’t see is the only kind you can’t schedule.

So let’s be blunt about the arms that feel weaker, the thickening middle, the 3am wakefulness and the temper that doesn’t sound like yours. None of that is a discipline problem, and none of it is invented. Researchers have measured, named and dated the whole sequence — you’ll see the dates in a minute. “It’s just your age” isn’t an explanation. It’s a shrug.

The three words, in the right order

People use these interchangeably. They are not the same thing.

Perimenopause is a span of years, not an event. Hormone levels lurch about instead of holding steady, periods lose their pattern, and the symptoms arrive. For most women it opens somewhere in the first half of their forties — earlier for some — and several years is entirely normal. Here’s the counter-intuitive bit: this is the noisiest part of the whole thing. It’s the swinging that causes the trouble, not the lower level you eventually settle at.

Menopause is not a span at all. It’s a single date, and you can only identify it looking backwards — the day you complete twelve months without a period.

Post-menopause is every day after that date.

One more thing, because it saves a great deal of frustration in a waiting room. Perimenopause is usually not confirmed by a blood test. The hormone measurement most women expect to be offered fluctuates too wildly during this phase to settle anything, so what a doctor works from instead is the shape of your symptoms and the way your cycle has changed. If bloods aren’t the first thing suggested, read that as competence rather than dismissal. Your doctor will also be checking that something else isn’t producing a near-identical picture — a sluggish thyroid and low iron will both do it convincingly. That last part is exactly why this belongs in a consulting room rather than a search bar.

The timeline: what shifts, and roughly when

One reframe does more work here than anything else. Stop measuring this transition against your age and start measuring it against your final period. The large cohort studies are built that way, because that is where the biology actually clusters. Two women born in the same month can be sitting in entirely different phases.

Phase	Roughly when	What is happening underneath	What to start now
1. The wobble	Often the first half of the forties; several years long	Hormones swing rather than fall smoothly. Cycles change. Sleep starts breaking. Shape begins reorganising before the scale explains it. Mood and concentration turn unreliable.	Start lifting. This is the cheapest phase to build in, and the muscle and bone you bank here is your buffer for phase 2.
2. The steep window	From ~12 months ahead of your last period until 2–3 years past it	The fastest bone loss of your life. [4][5] Lean mass stops rising and turns downward as the transition sets in, while the rate of fat gain roughly doubles. [1] Blood fats track the last period itself rather than simply tracking your age. [8]	Keep training through it, don’t pause. Load the bones. Protein at every meal. Ask for the medical checks that belong to you.
3. The long settle	From roughly 3 years past your last period onwards	Bone loss slows but doesn’t stop. Hot flushes commonly outlast the transition itself. [9] The cardiovascular head start women hold before this transition erodes. [14]	Strength becomes a permanent fixture, not a project. Balance work earns its keep. Standard heart checks matter now.

The most useful finding in that table: SWAN, a large cohort that scanned women’s body composition repeatedly across the transition, caught the moment lean mass changed direction. It had been inching upward for years. As the transition set in it turned and started falling, and the losses ran on until about two years after the final period. [1] Total weight, meanwhile, keeps climbing steadily through mid-life without a menopausal jump — so the scale genuinely under-reports what’s going on. The composition swap is the real event.

The symptom-to-action table

This is the table I’d hand a client at a first session. Four columns: what you notice, what’s driving it in plain words, what actually helps, and what belongs to a doctor.

What you notice	What’s driving it (plain words)	What helps (my lane)	Doctor conversation
Strength quietly leaving — jars, stairs, carrying feel harder	Everyone loses muscle with age. Falling oestrogen puts a foot on the accelerator, because oestrogen appears to help defend muscle strength [2]	Resistance training where the load genuinely climbs across weeks and months, rather than the same easy weight repeated indefinitely [3]	Sudden or one-sided weakness, or weakness with numbness
Bone thinning — usually silent until something breaks	Bone is on oestrogen’s protection list too, and density drops sharply once that support is withdrawn [4][5]	Resistance plus impact loading. A supervised trial raised bone density safely in women whose bone mass was already low [6]	Ask whether a bone-density scan is warranted. If osteoporosis is already on your file, get cleared and supervised before heavy loading
Falls and near-misses	Less muscle, less balance, slower reactions	Among community-dwelling older adults, exercise brings the fall rate down by about a quarter [7]	Dizziness, blackouts, or a fall you can’t account for
A belly appearing that was never there	The quantity of fat added in mid-life is largely an age story. The address it moves to — from hips and thighs to deep abdominal fat — is the menopause story [1][12][13]	Strength training, daily movement, food you can actually keep eating. A severe deficit is the wrong tool here — it spends the muscle you are trying to defend	Interpreting any scan or blood result. That’s theirs, not mine
Blood fats shifting	Cholesterol and related markers move on the clock of your last period rather than on the calendar [8]	The same two things doing double duty: strength work and everyday movement	All of it. Never read your own lipid panel off the internet
Hot flushes and night sweats	Your internal thermostat stops holding a steady setting. The clinical label is vasomotor symptoms, and they run on for years longer than most women are warned [9]	Layering, a cooler bedroom, tracking your triggers. Exercise improves what surrounds the flush — sleep, mood, energy — without proof it turns the flush off [11]	Effective medical treatments for troublesome flushes exist. Whether any suits you depends on your history and your risks — worth discussing with your doctor
Broken sleep, waking unrefreshed	Night sweats fragment sleep, and fragmented sleep amplifies everything else	Defend sleep hard. Expect disruption rather than treating each bad night as failure	Heavy snoring, or someone telling you that you stop breathing overnight. Sleep apnoea gets missed in women of this age far too often, it responds well to treatment, and the tiredness it causes is close to indistinguishable from the hormonal kind
Low mood, irritability, foggy thinking	Fluctuating hormones, plus wrecked sleep, plus the load most women are carrying in their forties anyway	Sleep, strength, and taking something off the plate	Depression risk is recognised to rise across perimenopause, and rises further where there is a previous history [10]. Low mood that is severe, that won’t shift, or that frightens you is not something to grind through
Aches, stiff shoulders, nagging tendons	Tendon and ligament collagen has oestrogen support behind it, and its withdrawal seems to matter [15]	Keep moving, keep loading gradually. General stiffness usually answers to strength	A single joint or shoulder that hurts needs a physiotherapist’s assessment. Hot, swollen or severe needs a doctor
Leaking when you cough or run; dryness or irritation	The pelvic floor loses support, and the tissue in that area is responsive to oestrogen [17]	Muscle training for the pelvic floor is the standard first treatment offered for stress leakage, and the trial evidence is solid — but it needs teaching by someone who can check what you are actually contracting [16]	Get a referral to a women’s-health physiotherapist; an internet routine is not a substitute. Dryness and irritation are treatable — say something [17]

Print that. Take it to your appointment. The fourth column is the part most women are never told exists.

The practical core: strength first, protein second

Everything above narrows to two things I can legitimately coach. They are unglamorous and they are not negotiable.

Lifting things that keep getting heavier

If you want the one intervention with the strongest evidence behind it for keeping and rebuilding muscle and strength across this stage of life, it is resistance training that gets progressively harder. [3] It also loads the bone that’s thinning fastest in the steep window, steadies the balance that stops falls, and improves how your body handles fuel. One habit, five payoffs.

Two corrections before you start.

“Progressive” is the whole word. Three sets of twenty with the same two-kilogram weights, repeated identically for a year, is not resistance training. It is aerobics while holding something. The signal your bones and muscles respond to is a bit more than last time — more weight, or more reps, or better control of the same load. If nothing has moved upward in six weeks, nothing is being asked of you.

A gym is optional. Bodyweight squats. Sit-to-stands out of a dining chair. An inexpensive set of bands. Shopping bags you deliberately make heavier month by month. Every one of those qualifies, provided the load keeps creeping upward. Start light if you must. Start.

And the one that matters most: this is not a men’s activity, and it will not turn you bulky. Visible size is slow and difficult for women to build — it takes years of training aimed at nothing else, and the women who chase it deliberately will tell you so. Lifting instead defends bone, keeps muscle on you, steadies balance, and supports the energy this transition is otherwise quietly draining. Of every myth attached to this stage of life, “lifting is unfeminine” carries the highest price tag, because whoever believes it opts out of the best-evidenced option before she has considered it.

From the coaching floor
She came to me in her late thirties with a profile that looked, on paper, like someone already doing the right things. Walking most days. A gentle yoga practice. Careful about food, though her protein was thin. What she couldn’t explain was the feeling that had crept in as forty came into view — that she’d turned breakable. Her lower back, her core, her joints all felt like they might give way on her.
The programme we started with would not impress anyone. Three sessions a week. One pushing movement, one pulling movement, something for the legs. Body weight only. No equipment, no cleverness.
Around the nine-month mark she found the words for what had shifted. Stairs had stopped being a calculation. She could pick things up and carry them without planning her route around the weight. She’d also started cycling, for no reason beyond enjoying it. Nothing got dropped — the walking and the yoga are still in her week. Her own summary was that strength had made her feel complete. That word has stayed with me, because years of doing everything else right had never produced it.

Giving your body something to build with

Strength training is the instruction. Protein is the raw material. Sending one without the other wastes both.

There’s a specific wrinkle that makes this more urgent, not less, as you get older. Ageing muscle hears the protein signal less clearly. The technical name is anabolic resistance; the practical meaning is that an identical meal produces a smaller building response than it did fifteen years ago. So the amount that carried you comfortably through your thirties can quietly stop being enough at precisely the moment muscle starts leaving.

I’m not going to hand you a gram target here, because the right number depends on your size, your training and your health, and because I’ve written about the amounts elsewhere. What I will give you is the shape that most often goes wrong: almost no protein at breakfast, something light at lunch, then the bulk of the day’s protein arriving at dinner. That pattern leaves the longest and busiest stretch of your day with nothing to build from. Spread it across every meal instead.

If your eating is very grain-heavy, or it has drifted lighter over the years without you noticing, an hour with a dietitian is one of the better things you can spend money on.

Your first eight weeks

Not a thirty-day protocol. Not punishment. This is the whole of it.

Three strength sessions a week. A push, a pull, and something for the legs. Thirty minutes is plenty at the start.
Write down what you lifted. Weight, reps, how it felt. You can’t progress what you don’t record.
Add something every week. A kilogram, a rep, or one more set. Small and boring beats heroic and abandoned.
Put a protein source in every meal, starting with the one you currently skip.
Add weight-bearing or gentle impact if you’re cleared for it — brisk walking, stairs, light hopping. Bone answers to being loaded, not to being rested.
Protect the sleep you can control. Cool room, dark, consistent wake time. Expect this phase to test it.
Take something off your plate. The load most women carry through their forties is not imaginary, and it shows up in the physical picture.
Book the appointment. Ask which checks are appropriate for you now, and use the word “perimenopause” rather than talking around it.

Eight weeks of that beats any supplement you’ll be sold this year.

What is not worth your money

I’d rather be blunt than polite here.

Anything sold as a cure for hot flushes. A Cochrane review of exercise for hot flushes and night sweats found the evidence insufficient to show it treats the flush itself. [11] That is exercise — the thing I recommend all day long. If exercise can’t claim it, a tea certainly can’t. So treat the word cure on any label — training plan, powder, herbal blend — as a claim the evidence does not currently support.

Crash diets. You’re in a phase where muscle is already walking out the door. A severe deficit speeds that up. You end up with a smaller version of a weaker body, and then it comes back.

“Burn off the menopause belly” programmes. The move to your middle is hormonal, not a penalty for laziness. Measure this transition by what you can lift, how you feel at four in the afternoon, and what your doctor’s checks say. The mirror is the least trustworthy instrument in the house. The scale is the second.

Most menopause supplements. What evidence exists is thin, inconsistent, or both — and no supplement stands in for medical care. Even calcium and vitamin D deserve a conversation with a doctor or dietitian before you start them — the amount is a clinical decision, not a comment-section one.

Self-tracker

Eight-week progression log

Enter the weight in kilograms (or reps, for bodyweight movements) you managed each week for a push, a pull and a legs movement. The log compares each week against your last entry and tells you whether the load is moving.

Movement	Wk 1	Wk 2	Wk 3	Wk 4	Wk 5	Wk 6	Wk 7	Wk 8	Trend
Push
Pull
Legs

Nothing you type here is stored or sent anywhere — the grid resets when you leave the page. Copy your numbers into a notebook if you want to keep them.

When to see a doctor

Nearly everything on this page is an ordinary transition, and the training and food side of it genuinely belongs to you. A handful of things do not, and I’d far rather you turned up early and were told it was nothing. Bleeding after menopause is the first of them: twelve months with no period followed by any bleeding at all needs a prompt appointment, never a wait-and-see. So does bleeding that turns very heavy or drags on, bleeding between periods, or a pattern that changes abruptly. Symptoms arriving before about forty need assessing rather than absorbing. Anxiety, hopelessness or a flatness that is severe, that won’t shift, or that has arrived from nowhere is not something to grind through — and if you ever feel unsafe, please treat that as urgent and contact a doctor or a crisis line straight away. A breast lump you haven’t had before, or weight dropping off without explanation, needs checking. And treat chest pressure, chest pain, breathlessness that doesn’t match the effort, or palpitations as an emergency. Worth knowing on that last one: chest pain is still the most common warning sign of a heart attack for women, as it is for men, but women more frequently get additional symptoms alongside it — unusual tiredness, breathlessness, nausea, or pain through the back or jaw. [14] None of that is a fitness problem, and none of it is mine to manage.

Read these next

Why Calcium Alone Won’t Save Your Bones After 30

The bone side in full: why loading beats supplementing, and what actually signals your skeleton to hold on.

The Three Types of Weight Training Most People Confuse

If “progressive resistance training” is a phrase you’ve nodded along to without being sure what it means, start here.

You Aren’t Eating Enough Protein

The amounts and the meal-by-meal spread I deliberately left out of this article.

The Body Composition Trap: BMI, the Scale, and Waist-to-Height

What to measure instead of the scale while your shape reorganises.

Frequently Asked Questions

1.What are the first signs of perimenopause?

Usually a change in your cycle — shorter, longer, heavier, less predictable — alongside sleep that starts fracturing around three in the morning, mood that swings more than it used to, and a shape that reorganises before your weight explains it. Hot flushes and night sweats are common but often arrive later, not first. Most women open this phase in the first half of their forties, some earlier, and symptoms are loudest while hormones are swinging rather than sitting low.

2.How long does perimenopause last?

Several years for most women, with a lot of variation. Menopause is only confirmed twelve months after your last period, so perimenopause covers everything symptomatic before that. Flushes and night sweats in particular outlast the transition: in SWAN, the median run of frequent symptoms was about 7.4 years, with roughly 4.5 of those years falling after the last period. [9] Considerably longer than most women are warned.

3.Why is my belly changing when my weight hasn’t moved much?

Two separate things are happening. A large pooled analysis found the quantity of fat gained in mid-life is driven mainly by age, with menopause contributing far less than most people assume. [13] What menopause changes is the address — hips and thighs to deeper abdominal fat, fairly independently of the scale. [12][13] At the same time lean mass turns downward as the transition sets in. [1] Fat and muscle trade places faster than a single number can report.

4.Does perimenopause actually cause muscle loss?

It accelerates it. Everyone’s muscle declines with age, men included. What this transition adds is speed, because oestrogen appears to help defend muscle strength and it’s on the way out. [2] SWAN’s scan data caught lean mass reversing direction as the menopause transition set in — it had been creeping up, and it began falling, with losses continuing until about two years after the final period. [1] Of everything on this page, this is the one to push back on hardest. Muscle is what strength, balance and an independent eightieth birthday are made of.

5.What is the best exercise during perimenopause?

Progressive strength training, without much competition. Nothing else has evidence this strong for holding onto muscle and strength [3], it loads bone [6], and stronger muscles with better balance mean fewer falls [7]. Add weight-bearing or gentle impact within your ability, and keep walking or cycling for your heart. If you have only ever been pointed towards gentle cardio and yoga, you’ve been handed half the picture — both earn their place in a week, but neither puts the kind of load through bone and muscle that this particular job needs.

6.When is bone loss fastest, and can I do anything about it?

The steepest stretch begins about twelve months ahead of your last period and runs until two or three years past it. [4][5] SWAN measured cumulative losses across the whole transition of roughly ten per cent at the spine and about nine per cent at the hip. [4] Bone answers to being loaded: a supervised trial of heavy resistance plus impact work raised bone density, safely, in post-menopausal women whose bone mass was already low. [6] Whether a bone-density scan is warranted is a question for your doctor.

7.I’ve been told I have osteoporosis. Can I still lift?

That is your doctor’s call, not mine, so take the question to them rather than to a web page. What I can tell you is what the research shows: the trial that improved bone density in women with low bone mass was supervised from start to finish, and the supervision is part of why it was safe. [6] So the order matters — get cleared, then get coached by someone competent, then load. Bone that is never loaded doesn’t hold still while you decide.

8.Will lifting weights make me bulky?

No. Visible size takes years of training aimed at nothing else, and it comes slowly even to the women who chase it on purpose. What strength work actually delivers through this transition is denser bone, retained muscle, steadier balance and better energy and mood. The belief that weights belong to men is the costliest idea attached to this stage of life, because it takes the highest-value option off the table before anyone weighs it up. Hauling, carrying and digging were progressive loading long before anyone sold a gym membership.

9.Do I need more protein during perimenopause?

Very likely. Older muscle answers the protein signal less readily — anabolic resistance is the technical term — so the amount you need holds up or rises at exactly the moment muscle starts leaving. How much depends on your size and your training, so I won’t hand you a number here. The change that helps almost everyone regardless: stop loading it all into dinner and put a protein source in every meal.

10.Does exercise stop hot flushes?

Not reliably, and I won’t tell you otherwise. A Cochrane review of exercise for hot flushes and night sweats found the evidence insufficient to show it treats the flush itself. [11] Exercise helps enormously with everything surrounding the flush — sleep, mood, weight, bone, energy. The treatments that work on the flush directly are medical ones, and whether one suits you depends on your history and risks. That’s a conversation for your doctor.

11.Why am I so tired and foggy in my forties?

Several things stacking. Fluctuating hormones affect mood and concentration directly, night sweats fragment your sleep, and most women in their forties are carrying a heavy load anyway. [9][10] Forgetfulness and losing words mid-sentence are common, real and usually temporary. But if it’s severe, getting steadily worse, or interfering with your work and your day, don’t park it under menopause. Raise it.

12.Is leaking when I cough or run just part of getting older?

It’s common — and no, that isn’t a reason to accept it, because it responds well to treatment. A weakened pelvic floor can follow childbirth and falling oestrogen. Muscle training for the pelvic floor is the standard first treatment for stress leakage and the trial evidence is solid — provided somebody qualified has checked what you are actually contracting. [16] That means booking a women’s-health physiotherapist, not copying a video. Dryness and irritation follow the same rule: treatable, so say something. [17]

References

Every reference below was verified against its primary source — author, year, journal and DOI — before publication.

1.Greendale et al. Changes in body composition and weight during the menopause transition

Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865.

https://doi.org/10.1172/jci.insight.124865

2.Lowe et al. Mechanisms behind estrogen’s beneficial effect on muscle strength in females

Lowe DA, Baltgalvis KA, Greising SM. Mechanisms behind estrogen’s beneficial effect on muscle strength in females. Exercise and Sport Sciences Reviews. 2010;38(2):61–67.

https://doi.org/10.1097/JES.0b013e3181d496bc

3.Beaudart et al. Nutrition and physical activity in the prevention and treatment of sarcopenia

Beaudart C, Dawson A, Shaw SC, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporosis International. 2017;28(6):1817–1833.

https://doi.org/10.1007/s00198-017-3980-9

4.Greendale et al. Bone mineral density loss in relation to the final menstrual period (SWAN)

Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). Journal of Bone and Mineral Research. 2012;27(1):111–118.

https://doi.org/10.1002/jbmr.534

5.Finkelstein et al. Bone mineral density changes during the menopause transition

Finkelstein JS, Brockwell SE, Mehta V, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. Journal of Clinical Endocrinology & Metabolism. 2008;93(3):861–868.

https://doi.org/10.1210/jc.2007-1876

6.Watson et al. High-intensity resistance and impact training and bone density (LIFTMOR trial)

Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research. 2018;33(2):211–220.

https://doi.org/10.1002/jbmr.3284

7.Sherrington et al. Exercise for preventing falls in older people (Cochrane)

Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;1(1):CD012424.

https://doi.org/10.1002/14651858.CD012424.pub2

8.Matthews et al. Cardiovascular risk factors in midlife women: ageing or the menopausal transition?

Matthews KA, Crawford SL, Chae CU, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? Journal of the American College of Cardiology. 2009;54(25):2366–2373.

https://doi.org/10.1016/j.jacc.2009.10.009

9.Avis et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN)

Avis NE, Crawford SL, Greendale G, et al.; Study of Women’s Health Across the Nation (SWAN). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015;175(4):531–539.

https://doi.org/10.1001/jamainternmed.2014.8063

10.Maki et al. Guidelines for the evaluation and treatment of perimenopausal depression

Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069–1085.

https://doi.org/10.1097/GME.0000000000001174

11.Daley et al. Exercise for vasomotor menopausal symptoms (Cochrane)

Daley A, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews. 2014;(11):CD006108.

https://doi.org/10.1002/14651858.CD006108.pub4

12.Lovejoy et al. Increased visceral fat and decreased energy expenditure during the menopausal transition

Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity. 2008;32(6):949–958.

https://doi.org/10.1038/ijo.2008.25

13.Ambikairajah et al. Fat mass changes during menopause: a meta-analysis

Ambikairajah A, Walsh E, Tabatabaei-Jafari H, Cherbuin N. Fat mass changes during menopause: a metaanalysis. American Journal of Obstetrics and Gynecology. 2019;221(5):393–409.e50.

https://doi.org/10.1016/j.ajog.2019.04.023

14.Mehta et al. Acute myocardial infarction in women (AHA scientific statement)

Mehta LS, Beckie TM, DeVon HA, et al.; American Heart Association. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133(9):916–947.

https://doi.org/10.1161/CIR.0000000000000351

15.Hansen et al. Effect of estrogen on tendon collagen synthesis in postmenopausal women

Hansen M, Kongsgaard M, Holm L, et al. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. Journal of Applied Physiology. 2009;106(4):1385–1393.

https://doi.org/10.1152/japplphysiol.90935.2008

16.Dumoulin et al. Pelvic floor muscle training for urinary incontinence in women (Cochrane)

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;10(10):CD005654.

https://doi.org/10.1002/14651858.CD005654.pub4

17.Portman & Gass. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy

Portman DJ, Gass MLS; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063–1068.

https://doi.org/10.1097/GME.0000000000000329

Want strength work built around this stage of life?

I coach adults over 30 through exactly this: progressive strength training and protein habits that defend muscle, bone and energy through perimenopause and beyond, built around a busy week.