Perimenopause, the transitional period before menopause, signals the lessening of estrogen levels in a female’s body. During this phase of life, which in some women can last for years, menopause-like symptoms such as hot flashes or irregular periods start to appear and continue with increasing regularity. Sleep disruption and weight gain sometimes ensue. Exercise and nutrition become a priority to ensure a healthy body, yet many individuals fail to realize its importance. Read on to learn how personal trainers can help clients navigate perimenopause with confidence.
The Science of Perimenopause
Perimenopause and its physiological effects bring about a myriad of undesirable changes. In addition to altered sleep patterns and decreased levels of energy, the loss of lean muscle mass and the redistribution of fat mass in the abdominal region represent two of the most common complaints during this transitional period of life. For many women, the onset of perimenopause symptoms occurs in their late 30’s, with menopause not setting in until 50 years of age.
Since this unique time in a female’s life can represent up to a decade in length, integrating regular strength training programs and cardiovascular exercise can help offset some of bodily changes. We already know that maintaining muscle mass remains even more critical for facilitating bone density, thereby reducing injury risks as we age. Research now indicates that exercise in general can help individuals face the aging process with greater success.
Significant Health Changes
Personal trainers can better help clients work smarter through this phase of life by understanding exactly how perimenopause impacts the body on many levels ~
- Alterations in the musculoskeletal system as a result of lowered levels of circulating estrogen cause a reduction in muscle size as well as its ability to generate force (sarcopenia). This often progresses to the appearance of osteoporosis and/or osteoarthritis.
- Aging causes ligaments and muscle tendons to have reduced biomechanical function.
- Changes in the cardiovascular system, specifically a thickening and stiffening of the cardiac muscle and its accompanying vascular system, diminish blood flow and the exchange of oxygen and nutrients with tissues.
- The nervous system tends to lose neurons, leading to the slowing of nerve signal transmission. This can bring about a dip in cognitive function, and also impairs the ability of the nervous system to repair itself after injury.
- Loss of estrogen can potentially hasten the hallmarks of dementia.
- Low estrogen affects the genitourinary system, causing problems with the urethra, vulva, and vagina, reducing their resilience and exacerbating urinary and sexual symptoms/pelvic floor dysfunction.
The Benefits of Exercise
Even for women unaccustomed to regularly working their bodies, a prudent exercise program during perimenopause typically includes cardiovascular activities, strength training and balance/flexibility practices (yoga, Pilates, T’ai Chi).
Experts suggest aiming for 2.5 hours of moderate aerobic activity per week, due to the following benefits ~
- By increasing cardiorespiratory function, exercise lessens the metabolic risks associated with declining estrogen.
- Exercise may bring about a reduced risk of high blood pressure, heart attack and stroke.
- By creating a calorie deficit, individuals can help counter or eliminate weight gain.
- Activities that cause an impact, such as walking or jogging, can build bone mass and help to offset the tendency toward osteoporosis.
- Exercise may help reduce low back pain and overall stress levels while elevating one’s mood.
Finding a mode of exercise that a client enjoys guarantees she will remain consistent in her participation over time. Some general suggestions might include ~
- Swimming
- HIIT workouts
- Running
- Walking
- Cycling
- Elliptical machine
- Step machines
- Dancing, jumping rope, and team sports such as tennis, basketball or volleyball can work as safe options if a client has no presentation of osteoarthritis or severe osteoporosis.
Encourage clients to try out several of these activities to help alleviate boredom and ensure consistency while presenting new and fun ways to challenge their bodies.
Resistance Training During Perimenopause and Beyond
Sadly, at or around the tender age of 30, our bodies begin losing approximately 1% of their hard-earned muscle mass each year. Because metabolically active muscle tissue burns fat, the loss can cause fat-based weight gain.
Resistance training can help increase muscle power as well as bone density, and help improve hormone levels and metabolism.
The CDC recommends performing strength training at least 2x/week, ideally 3, targeting all of the major muscle groups in the body. Experts suggest not working the same muscle group(s) 2 days in a row. Lots of options exist for weightlifting, including some for which one need not have access to a fitness center ~
- Body weight exercises (squats, pull-ups and push-ups)
- Dumbbells/Barbells/Kettlebells
- Resistance bands
- Cables or weight machines
- Medicine balls
- Weighted household item, such as a water jug, a gallon of milk, or a full laundry detergent container
Dr. Stacy Sims, a member of Stanford Lifestyle Medicine, suggests that women challenge themselves to lift weights heavy enough to near failure, 3-5 sets of 4-6 reps. “Overall, [we are] breaking the stigma that women need to prioritize long, endurance exercises and exclusively body weight work because they offer little benefits for body composition or lean mass during this time. Instead, lifting heavy (whatever that means to you) will help most during this transitional period,” says Stacy Sims, PhD, MSc, Exercise Physiologist.
Sample Program
In addition to one’s cardiovascular activity of choice, perimenopausal females might consider starting weightlifting with a sample program that will hit all major muscle groups ~
- Squats performed on a Smith machine or with weights
- Lat pull downs
- Leg presses, either both legs together or unilaterally
- Dumbbell military presses
- Seated rows
- Back extensions
As strength increases, slowly and prudently increasing the amount of resistance used will help prevent a plateau.
Research Strengthens this Position
One research study on resistance training included 31 women experiencing perimenopause. The aim was to observe the changes in fat-free body mass, lean muscle tissue and muscle thickness following a regimen of regular weightlifting. At the conclusion of the study, all of the above increased significantly.
The National Strength and Conditioning Association (NSCA) advocates for higher intensity lifting for women past the age of 50: 2 to 3 sets of 1 or 2 multi-joint exercises for every major muscle group, at 70 to 85% of 1 RM. NSCA also suggests women include power exercises performed at higher velocities, with moderate intensities hovering around 40–60% of 1RM.
Ample research suggests that a female can build hypertrophy using a variety of repetition ranges. Switching up an exercise routine every few weeks, at different intensities and rep ranges, helps alleviate boredom and generates a constant challenge for the body.
Improving Bone Mineral Density
The bones in a human body represent a perfect example of the adage that “form follows function”. Bone density and bone remodeling occur at different rates. Approximately 80% of bone mass comes under the classification of cortical. The spongy trabecular bone boasts a higher surface- to -volume ratio than cortical bone. As we age, the cortex of a bone increases in its porous quality, gaining surface area but, unfortunately, losing strength. In the long bones, increased porosity near the periosteal surface leads to a greater loss of strength than increased porosity near the endocortical surface.
Both cortical and trabecular bone play important roles in bone strength. The spine and its vertebrae constitute the quintessential trabecular bone site; doctors consider vertebral compression fractures a strong indication of osteoporosis. However, the thin cortical shell also plays a key role.
The hip represents cortical bone, but both cortical and trabecular bone contribute to the strength of the femur. Interestingly, the contribution of the cortical bone takes on a larger role in femurs with lower trabecular bone density. In addition, cortical bone supports bending in the distal region of the femoral neck, while the trabecular bone supports the proximal load.
The trabecular bone of the spine remodels more rapidly than the cortical bones of the hip and wrist. Under optimal conditions – in a young person, for example – bone remodeling can take anywhere from 4 to 6 months; any measurable effect that strength training may have on this process often takes years to show. In contrast, increases in bone density reveal themselves more rapidly in the presence of resistance training. Some studies show that bone density improvement can occur when a woman engages in five key resistance exercises: hip extension, knee extension, lateral pull-down, back extension, and abdominal flexion. If one performs these moves at 80% of 1RM, 3 sets of 8 reps per exercise, 2x/week over the course of a year, bone density will greatly improve.
Imagine a physician informing his perimenopausal patient that her bone density actually improved after engaging in a regular regimen of strength training. At this time of a woman’s life, when she feels her body changes represent a constant upward battle, such news could provide just the impetus she needs to keep moving forward with her new exercise regime!
Perimenopause and Weight Gain
Women tend to blame abdominal weight gain, during both perimenopause and menopause, on hormonal shifts; however, this does not fully explain the reality. More often, such gains relate to the aging process itself as well as genetics and lifestyle.
As mentioned above, the loss of lean muscle mass decreases the rate at which the body burns calories (metabolic rate). Knowingly allowing this to occur makes maintaining a healthy weight for one’s height even more of a challenge. If we consider a simple calories in/calories burned scenario, continuing to eat as much as one did prior to perimenopause, and in the absence of increasing activity levels will no doubt cause the number on the scale to nudge upward.
Sadly, especially in this country, the majority of individuals exercise less as they age. For those who remain active, genetics may dictate the distribution of weight around the midsection, providing yet another obstacle difficult to overcome. Losing interest in preparing healthy meals often occurs in older Americans, as does lack of proper sleep. When people fail to achieve a full night’s rest, they tend toward excess snacking and more “mindless eating”, leading to the consumption of excess calories.
At this stage of life, excess body fat comes at a cost: weight gain during perimenopause and menopause can seriously affect a woman’s health. Many of the health issues commonly reported to doctors include breathing complications, heart disease, joint problems and type 2 diabetes. Several cancers post increased risks associated with weight gain, including breast, colon and endometrial cancers.
Changes in one’s lifestyle that include cardiovascular activity and weight-bearing exercises add up to an easier time maintaining weight, increasing metabolism, and thwarting many health problems.
Protein Needs
Many a dietitian will recommend that adults aim to take in 0.8 grams/kilogram of body weight in lean protein each day. For a female weighing 120 pounds, this translates roughly to 43.5 grams of daily protein. For a sedentary individual this may suffice; but not for a female in the perimenopausal years who remains active and incorporating strength training into her regular lifestyle.
The 2023 International Society of Sports Nutrition recommends “Daily protein intake should fall within the mid-to-upper ranges of current sport nutrition guidelines (1.4–2.2 grams/kg body weight/day) for women, with protein doses evenly distributed every 3 to 4 hours across the day.” This number far exceeds the previous standard, and highlights the need for active perimenopausal women to ingest sufficient high-quality lean protein to fuel the building of muscle mass.
Take-Home Message
Once your perimenopausal clients commit to embarking upon a new lifestyle path including increased physical activity and resistance training, remember that small changes evolve into long-lasting success. I love when a female client expresses great interest in “diving right in” to a new program with positive energy; however, introduce changes gradually rather than trying to start with 3 hours a week of moderate-to-intense cardiovascular exercises and hitting 1RM’s the second week of training. Consistency will always beat perfection.
Sometimes the less desirable effects of a body going through a change of life take longer to address than women would like. Personal trainers who listen well, modify workouts when necessary, and explain the science along with the benefits of training translate into allies and partners for success.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296386/
https://www.theoriginway.com/blog/the-best-exercise-for-perimenopause-menopause
https://hellobonafide.com/blogs/news/best-workouts-for-perimenopause
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10559623/
https://www.feistymenopause.com/blog/menopausal-women-need-unique-muscle-making-guidelines
https://my.clevelandclinic.org/health/diseases/21608-perimenopause
https://karger.com/ajn/article/47/6/373/32936/Cortical-or-Trabecular-Bone-What-s-the-Difference#