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Exercise Needs in Perimenopause Are Different than Postmenopause

Perimenopause should not be treated the same as Postmenopause

There is a lot of misconception about exercise and weight loss, especially among women, and even more in menopause. The exercise Guidelines in adults are 150 minutes of at least low to moderate-intensity activity per week. I've heard from nutritionists and fitness experts and read some research recently about the benefits of high-intensity interval training (HIIT) exercise, for 75 min per week for weight loss (this, and this). This is supposed to help with visceral (abdominal) fat loss and strengthen metabolic flexibility (ability to burn fat as fuel), which women lose as we age and produce less sex hormones. But I note that that research was in post-menopausal women, i.e., women who no longer have any periods (their estrogen and progesterone and testosterone levels are low).

I have a theory, which is that in perimenopause (transition to menopause - you still have periods but they are starting to change), it's a different story, and doing a lot of high-intensity exercise might actually be counter-productive to losing weight (and other common symptoms during this period like sleep disturbances, low mood, fatigue, hot flushes, etc.).

There is limited research in perimenopause and particularly when it comes to exercise. [Most studies tend to separate women in pre-menopause vs post-menopause, without differentiating this very important decade of hormone transitioning to menopause.] But what we know from the research is that our bodies need progesterone to counter the effects of estrogen. During perimenopause, we get super high levels of estrogen, but lower levels of progesterone (this is called estrogen dominance). Our ovaries stop releasing eggs, and the egg release is what prompts progesterone release in the second half of our cycle. When that doesn’t happen, high estrogen levels go unchecked, and this is why women may experience heavier bleeding and longer periods, anxiety, brain fog, sleep difficulties, weight gain, hot flushes, etc. A recent study even demonstrated that perimenopausal women administered a small dose of progesterone saw better improvements in vasomotor symptoms (hot flushes) than those administered estradiol (estrogen), which is the hormonal treatment of choice for postmenopausal women (up to 10 years post) experiencing hot flushes.

Research shows that low progesterone-high estrogen equates lower stress resilience (here, and here). You may be experiencing this as general fatigue and trouble sleeping, low motivation or mood, and slower recovery from exercise. This has happened to me since the past 2 years. This is because as our ovaries produce less progesterone, our adrenal glands (located above the kidneys) become the dominant supplier of progesterone in our body (as well as estrogen and testosterone). BUT, the adrenals are already responsible for our stress hormones: cortisol, epinephrine and adrenaline. So, when we are stressed, we produce less progesterone, and lower progesterone means worse perimenopause symptoms, and also more stress. It’s a vicious cycle.

What does this have to do with exercise? Isn’t exercise supposed to be a stress reliever? Well, sometimes yes and sometimes no. It depends on the health of your adrenals and your cortisol response. Higher intensity exercise releases more cortisol, and then over time, if your adrenals and cortisol response are healthy, your cortisol levels go down to below baseline, and eventually back to baseline. But, if your cortisol levels are already elevated or too low, then high-intensity exercise is harder to recover from, and your cortisol levels may not go back down for a long time. This is why during perimenopause many women may feel more fatigue and may notice longer recovery periods after exercise, especially high-intensity exercise like endurance sports or short-rest circuits of resistance training.

So, the priority then during perimenopause is to manage, and reduce, cortisol levels, to optimize your progesterone production. But resistance training is also recommended to prevent or slow down muscle and bone deterioration due to loss of hormones, and HIIT also has its place in improving metabolic fitness. So, it's about finding the right balance between them for your body.

I think that replacing some high-intensity exercise with low to moderate intensity exercise that also includes resistance training may actually be more beneficial to weight loss and general quality of life (including sleep) than doing 3 sessions of high-intensity interval training per week, as per recommendations for post-menopausal women. This is also what several integrative health experts already believe and practice (here, here, and here).

So if you’ve been trying to lose weight, and you’re in perimenopause (your cycles haven’t completely stopped yet), and you’re doing a lot of high-intensity exercise or high-intensity interval training to lose weight, maybe you're feeling wired but tired or just simply tired all the time, and your sleep is off: you may want to change your strategy and aim for less high-intensity and more low-moderate exercise including resistance training, to lower your cortisol response. This could be as simple as taking longer breaks between your exercises in a weight lifting session, or splitting your typical 1-hr workout over 2 days of 30min each, or having a day of strictly weight lifting with core, and another day of more stretching or mobility exercises instead of more intense core work. I've had some success implementing both of these strategies. Aerobic exercise (e.g. cardio) is also more cortisol-producing than anaerobic exercise (weight training), so you could also swap out 1-2 sessions of running or other cardio per week to an additional resistance training session. Mostly, it's about listening to your body and not overdoing it.

It also becomes more important to actively do things to reduce your stress/cortisol even when not exercising, like breathing, meditating or being mindful, tapping (EFT), slow mindful exercise like yoga, tai-qi or qi-gong, working with a coach or therapist, taking natural therapies for your adrenal health (guided by your nutritionist, naturopathic doctor or herbalist), etc.

One thing I’ve done to optimize exercise for my perimenopause and my clients' is to marry the two: resistance training and mindfulness integrated into the same workout. We do several body scans in between strength circuits to counter cortisol increase, as well as to optimize our neuromuscular response to the loads by paying attention to changes happening in our body. So the training is less taxing, but still effective.

My rates are going up in January, so grab your 1-month or 3-month pass while still at the discounted rates! We meet on Wednesdays 5:30 and 6:45 at 250 City Centre (suite 304), or you can join from home or catch the replay if you can’t make it then.

I've got a refer a friend program where if one of your friends buys a 3-month pass, you get 1 month free.

I just signed up for 2 Girls Gone Strong Certifications: Women Coaching Specialist Level 1, and Menopause Coaching Certification. I am still learning about unique exercise needs in women and specifically in perimenopause, so bear with me as I make sense of it all and share what I am learning! I hope this is helpful to you. Leave me a comment if you have any questions that you'd like me to explore and talk about.

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